title: Stress Management in Patients Undergoing Carotid Endarterectomy for Carotid Artery Stenosis: A Pilot Randomized Controlled Trial.
abstract: BACKGROUND
  Psychological stress is common to patients submitted to cardiovascular operations. The purpose of this pilot, single-center, open-label, randomized controlled trial was to investigate the effects of a stress management program (SMP) on patients undergoing carotid endarterectomy (CEA).
  
  
  METHODS
  A sample of 24 patients with significant (>70%) carotid stenosis was finally randomized to SMP (intervention group; n = 12) or no-stress management intervention (control group; n = 12) before CEA. SMP consisted of 2 relaxation techniques (relaxation-breathing and guided imagery) before and 8 weeks after CEA. Measurements included Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HADS), Health Locus of Control Scale (HLC), and blood pressure and heart rate.
  
  
  RESULTS
  The 2 groups did not differ in terms of demographic characteristics, vascular risk factors, and baseline psychometric measurements. No delay on the time of surgery was caused by the practice of the relaxation techniques. Both perceived stress and anxiety improved within the intervention group at the end of the program (P = 0.005 and P = 0.007, respectively). No improvement in PSS-14, HLC, and HADS scores were documented in control group at the end of the 8-week follow-up period. The intervention group had lower PSS-14 scores at 8 weeks after CEA (median PSS-14 score, 20 points; range, 10-28) compared with control group (median PSS, 25 points; range, 11-47; P = 0.026). No significant effect of SMP was found for blood pressure and heart rate measurements.
  
  
  CONCLUSIONS
  Our results indicate that relaxation techniques appear to be beneficial in terms of stress and anxiety reduction in patients undergoing CEA. These findings require independent confirmation in the setting of a larger, double-blind randomized controlled trial.
authors.affiliation: Vascular Unit, 3rd Surgical Department, Athens University Medical School, Athens, Greece; Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece; Postgraduate Course in Stress Management and Health Promotion, University of Athens Medical School, Athens, Greece; Biomedical Research Foundation, Academy of Athens, Athens, Greece. Electronic address: svasdek@med.uoa.gr.
authors.forename: Spyros N
authors.initials: SN
authors.lastname: Vasdekis
authors.affiliation: Postgraduate Course in Stress Management and Health Promotion, University of Athens Medical School, Athens, Greece; Biomedical Research Foundation, Academy of Athens, Athens, Greece; Second Department of Neurology, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Andromachi
authors.initials: A
authors.lastname: Roussopoulou
authors.affiliation: Vascular Unit, 3rd Surgical Department, Athens University Medical School, Athens, Greece; Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Lazaris
authors.affiliation: Vascular Unit, 3rd Surgical Department, Athens University Medical School, Athens, Greece; Department of Vascular Surgery, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Antonopoulos
authors.affiliation: Second Department of Neurology, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Voumvourakis
authors.affiliation: Postgraduate Course in Stress Management and Health Promotion, University of Athens Medical School, Athens, Greece; Biomedical Research Foundation, Academy of Athens, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Darviri
authors.affiliation: Second Department of Neurology, University of Athens Medical School, "Attikon" University Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000517:prevention & control / Q000523:psychology; D001945:Breathing Exercises / Q000009:adverse effects; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000523:psychology; D005260:Female; D006115:Greece; D006801:Humans; D019018:Imagery, Psychotherapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012064:Relaxation Therapy / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome