| The purposes of this study were to (a) investigate the effects of the cognitive-behavioral intervention of Stress Inoculation Education (SIE) and counseling on anxiety, depression, psychosocial adjustment to illness, perception of hemodialysis stressors, and adherence to the medical regimen, and to (b) examine the relationship of psychosocial reactions and adherence to physiological problems while on hemodialysis. Two intervening variables, interpersonal support and control, were examined to determine their influence on adherence to the medical regimen and psychosocial variables. While physical and physiological demands of hemodialysis are universal, psychosocial responses to these demands are unique. Hemodialysis requires multiple and radical lifestyle changes and the anxiety and depression experienced by many patients justify the need for examining interventions to assist with the patient's adjustment.;A single-subject experimental design with multiple, repeated measures was used. Six subjects between the ages of 30 and 47, who had been on hemodialysis at least 6 weeks but not longer than 3 months, participated in six sessions of the intervention. SIE, based on the transaction model of stress as a relationship between person and environment, has three phases; i.e., conceptualization phase, skills acquisition and rehearsal phase, and application and follow-through phase.;The instruments used to examine change included the Clinical Anxiety Scale, the Generalized Contentment Scale, the Psychosocial Adjustment to Illness Scale Self-Report, and the Hemodialysis Stressor Scale. In addition, researcher-developed instruments included the Self Assessment Form for subjects to record daily perception of adherence to diet, fluid, and medication regimen and level of feelings, and the Physiological Data Form to document the number and type of problems experienced during hemodialysis.;The analyzed data suggested that SIE and counseling was effective in reducing some problems for all subjects. All experienced lower post-test anxiety scores. Four experienced lower post-depression scores. Three subjects experienced a lower perception of hemodialysis stressors and four had a higher level of psychosocial adjustment to illness. There was no evidence, however, that SIE and counseling improved adherence to the medical regimen. |
