Stress, emotion and the heart

Basic Reading

This course is not organised around a textbook. I shall refer primarily to material in journals. Also consult basic health psychology texts such as

EP Sarafino 2006 Health Psychology: biopsychosocial interactions (5th Edition)

S Taylor (2006) Health Psychology (6th Edition)

The is also an excellent by old book on the topic

A Steptoe (1981) Psychological factors in cardiovascular disorders.

Steptoe has also written a very good chapter on “Psychophysiological bases of disease” in Johnston & Johnston, Health Psychology, volume 8 of Bellack & Hersen Comprehensive Clinical Psychology (find under Bellack & Hersen)

Definition

Health Psychology

The study of psychological process in health, illness and health care

John Hunter famous 18th century Scottish surgeon & anatomist of the 18th century “ My life is in the hands of any rascal who chooses to annoy or tease me” Died after argument at St George hospital medical school (over student admissions)

1897, William Osler - dominant figure in internal medicine - described the typical heart disease patient as "a keen and ambitious man, the indicator of whose engine is always at 'full speed ahead.”

Patients’ beliefs about causes of MI. Percentage considering factor a possible cause

At discharge 2month 6 months 12 months

Stress 70 72 61 61

Smoking 59 55 47 53

Worry 58 55 33 28

Will of God 27 21 9 2

Gudmunsdottir, Johnston, Johnston & Foulkes, (2001) BJHP, 6, 81-96.

Brod. Mental arithmetic leads to increase in cardiac output (blood pumped by heart). Decrease in peripheral resistance, but blood pumped bigger effect in this case so blood pressure increases.

Heart Rate increased by stress. Decreases again with exposure but less so in hard but not impossible condition. Obrist. Hard condition involves “active coping”

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Guest lecturer speaking to this class last year. HR high before and during lecture . Took at least an hour to get back to normal

Coronary Heart Disease and Acute Coronary Syndromes

1. A slow process of arterial deterioration

2. An acute process that triggers a clinical event

The Reactivity HypothesisStress (and some emotions) leads to altered physiological responses in some people and these responses are harmful to the arteries.

A stress diathesis (vulnerability) model.

Studies in Health populationsKuper Marmot & Hemingway (2002), Seminars in Vascular Medicine,2, 267-313

Psychological process positive/no. of studies

Type A / Hostility 6/18

Depression 15/22

Anxiety 4/8

Work characteristics 10/13

(Social Support 6/9)

Studies in Populations with Cardiovascular Disease

Type A/Hostility 2/15

Depression 18/34

Anxiety 8/18

Work characteristics 2/4

(Social Support 14/21)

Seen as positive support overall By K,M & H

Recruit Discharge 2Mnth 6Mnth 1 Year

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Johnston,M, Foulkes J, Johnston, D, Pollard, B, Gudmundsdottir, H (1999) Psychosomatic Medicine, 61, 225-233

Depression reduced in patients after MI by simple Counselling intervention

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Johnston,M, Foulkes J, Johnston, D, Pollard, B, Gudmundsdottir, H (1999) Psychosomatic Medicine, 61, 225-233

Depression reduced in partners of MI patients who received counselling

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Cardiac Counseling (Marie Johnston et al, 1999)Patients

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Cardiac Counseling (Marie Johnston et al, 1999)Partners

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