Anxiety before surgery may prove healthful.

A new study suggests that physicians and nurses should offer this seemingly paradoxial advice to patients awaiting surgery: Don't relax, be worried.

Relaxation training helps people feel less tense before and after surgery for non-life-threatening conditions, but it also seems to spark a potentially harmfull surge of two key "stress hormones" during and after surgery, concludes a study reported inb the May/June PSYCHOSOMATIC MEDICINE. In contrast, surgical patients who recieve no relaxation training experience considerable anxiety, but their stress-hormone levels remain stable or decline slightly after surgery.

Medical evidence now suggest that high levels of stress hormones on the days following surgery may contribute to weight loss, fatigue and impaired immune function, say British psychologist Anne Manyande of University College in London and her colleagues. However, researchers have yet to establish a clear link between stress-hormone levels and medical complications after surgery.

"Our data indicate that simple, innocous forms of reasurance before surgery can have real biological effects and may need to be used as carefully as medication," contends psychologist Peter Salmon, also of University College, who took part in the investigation. "Preoperative anxiety may protect against the stressfulness of surgery."

The findings support a theory -- proposed in 1958 by psychologist Irving L. Janis -- that worrying represents mental preparation for surgery and ultimately reduces its stressfulness.

Manyande's team studied adults undergoing minor operations, such as an ulcer repair of the removal of hemorrhoids. The day before surgery, 21 patients listened to a 15-minute tape recording that described mental strategies to reduce tension in different muscle groups. A control group of 19 patients listened toa 15-minute recording that gave background information about the hospital andits staff.

Before and after listening to the tapes, all patients filled out questionnaries assesing the extent to which they felt anxious in general and in response to the upcoming surgery. Patients listened to their assigned tapes at least twice more before surgery and as often after surgery as they wished. On the two days following surgery, each participant again completed questionnaires, as well as a survey, such as worry ("considered several ways of handling the situation"), action ("watched others going through the same thing") or suppression ("tried to relax and not think about the situation").

The researchers obtained blood samples from each participant before and after the patient listened to tapes, just before surgery, in the recovery room and on the two days following surgery.

Levels of adrenaline and cortisol -- two hormones associated with the body's reaction to stress and danger -- increased significantly during and after surgery only among patients who listened to the relaxation tape. Yet compared with the control group, relaxation patients reported less anxiety and worry, displayed a lower average heart rate and blood pressure, and received fewer pain-killing drugs following surgery.

Relaxation training may serve to distract people from focusing constructively on the upcoming surgery, Salmon suggests. "Our hypothesis is that thinking about and preparing for a stressful event is a better tactic," he says.

Further support for this notion comes from an unpublished study directed by Salmon. Surgical patients shown a videotape that describes ways to prepare mentally for surgery displayed lower adrenaline and cortisol levels than did controls, he maintanins. Another study, reported by Salmon in the June 2, 1990 LANCET, charted marked jumps in stress hormones following major abdominal surgery among the least anxious patients.