Brief intervention for stress management and change in illness perception among hypertensive and normotensive workers: pilot study and protocol

Pires, Gerusa Estelita; Peuker, Ana Carolina; Castro, Elisa Kern

doi:10.1186/s41155-017-0080-x

Gerusa Estelita Pires ^** Correspondence: gerusapires@gmail.com

Programa de Pós-Graduação em Psicologia, Universidade do Vale do Rio dos Sinos, Avenida Unisinos, 950, prédio E01, sala 215, São Leopoldo, RS 93022-750, Brazil

Ana Carolina Peuker

Programa de Pós-Graduação em Psicologia, Universidade do Vale do Rio dos Sinos, Avenida Unisinos, 950, prédio E01, sala 215, São Leopoldo, RS 93022-750, Brazil

Elisa Kern Castro

Programa de Pós-Graduação em Psicologia, Universidade do Vale do Rio dos Sinos, Avenida Unisinos, 950, prédio E01, sala 215, São Leopoldo, RS 93022-750, Brazil

* Correspondence: gerusapires@gmail.com

Authors’ contributions

GEP and ACP conceived the idea for this study and developed the protocol. GEP, EKC, and ACP developed the methods and the data analysis. GEP wrote the initial draft of the paper, and the other authors contributed to its review. All authors read and approved the final manuscript and have given final approval of the article to be published.

Competing interests

The contents of this manuscript have not been copyrighted or published previously and not now under consideration for publication elsewhere. The authors declare that they have no competing interests.

Item number		Item
Brief name
	1	Brief intervention for stress management and change in illness perception among hypertensive and normotensive workers: pilot study and protocol.
Why
	2	The study aimed to describe and evaluate the effects of a pilot intervention on illness perception, perceived stress and knowledge about the illness among hypertensive and normotensive workers. The main rationale was to improve the knowledge about hypertension, adjust the participants’ perceptions to the average threat level of the disease.
What
	3	The intervention group received a psychoeducation training program that took practitioners through clinical aspects of systemic arterial hypertension, life style and stress management, the methodology was expository, included group dynamics/exercises and classroom discussion. The participants received a folder, containing clarifications on the hypertension, a certificate of participation and a summary with tips for relaxation in stressful situations (available on https://osf.io/jyr6c/). Precise details of the components of the training program can be found in ^Appendix Appendix Description of the intervention protocol and the schedule of intervention meetings: Table 5 Description of the intervention protocol Meeting Objective Procedures Attraction Introduce the project proposal and sensitize workers, arousing interest in joining the intervention. Introduction to the Project, the stages of the intervention and the study.Sensitization to the theme “psychological aspects and behavior in health” and to the idea that the participants could become multipliers of the knowledge acquired, with their relatives and other people close to them.Pre-test: Clarification of doubts and data collection. Session I: Perception and clinical aspects of SAH To raise awareness among the participants about the influence of psychological aspects on health behavior and to increase their knowledge about hypertension, promoting greater self-management in relation to the illness. Introductions: introduction of the facilitator and definition of psychological agreement with the group (secrecy, respect, schedules, participation). Participants introduced themselves by informing name, work area and what hypertension represented for each one.Reflection on perception: it was proposed that participants should close their eyes, breathing deeply and thinking about the following question: “What does SAH represent (as I perceive it) to me, does it draw me closer to or distract me from well-being?”. After about 10 s, participants were asked to open their eyes and write down what they thought, keeping the note to themselves. Then they were asked how they felt thinking about it (the idea was not to read what they wrote, but to have someone comment on what they felt if they wanted to share). At that moment, there was a connection between perception and hypertension, highlighting the importance of how participants perceived hypertension for the adoption of illness prevention and control behaviors. Cognition and behavior—Perception and Hypertension: exposition of the main components of perception, as well as cognition and behavior (thought, feeling, behavior), including the use of metaphors and everyday examples, to emphasize the influence of perceptions/beliefs on behavior in health. Examples of metaphors: The image of a ferocious lion was used, associating it with the fact that some people perceive SAH as very threatening, while others may perceive it as a cat's cub (images of a lion and a cat were presented). When, in fact, what is appropriate is that it is neither of these extremes, but rather that hypertension is seen as a serious disease, but capable of total prevention and control. The image of the scales was also used in order to illustrate that the ideal is not to weigh the scales very much to one side or another, but rather that the scales be balanced.Health Quiz (individual): activity to assess the level of the participants’ prior knowledge about SAH. Participants received a questionnaire with affirmations to mark true or false. The questions addressed the content of the illness perception dimensions, the Common-Sense Model(CSM). They were asked to answer individually, remaining with the questionnaire until the end of the next activity. It was reinforced that they would not need to share their answers with the group and that if they did not know how to answer a question; the doubts would be clarified in the group activity without exposing the individual sheets.Health Quiz (collective): Psychoeducational activity on hypertension. After answering individually, the participants answered the same questions, discussing the correct answers with the facilitator and other participants. At the end, the individual questionnaires were collected, with the purpose of comparing the responses of the first application (pre-test) with the application of the same questionnaire (post-test) to be performed in the last session of the intervention. Closing Session II: Stress management Psychoeducation participants on stress and management strategies, improving their resources for everyday stress management Review of the previous session: participants were asked to share what they scored in relation to the previous session. With this information, the facilitator connected the first session with the current one.Psychoeducation about stress: brief presentation of the risk factors for hypertension, focusing on the stress factor and the relationship between stress and illness.Presentation of the concept of stress (Stress Transactional Model), highlighting the individual as active in the stress management process, from the way everyday events are perceived to the strategies adopted to deal with stressors.Experiential technique “Thoughts and emotions”: a volunteer from the group was asked to share an unpleasant situation that has happened to him/her in recent weeks, verbalizing the feelings, emotions that he/she experienced during the situation. Then the person was asked to stand in the middle of the circle formed by the group and that the large group interpreted the thoughts and emotions described by the person, repeating verbally several times. In the activity processing, both the group and the volunteer were questioned about how they felt during the activity. It was exposed to the group that besides the initial suffering we have secondary suffering, generated from the way we perceive and react to stress, which can cause even more suffering, depending on how the individual handles the emotions generated by the situation. The importance of perceiving and reacting positively to a more effective coping of situations was highlighted.Mindfulness-based stress reduction technique: The technique was presented as a resource to be used in unpleasant moments in order to assist in stress management. The technique is structured as follows:stop (step one): Choose to exit the autopilot by bringing conscious attention to the present moment. After that, pay attention (step two) to what is happening at the moment in your body, your emotions and thoughts. Direct your attention and focus simply on breathing (step three). Enlarge (step four) your consciousness again, including the perception of the body as a whole and the situation you are experiencing. Notice now that you can respond with awareness right now. Participants received a piece of paper with the description of the technique and were informed that this exercise could be used in any situation and that, like any practice, its regular cultivation, even in neutral situations, potentiates the positive result in difficult moments.Mindfulness Initial Practice (Mindfulness-based stress reduction): Participants were asked to sit comfortably on the chair, keeping their eyes open or closed. From this, they were led step by step for 5 min to be attentive to their breathing, to let their thoughts flow without judging whether they were good or bad, trying to experience the present moment. This technique was used to demonstrate how full consciousness training can improve self-perception and reflect on the body, mind, and experience as a whole, further contributing to the choice of behaviors that are in accordance with what is important in each one's life.Video “The unwelcome guest”: presentation of the video, which addresses perception and behavior in the face of unpleasant situations, moments of anger. Processing: discussion of the impressions of the participants about the video. It has been argued that people can stop doing things that are important to themselves by being stuck with negative thoughts and emotions generated in unpleasant moments. In this sense, the active role of the individual to deal with stress was worked out; from the way he or she perceives and coping stressful situations.“Values” technique: From the discussion of the video, the participants were invited to think and write down a life value, which they think they can connect to contribute to the improvement of their health. It was then opened up for discussion about what the participants chose and the importance of connecting to their values so that they could change some behavior.Folder: delivery and presentation of the folder about hypertension.Closing and evaluation: Final thoughts on the meeting and participants expressed their impressions and what they considered important for themselves. Filling out of questionnaires and delivery of certificates to participants. Table 6 Schedule of the intervention meetings Duration Activity Variables Instruments Attraction 10 min Introduction to the project and the research group – Biosociodemographic questionnaire, Illness perception scale, Perceived stress scale 10 min Sensitization about “psychological aspects and health behaviors” 10 min Introduction to the stages of the intervention and the study 30 min Clarification of doubts and initial data collection (pre-test) Total: 1 h Session 1 5 min Introduction and agreement Illness Perception, knowledge Pre-test of the Health Quiz and satisfaction assessment 20 min Introductions of participants 10 min Reflection about perception 30 min Cognition and behavior Psychoeducation 10 min Health Quiz (individual—pre-test) 30 min Health Quiz (collective) 15 min Closing and evaluation Total: 2 h Session 2 10 min Review of previous session Illness Perception and perceived stress Post-test of the Health Quiz and satisfaction assessment 30 min Psychoeducation about stress: risk factors, perception and stress 15 min Experience “Thoughts and emotions” 10 min P.A.R.A.R (STOP) technique and initial practice of mindfulness 20 min Video “The unwelcome guest” 15 min Technique “Values” 5 min Folder 15 min Closing, evaluation and delivery of certificates Total: 2 h .
	4	The detailed agenda can be found on ^Appendix Appendix Description of the intervention protocol and the schedule of intervention meetings: Table 5 Description of the intervention protocol Meeting Objective Procedures Attraction Introduce the project proposal and sensitize workers, arousing interest in joining the intervention. Introduction to the Project, the stages of the intervention and the study.Sensitization to the theme “psychological aspects and behavior in health” and to the idea that the participants could become multipliers of the knowledge acquired, with their relatives and other people close to them.Pre-test: Clarification of doubts and data collection. Session I: Perception and clinical aspects of SAH To raise awareness among the participants about the influence of psychological aspects on health behavior and to increase their knowledge about hypertension, promoting greater self-management in relation to the illness. Introductions: introduction of the facilitator and definition of psychological agreement with the group (secrecy, respect, schedules, participation). Participants introduced themselves by informing name, work area and what hypertension represented for each one.Reflection on perception: it was proposed that participants should close their eyes, breathing deeply and thinking about the following question: “What does SAH represent (as I perceive it) to me, does it draw me closer to or distract me from well-being?”. After about 10 s, participants were asked to open their eyes and write down what they thought, keeping the note to themselves. Then they were asked how they felt thinking about it (the idea was not to read what they wrote, but to have someone comment on what they felt if they wanted to share). At that moment, there was a connection between perception and hypertension, highlighting the importance of how participants perceived hypertension for the adoption of illness prevention and control behaviors. Cognition and behavior—Perception and Hypertension: exposition of the main components of perception, as well as cognition and behavior (thought, feeling, behavior), including the use of metaphors and everyday examples, to emphasize the influence of perceptions/beliefs on behavior in health. Examples of metaphors: The image of a ferocious lion was used, associating it with the fact that some people perceive SAH as very threatening, while others may perceive it as a cat's cub (images of a lion and a cat were presented). When, in fact, what is appropriate is that it is neither of these extremes, but rather that hypertension is seen as a serious disease, but capable of total prevention and control. The image of the scales was also used in order to illustrate that the ideal is not to weigh the scales very much to one side or another, but rather that the scales be balanced.Health Quiz (individual): activity to assess the level of the participants’ prior knowledge about SAH. Participants received a questionnaire with affirmations to mark true or false. The questions addressed the content of the illness perception dimensions, the Common-Sense Model(CSM). They were asked to answer individually, remaining with the questionnaire until the end of the next activity. It was reinforced that they would not need to share their answers with the group and that if they did not know how to answer a question; the doubts would be clarified in the group activity without exposing the individual sheets.Health Quiz (collective): Psychoeducational activity on hypertension. After answering individually, the participants answered the same questions, discussing the correct answers with the facilitator and other participants. At the end, the individual questionnaires were collected, with the purpose of comparing the responses of the first application (pre-test) with the application of the same questionnaire (post-test) to be performed in the last session of the intervention. Closing Session II: Stress management Psychoeducation participants on stress and management strategies, improving their resources for everyday stress management Review of the previous session: participants were asked to share what they scored in relation to the previous session. With this information, the facilitator connected the first session with the current one.Psychoeducation about stress: brief presentation of the risk factors for hypertension, focusing on the stress factor and the relationship between stress and illness.Presentation of the concept of stress (Stress Transactional Model), highlighting the individual as active in the stress management process, from the way everyday events are perceived to the strategies adopted to deal with stressors.Experiential technique “Thoughts and emotions”: a volunteer from the group was asked to share an unpleasant situation that has happened to him/her in recent weeks, verbalizing the feelings, emotions that he/she experienced during the situation. Then the person was asked to stand in the middle of the circle formed by the group and that the large group interpreted the thoughts and emotions described by the person, repeating verbally several times. In the activity processing, both the group and the volunteer were questioned about how they felt during the activity. It was exposed to the group that besides the initial suffering we have secondary suffering, generated from the way we perceive and react to stress, which can cause even more suffering, depending on how the individual handles the emotions generated by the situation. The importance of perceiving and reacting positively to a more effective coping of situations was highlighted.Mindfulness-based stress reduction technique: The technique was presented as a resource to be used in unpleasant moments in order to assist in stress management. The technique is structured as follows:stop (step one): Choose to exit the autopilot by bringing conscious attention to the present moment. After that, pay attention (step two) to what is happening at the moment in your body, your emotions and thoughts. Direct your attention and focus simply on breathing (step three). Enlarge (step four) your consciousness again, including the perception of the body as a whole and the situation you are experiencing. Notice now that you can respond with awareness right now. Participants received a piece of paper with the description of the technique and were informed that this exercise could be used in any situation and that, like any practice, its regular cultivation, even in neutral situations, potentiates the positive result in difficult moments.Mindfulness Initial Practice (Mindfulness-based stress reduction): Participants were asked to sit comfortably on the chair, keeping their eyes open or closed. From this, they were led step by step for 5 min to be attentive to their breathing, to let their thoughts flow without judging whether they were good or bad, trying to experience the present moment. This technique was used to demonstrate how full consciousness training can improve self-perception and reflect on the body, mind, and experience as a whole, further contributing to the choice of behaviors that are in accordance with what is important in each one's life.Video “The unwelcome guest”: presentation of the video, which addresses perception and behavior in the face of unpleasant situations, moments of anger. Processing: discussion of the impressions of the participants about the video. It has been argued that people can stop doing things that are important to themselves by being stuck with negative thoughts and emotions generated in unpleasant moments. In this sense, the active role of the individual to deal with stress was worked out; from the way he or she perceives and coping stressful situations.“Values” technique: From the discussion of the video, the participants were invited to think and write down a life value, which they think they can connect to contribute to the improvement of their health. It was then opened up for discussion about what the participants chose and the importance of connecting to their values so that they could change some behavior.Folder: delivery and presentation of the folder about hypertension.Closing and evaluation: Final thoughts on the meeting and participants expressed their impressions and what they considered important for themselves. Filling out of questionnaires and delivery of certificates to participants. Table 6 Schedule of the intervention meetings Duration Activity Variables Instruments Attraction 10 min Introduction to the project and the research group – Biosociodemographic questionnaire, Illness perception scale, Perceived stress scale 10 min Sensitization about “psychological aspects and health behaviors” 10 min Introduction to the stages of the intervention and the study 30 min Clarification of doubts and initial data collection (pre-test) Total: 1 h Session 1 5 min Introduction and agreement Illness Perception, knowledge Pre-test of the Health Quiz and satisfaction assessment 20 min Introductions of participants 10 min Reflection about perception 30 min Cognition and behavior Psychoeducation 10 min Health Quiz (individual—pre-test) 30 min Health Quiz (collective) 15 min Closing and evaluation Total: 2 h Session 2 10 min Review of previous session Illness Perception and perceived stress Post-test of the Health Quiz and satisfaction assessment 30 min Psychoeducation about stress: risk factors, perception and stress 15 min Experience “Thoughts and emotions” 10 min P.A.R.A.R (STOP) technique and initial practice of mindfulness 20 min Video “The unwelcome guest” 15 min Technique “Values” 5 min Folder 15 min Closing, evaluation and delivery of certificates Total: 2 h .
Who provided
	5	The sessions were given by a psychologist, with a master degree in clinical psychology and a solid experience conducting group intervention for psychoeducation or change of health behavior.
How
	6	The sessions were presence, being held weekly and facilitated in groups of 4-8 participants, lasting 2 h each.
Where
	7	The participants were recruited at their workplace (petrochemical industry) and the sessions were carried out in the same location. The infrastructure included a private meeting room, chair, projector, computer (for slides presentation) and air conditioning.
When and how much
	8	The intervention was composed of two weekly sessions plus a first meeting called “Attraction”, in which the participants received information about how the intervention would work, gave their consent and responded the first stage of data collection. The first session lasted 1 h and the others 2 h. The sessions were set up at different times, according to the participants’ availability. Two groups occurred in the afternoon, from 2.00 p.m. to 4.00 p.m. (one of hypertensive and another of normotensive participants) and two groups in the morning, from 10.00 a.m. to 12.00 p.m., separated by condition (clinical or nonclinical).
Tailoring
	9	The intervention was not planned to be personalized, titrated, or adapted.
Modifications
	10	Intervention adherence or fidelity was not assessed.
How well
	11	There were no modifications during the intervention.
	12	The mean (SD) number of intervention sessions attended was 2.05 for hypertensive and 2.29 for normotensive group (including the meeting of attraction). Sixteen participants completed the program—eight hypertensive and eight normotensive (48%). The reasons given for non-attendance to the intervention were a lot of work demand, work trip, or pre-scheduled medical procedure.

Condition		Hypertensive		Normotensive
		N (19)		N (14)
		M	DP	M	DP
Mean age		48.95	6.95	36.21	7.38
Time of diagnosis of SAH^a a Mean in years		2.68	5.82	–	–
Frequency/percentile		F	%	F	%
Sex	Female	2	10.5	6	42.9
	Male	17	89.5	8	57.1
Marital status	Separate/widowed	0	0	3	21.4
	Single	1	5.2	2	14.3
	Stable union/married	18	94.7	9	64.3
Time of work in the company	0 to 9 years	1	5.2	7	50
	10 to 19 years	5	26.3	5	35.7
	20 to 30 years	8	47.3	2	14.2
	Over 30 years	5	26.3	0	0
Education	Incomplete high school	1	5.2	0	0
	Complete high school	5	26.3	1	7.1
	Incomplete higher education	2	10.5	3	21.4
	Complete higher education	4	21	1	7.1
	Incomplete post-graduate education	7	36.8	8	57.1
	Complete post-graduate education	0	0	1	7.1
Takes medication for SAH	Yes	16	84.2	0	0
	No	3	15.8	0	0
Family history of SAH	Yes	16	84.2	14	100
	No	3	15.8	0	0

	Hypertensive					Normotensive
	Pre		Post		Sig	Pre		Post		Sig
	Mean	SD	Mean	SD		Mean	SD	Mean	SD
Perceived stress	23.45	6.44	21.83	7.80	0.05	22.83	8.24	19.08	6.58	0.03
Health status	6.89	0.83	7.56	0.85	0.01	7.86	0.86	8.23	0.93	0.27
	Effect size (d)		IC_d 95%			Effect size (d)		IC_d 95%
			Inferior		Superior			Inferior		Superior
Perceived stress	– 0.22		– 0.25		– 0.21	– 0.65		– 0.68		– 0.63
Current health status	0.79		0.79		0.82	– 0.01		– 0.00		0.03

	Hypertensive					Normotensive
	Pre		Post		Sig	Pre		Post		Sig
Brief IPQ dimensions/items	Mean	SD	Mean	SD		Mean	SD	Mean	SD
Total perception	27.8	7.92	24.8	7.49	0.08	36.9	6.69	35	5.84	0.15
Identity	3.63	2.45	3.32	2.45	0.57	6.93	2,26	6.92	2.49	0.93
Consequences	4.26	2.42	4.11	2.92	0.69	8.79	1.52	8.85	1.21	0.86
Personal control	6.05	1.31	6.84	1.53	0.02	6.93	1.38	8.31	1.31	0.00
Treatment control	7.89	1.32	8.53	0.96	0.05	8.93	1.26	8.85	1.57	0.73
Emotional representation	5.12	2.72	5	2.56	0.86	6.39	2.78	6.9	2.36	0.75
Coherence	6	1.70	7.32	1.82	0.00	5.71	2.16	7.75	0.96	0.01
	Effect size (d)		IC_d 95%			Effect size (d)		IC_d 95%
			Inferior		Superior			Inferior		Superior
Total perception	– 0.38		– 0.41		– 0.36	– 0.30		– 0.33		– 0.27
Identify	– 0.12		– 0.14		– 0.11	–0.00		– 0.02		0.01
Consequences	– 0.05		– 0.06		– 0.04	0.04		0.02		0.05
Personal control	0.55		0.53		0.57	1.02		1.01		1.03
Treatment control	0.56		0.54		0.58	-0.05		– 0.07		– 0.04
Emotional representation	– 0.04		– 0.06		– 0.02	0.19		0.17		0.22
Coherence	0.75		0.73		0.76	1.30		1.28		1.33

Meeting	Objective	Procedures
Attraction	Introduce the project proposal and sensitize workers, arousing interest in joining the intervention.	Introduction to the Project, the stages of the intervention and the study. Sensitization to the theme “psychological aspects and behavior in health” and to the idea that the participants could become multipliers of the knowledge acquired, with their relatives and other people close to them. Pre-test: Clarification of doubts and data collection.
Session I: Perception and clinical aspects of SAH	To raise awareness among the participants about the influence of psychological aspects on health behavior and to increase their knowledge about hypertension, promoting greater self-management in relation to the illness.	Introductions: introduction of the facilitator and definition of psychological agreement with the group (secrecy, respect, schedules, participation). Participants introduced themselves by informing name, work area and what hypertension represented for each one. Reflection on perception: it was proposed that participants should close their eyes, breathing deeply and thinking about the following question: “What does SAH represent (as I perceive it) to me, does it draw me closer to or distract me from well-being?”. After about 10 s, participants were asked to open their eyes and write down what they thought, keeping the note to themselves. Then they were asked how they felt thinking about it (the idea was not to read what they wrote, but to have someone comment on what they felt if they wanted to share). At that moment, there was a connection between perception and hypertension, highlighting the importance of how participants perceived hypertension for the adoption of illness prevention and control behaviors. Cognition and behavior—Perception and Hypertension: exposition of the main components of perception, as well as cognition and behavior (thought, feeling, behavior), including the use of metaphors and everyday examples, to emphasize the influence of perceptions/beliefs on behavior in health. Examples of metaphors: The image of a ferocious lion was used, associating it with the fact that some people perceive SAH as very threatening, while others may perceive it as a cat's cub (images of a lion and a cat were presented). When, in fact, what is appropriate is that it is neither of these extremes, but rather that hypertension is seen as a serious disease, but capable of total prevention and control. The image of the scales was also used in order to illustrate that the ideal is not to weigh the scales very much to one side or another, but rather that the scales be balanced. Health Quiz (individual): activity to assess the level of the participants’ prior knowledge about SAH. Participants received a questionnaire with affirmations to mark true or false. The questions addressed the content of the illness perception dimensions, the Common-Sense Model(CSM). They were asked to answer individually, remaining with the questionnaire until the end of the next activity. It was reinforced that they would not need to share their answers with the group and that if they did not know how to answer a question; the doubts would be clarified in the group activity without exposing the individual sheets. Health Quiz (collective): Psychoeducational activity on hypertension. After answering individually, the participants answered the same questions, discussing the correct answers with the facilitator and other participants. At the end, the individual questionnaires were collected, with the purpose of comparing the responses of the first application (pre-test) with the application of the same questionnaire (post-test) to be performed in the last session of the intervention. Closing
Session II: Stress management	Psychoeducation participants on stress and management strategies, improving their resources for everyday stress management	Review of the previous session: participants were asked to share what they scored in relation to the previous session. With this information, the facilitator connected the first session with the current one. Psychoeducation about stress: brief presentation of the risk factors for hypertension, focusing on the stress factor and the relationship between stress and illness. Presentation of the concept of stress (Stress Transactional Model), highlighting the individual as active in the stress management process, from the way everyday events are perceived to the strategies adopted to deal with stressors. Experiential technique “Thoughts and emotions”: a volunteer from the group was asked to share an unpleasant situation that has happened to him/her in recent weeks, verbalizing the feelings, emotions that he/she experienced during the situation. Then the person was asked to stand in the middle of the circle formed by the group and that the large group interpreted the thoughts and emotions described by the person, repeating verbally several times. In the activity processing, both the group and the volunteer were questioned about how they felt during the activity. It was exposed to the group that besides the initial suffering we have secondary suffering, generated from the way we perceive and react to stress, which can cause even more suffering, depending on how the individual handles the emotions generated by the situation. The importance of perceiving and reacting positively to a more effective coping of situations was highlighted. Mindfulness-based stress reduction technique: The technique was presented as a resource to be used in unpleasant moments in order to assist in stress management. The technique is structured as follows: stop (step one): Choose to exit the autopilot by bringing conscious attention to the present moment. After that, pay attention (step two) to what is happening at the moment in your body, your emotions and thoughts. Direct your attention and focus simply on breathing (step three). Enlarge (step four) your consciousness again, including the perception of the body as a whole and the situation you are experiencing. Notice now that you can respond with awareness right now. Participants received a piece of paper with the description of the technique and were informed that this exercise could be used in any situation and that, like any practice, its regular cultivation, even in neutral situations, potentiates the positive result in difficult moments. Mindfulness Initial Practice (Mindfulness-based stress reduction): Participants were asked to sit comfortably on the chair, keeping their eyes open or closed. From this, they were led step by step for 5 min to be attentive to their breathing, to let their thoughts flow without judging whether they were good or bad, trying to experience the present moment. This technique was used to demonstrate how full consciousness training can improve self-perception and reflect on the body, mind, and experience as a whole, further contributing to the choice of behaviors that are in accordance with what is important in each one's life. Video “The unwelcome guest”: presentation of the video, which addresses perception and behavior in the face of unpleasant situations, moments of anger. Processing: discussion of the impressions of the participants about the video. It has been argued that people can stop doing things that are important to themselves by being stuck with negative thoughts and emotions generated in unpleasant moments. In this sense, the active role of the individual to deal with stress was worked out; from the way he or she perceives and coping stressful situations. “Values” technique: From the discussion of the video, the participants were invited to think and write down a life value, which they think they can connect to contribute to the improvement of their health. It was then opened up for discussion about what the participants chose and the importance of connecting to their values so that they could change some behavior. Folder: delivery and presentation of the folder about hypertension. Closing and evaluation: Final thoughts on the meeting and participants expressed their impressions and what they considered important for themselves. Filling out of questionnaires and delivery of certificates to participants.

	Duration	Activity	Variables	Instruments
Attraction	10 min	Introduction to the project and the research group	–	Biosociodemographic questionnaire, Illness perception scale, Perceived stress scale
	10 min	Sensitization about “psychological aspects and health behaviors”
	10 min	Introduction to the stages of the intervention and the study
	30 min	Clarification of doubts and initial data collection (pre-test)
Total:	1 h
Session 1	5 min	Introduction and agreement	Illness Perception, knowledge	Pre-test of the Health Quiz and satisfaction assessment
	20 min	Introductions of participants	Illness Perception, knowledge	Pre-test of the Health Quiz and satisfaction assessment
	10 min	Reflection about perception
	30 min	Cognition and behavior Psychoeducation
	10 min	Health Quiz (individual—pre-test)
	30 min	Health Quiz (collective)
	15 min	Closing and evaluation
Total:	2 h
Session 2	10 min	Review of previous session	Illness Perception and perceived stress	Post-test of the Health Quiz and satisfaction assessment
	30 min	Psychoeducation about stress: risk factors, perception and stress	Illness Perception and perceived stress	Post-test of the Health Quiz and satisfaction assessment
	15 min	Experience “Thoughts and emotions”
	10 min	P.A.R.A.R (STOP) technique and initial practice of mindfulness
	20 min	Video “The unwelcome guest”
	15 min	Technique “Values”
	5 min	Folder
	15 min	Closing, evaluation and delivery of certificates
Total:	2 h

[1] * Correspondence: gerusapires@gmail.com

Brasil

Brasil

Brief intervention for stress management and change in illness perception among hypertensive and normotensive workers: pilot study and protocol

Abstract