Lecture 11. Health Psychology and interventions to prevent or alleviate cardiovascular disease.

Lectures 10 & 11 Reading

Usual texts. Also chapter by Krantz & Lundeman on Cardiovascular disorders in Johnston & Johnston good on interventions (& other parts of course). See also Krantz & McCeney Annual Rev Psychol 2002 53: 341-369.

There is discussion of interventions in CHD in Schiederman, Antoni, Sabb & Ironson (2001) Health Psychology: psychosocial and biobehavioural aspects pf chronic disease management. Annual Rev Psychology, 52: 555-580. Especially 555-560

I nterventions in Health Psychology Prevention (lengthening life?)

Primary Secondary Tertiary

I nterventions to improve life (Quality of Life?) Examples of target variables:

Distress Pain Return to work Disability Social functioning

Prevention

Primary Modification of risk factors before disease develops

Not related to stress or reactivity

Secondary Arrest or reverse risk factors or disease processes when risk identified but disease may not be obvious

Behavioural treatment of high blood pressure

Tertiary Stop or inhibit progress of established disease

CHD Type A modification (Friedman)

Patel,C,Marmot,MG,Terry,DJ,Carruthers,M,Hunt,B,Patel,M, (1985)Trial of relaxation in reducing coronary risk: four year follow up. British Medical Journal,290,1103,1106

Johnston,DW,Gold,A,Kentish,J,Smith,D,Vallance,P,Shah,D,Leach,G,Robinson,B,(1993) Effect of stress management on blood pressure in mild primary hypertension. British Medical Journal, 306,963,966,

Schneider,RH,Staggers,F,Alexander,CN,Sheppard,W,Rainforth,M,Kondwani,K,Smith,S,King,CG,(1995) A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension,26,820,827

Stress Management in the reduction of hypertension Simple stress management (Patel) 1. Live relaxation training 2. Regular home practice 3. Application in real life

4. Simple counseling

0 2 8 48

Time in Months

70

76

82

88

94

100

DB

P m

m H

g

Stress Management v measurement (Patel

Stress management

Measurement

Pre-treatment Post-treatment70

76

82

88

94

100

DB

P m

m H

g

Stress Management v Exercise (Johnston)

Stress management

Exercise

0 1 2 3

Time in treatment (months)

-10

-7

-4

-1

2

5

Ch

an

ge in

DB

P (

mm

Hg

)

Meditation & hypertension (Schneider)(Elderly black Americans)

Education

Relaxation

TM

Friedman,M,Thorensen,CE,Gill,JJ,Powell,LH,Ulmer,D,Thompson,L,Price,VA,Rabin,DD,Breall,WS,Dixon,T,Levy,R,Bourg,E( 1984) Alteration of Type A behaviour and reduction in cardiac recurrences in postmyocardial infaction patients American Heart Journal,108,237,248

Recurrent Coronary Prevention Project (RCPP- Friedman & Thoresen, 1985)

Questions

Can Type A behaviour be reduced?

Does reducing Type A reduce risk of recurrent MI

Design

Patients who had experienced an MI

Type A Change + cardiac care (592)

Cardiac care only (270)

Outcomes

Type Behaviour

New MI

Components of Type A Change 1. Environmental 2. Behavioural 3. Cognitive

Environmental

Speak to neighbours Drive more slowly No new tasks without dropping old Relax regularly

Behaviour

Speech: talk more slowly Listening: less fidgeting, listen Waiting: practice waiting in

queues Modelling: pretend to be Type B

Drills Monday Look at faces Tuesday Remove grimace Wednesday Walk more slowly

than spouse Thursday Eat more slowly Friday No knee jiggling Saturday Linger at table Sunday Speak more slowly

Cognitive

Use feelings to examine beliefs How you see things is the problem Practice self- talk Do not see events & people as threats

I schaemic Heart Disease Life Stress Monitoring Program (Frasure- Smith)

Treatment group (n=229) Stress monitored monthly, if high visited by nurse and help provided Control group (n=224) Normal care Approx. 50% needed stress related visit, and almost 6 hours of help used. Program reduced sudden deaths and recurrent MI

Cardiac Counseling from nurse(Marie J ohnston et al, 1999) Randomised Controlled Trial (RCT) Routine Care (n=33). I npatient Counseling (n=38). 5 sessions, 3.7 hours I n & Outpatient Counseling (n=29). 9 sessions, 8 hours. Patient & partner chose from menu on

Explanation of MI I nvestigations

Risk factors Emotional eff ects o

Menu (cont.)

Risk factors

Emotion effects of MI

Recovery Period

Additional investigations

Recruit Discharge 2Mnth 6Mnth 1 Year

Time

0

2

4

6

8

10

Mean

Dep

ressio

n (

HA

DS

)

Cardiac Counseling (Marie Johnston et al, 1999)Patients

Control

Inpatient

Extended

Recruit Discharge 2Mnth 6Mnth 1 Year

Time

0

2

4

6

8

10

Mean

Dep

ress

ion

(H

AD

S)

Cardiac Counseling (Marie Johnston et al, 1999)Partners

Control

Inpatient

Extended

Recruit Discharge 2Mnth 6Mnth 1 Year

Time

0

2

4

6

8

10

Mea

n D

epre

ssio

n (

HA

DS

)

Cardiac Counseling (Marie Johnston et al, 1999)Patients

Control

Inpatient

Extended

Recruit Discharge 2Mnth 6Mnth 1 Year

Time

0

2

4

6

8

10

Mean

Dep

ress

ion

(H

AD

S)

Cardiac Counseling (Marie Johnston et al, 1999)Partners

Control

Inpatient

Extended

Johnston M, Foulkes J, Johnston DW, Pollard B, Gudmundsdottir H. (1999) The impact on patients and partners of inpatient and extended counseling and rehabilitation: a controlled trial: Psychosomatic Med 61, 225-233