Research

OBJECTIVES:
The purpose of this study was to examine the effectiveness of a comprehensive stress management program in women with reproductive disorders in an outpatient setting . Stress influences the physiological and psychological well-being of the woman and may directly affect the reproductive process through the dopaminergic access, increase secretion of beta endorphin and other endogenous opiates and activation of the CRF system on a central basis. Previous studies have indicated a link between stress, anxiety, depression and infertility. The recognition and treatment of infertility itself may be a major stressor to patients who might manifest other underlying disturbances of depression and anxiety. This study addresses the role of a comprehensive program for promoting health and well-being utilizing educational and experiential principles to facilitate positive stress coping mechanisms and enhance overall well-being.

DESIGN:
Women attending an outpatient clinical facility were invited to participate in a eight-week counseling program encompassing positive restructuring in individual stress management. On average the women were 33.4 years of age (SD = 3.8). The patient outcome was evaluated on an objective basis by the same examiner at the beginning, middle and end of eight weekly sessions of positive restructuring for individual stress management.

MATERIALS AND METHODS:
Women completed a ten question scoring sheet, which provided an objective index of the level of stress, anxiety and depression. In addition, a separate score for level of rapport with the individual patient was ascertained. The eight-week program consisted of serial and sequential exposure to stress reduction, muscle relaxation, nutritional counseling, exercise program, neurolinguistic programming, reciprocal inhibition, guided imagery, and the relaxation response. Women completed individual symptom response sheets on a weekly basis from the first week of the program. The questionnaire was repeated upon completion of the program. In addition, the comprehensive questionnaire was completed before starting the program, at four weeks into the program and upon completion of the program.

RESULTS:
Overall, woman reported experiencing significantly more positive reinforcement and reduction of stress upon completing the program. The data on 14 patients was completed over a period of nine months. The initial scores ranged from 20-71. Upon completion of the program, the scores ranged from 9-55. Overall, the mean score went from a pretreatment level of 52.1 � 3.6 down to the level of 30.2 � 3.3 upon completion of the program (P=.0001). Overall there was a 42% drop in the patient's objective scores as ascertained in the questionnaires. With respect to the subgroup of patients with primary depression, the symptom score went from 50.0 � 12 pretreatment, down to 32.5 � 4.5 upon completion of the program (P>.05). With respect to the subgroup of patients with primary anxiety, the symptom score went from 56.2 � 3.9 down to 31.8 � 4.9 upon completion of the program (P<.05). For patients that primarily identified their problem as a stress-related problem, the overall symptom score dropped from 48.7 � 6.9 down to 27.8 � 6.2 upon completion of the program (P<.05).

CONCLUSION:
A comprehensive sequential program of positive restructuring for individual stress management is an important tool in the clinical care of patients with reproductive disorders. The application of stress reduction techniques results in major decreases in objective symptom scores, enhances well-being, and reduces anxiety and depression. Reinforcement of the relaxation response results in a predictable, positive, clinical outcome. Future studies address the optimum time period for reinforcement of the clinical paradigms of the program. A program of positive restructuring for individual stress management enhances clinical outcomes by stratifying patients according to clinical profiles which would benefit from the use of further diagnostic and treatment modalities.