114 Asthma
feelings of well-being, and fewer symptoms of panic. One
was an uncontrolled trial (Jain et al., 1991), while the other
had a no-treatment control condition (Vedanthan et al., 1998).
These studies suggested that yoga may have greater effects
on the subjective symptoms of asthma than on physiological
function. However, these conclusions remain tentative be-
cause of the small amount of research on this topic, and the
wide variety of yoga methods used throughout the world.
Hypnosis
In a controlled study of hypnosis as a treatment of asthma
among children, Kohen (1995) noted improvement in asthma
symptoms, but not in pulmonary function, compared with no
treatment and waking suggestion groups. A greater decrease
in emergency room visits and missed days in school also
were found in the hypnosis group. These data suggest that
hypnotic interventions may improve asthma quality of life,
but not pulmonary function. Further evaluation of these ef-
fects is warranted. Similar “ndings were obtained in a later
uncontrolled study among preschool children (Kohen &
Wynne, 1997) for parental reports of asthma symptoms, but
not pulmonary function.
Discussion
Asthma education programs that emphasize asthma self-care
have become standard components in the accepted protocol
for treating asthma and are of proven effectiveness in reduc-
ing general asthma morbidity. However, these interventions
are complex, and the task of component analysis has just
begun to determine which aspects of these programs are most
effective, and the particular population to whom each should
be directed. Also, the possibly independent effects of these
interventions on pulmonary function and asthma quality of
life deserve further evaluation.
In addition, future research may identify more exactly the
individuals for whom stress-management interventions (such
as relaxation therapies) should be targeted (e.g., people who
frequently experience stress-induced asthma exacerbations),
and the magnitude of this effect. The overall effects of these
methods appear to be small, but studies of more “nely
targeted populations may show greater results. Finally, the
effects of these interventions on mediating immune and in-
”ammatory processes have not yet been investigated, so the
pathway of their effects has not yet been established.
Other promising new interventions for asthma include
biofeedback training to increase the amplitude of respiratory
sinus arrhythmia, practice in slow breathing, and training to
improve accuracy of perceiving airway obstruction (Harver,
1994; Stout, Kotses, & Creer, 1997) to increase patients•
abilities to respond appropriately and in a timely fashion to
asthma symptoms.CONCLUSIONS, UNANSWERED QUESTIONS, AND
FUTURE DIRECTIONSAsthma is a common and costly chronic illness associated
with signi“cant morbidity and mortality, which have in-
creased in recent years despite advances in knowledge about
asthma and its treatment.
A review of the application of major psychological theories
to asthma research revealed that there is some support for the
roles of classical conditioning of respiratory resistance and
asthma symptoms (e.g., cough), and cognitive processes in-
cluding suggestion and other perceptual processes in asthma.
By contrast, research informed by other theories is appealing
but relatively unexplored. Future research could examine
the contributions of operant conditioning (e.g., to what extent
is self-management behavior shaped by consequences in
patients• environments?), questionnaire or observational re-
search of key constructs from family systems theories, and
covariates of repressive-defensive coping among adults with
asthma.
Our review of the associations of asthma with stress or
emotions suggested that few general statements can be made
across persons: Stress or emotions are associated with pul-
monary function among some but not all persons with
asthma, and furthermore, emotions associated with asthma
may vary from person to person. Despite the methodological
challenges inherent in this area of research, an appropriate
conclusion appears to be that stress or certain emotions are
salient covariates of pulmonary function for some persons
and that this association should be determined on a personal,
or idiographic, basis.
Behavioral scientists interested in asthma will “nd many
other fertile areas for research and treatment development,
including psychosocial variables affecting adherence with
treatment recommendations and self-management practices,
new behavioral interventions for asthma, and identifying the
characteristics of persons who would most bene“t from these
interventions. A focus on behavior, to characterize pathologi-
cal processes and develop relevant behavioral interventions,
is crucial to reverse the disturbing trend of increasing mor-
bidity and mortality among persons with asthma.REFERENCESAdams, S., Pill, R., & Jones, A. (1997). Medication, chronic illness
and identity: The perspective of people with asthma. Social
Science and Medicine, 45,189...201.