Manyande, V. C. Anne; (1992) Psychological effects on surgical stress and recovery. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The role of psychological factors in recovery from surgery is not fully understood. Studies which examined surgical stress and psychological intervention were reviewed in chapters one and two, while methods of assessing surgical stress were discussed in chapter three. Studies of psychological and neuroendocrine parameters were undertaken in patients undergoing minor and major abdominal/perineal surgery. The study in chapter four examined the possible relationship between state anxiety and emotional and physical recovery from both minor and major surgery. State anxiety was found to be related to a poorer recovery while arousal was associated with a better outcome. The effectiveness of relaxation training given pre- operatively, in attenuating the stress response to major surgery and in reducing post operative discomfort was examined in chapter five. The results suggest that the relaxation training improves surgical patients' rate of recovery. The study in chapter six looked at the effects of relaxation training on endocrine responses and recovery from both major and minor surgery. The results show cortisol and adrenaline responses. They also show that patients who had minor surgery and had listened to the relaxation tape had higher levels of adrenaline and cortisol during surgery than the control group. This result was not found in patients who had major surgery. Patients who had major surgery and relaxation training were however, discharged 3 days earlier than those in the control group. The final study in chapter seven tested the ability of a different psychological intervention (relaxation with imagery) to influence the endocrine responses to and recovery from minor surgery. The results show that patients who received relaxation with imagery displayed higher levels of adrenaline and noradrenaline but lower cortisol levels, and their blood pressure and heart rate declined more than the control group. It is concluded that pre-operative psychological intervention influenced recovery from surgery. The most effective type of intervention has been to provide patients with instruction in some form of cognitive strategy for managing physical or emotional distress associated with surgery and hospitalization. The results are discussed in relation to the literature reviewed on physiological stress, psychoendocrinology and anxiety. Janis theory of the "work of worry" - The in this thesis and is discussed as a conceptual framework for health psychology. Implications are drawn for the role of health psychology in designing health care delivery systems.

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