Hypnotherapeutic ego strengthening with coronary artery bypass surgery patients and their spouses / acoba Elizabeth de Klerk
De Klerk, Jacoba Elizabeth
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Coronary artery bypass surgery (CABS) is highly stressful for couples, since comorbid anxiety and depression are most commonly reported and hence most researched pre- and postoperative emotional states. Thus, patients' psychological well-being may contribute more to the level of disability than their physical impairment. Despite this extremely stressful process, psychological preparation is ironically often neglected in CABS couples. The primary aim of the study was to examine the feasibility of hypnotherapeutic ego strengthening (HES) to enhance the ability of CABS couples' to cope with psychological distress associated with hospitalisation and surgery. Secondary aims were to determine the contribution of HES in reducing anxiety and depression, as well as enhancing and maintaining ego strength, quality of life and dispositional optimism in CABS patients and spouses. An overview of coronary heart disease (CHD), risk factors involved, psychological aspects concomitant to CABS (specifically anxiety and depression) and a conceptualisation of HES according to the relevant literature, preceded the empirical study. The experimental design consisted of a two-group, pre-post-follow-up assessment design. A sample of fifty married, male patients admitted to Unitas Hospital in Pretoria with a first, uncomplicated CABS was randomly assigned, together with their spouses, to an experimental- (n = 25) and control group (n = 25). Informed consent was obtained for all project participants. Thus, both groups consisted of twenty-five patients and spouses. To test the hypotheses, experimental patients and spouses were required to participate in the HES intervention. Respondents completed the Beck Depression Inventory (BDI-II) (Beck, Steer, & Brown, 1995). Profile of Mood States (POMS) (McNair, Lorr & Doppleman, 1992), Epstein and O'Brien Ego Strength Scale (1982), Quality of Life Inventory (QOLI) (Frisch, 1994) as well as the Life Orientation Test (LOT) (Scheier & Carver, 1985). Test administration of couples occurred preoperatively, on the day of discharge, and at six-week follow-up. Before commencing the intervention, group comparability was confirmed by means of the t-test for independent groups. At programme completion the significance of differences within and between groups was determined by means of t-tests. Statistically significant p-values were subjected to Cohen's d statistic to determine the practical significance of the findings. A confidence interval of 99% determined the values of the differences between the postoperative and follow-up findings. Results confirmed that the HES intervention significantly reduced postoperative anxiety and depression levels in experimental CABS patients and spouses, which was maintained at follow-up. No change was observed among control group patients and spouses. Moreover, the HES intervention significantly improved and maintained postoperative ego strength, quality of life and dispositional optimism in experimental CABS couples. The overall outcome of the control patients and spouses revealed a decreasing trend with regard to dispositional optimism and quality of life. Qualitative responses largely confirmed quantitative indications of reduced comorbidity and enhanced psychological well-being among experimental participants. Despite design limitations, the results confirmed that HES enhanced CABS couples' inner resources and attenuated concomitant negative mood states. Thus, it was concluded that HES played a meaningful role in the preparation and care of CABS couples by reducing comorbidity and improving their psychological well-being. Finally, recommendations for further studies were made.
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