Lecture 3 Health Psychology and Physical Illnesses I (Part 3)

1. Lecture 3Health Psychology and Physical Illnesses I (Part 3) Dr. Antoinette Lee The University of Hong Kong

2. Coronary Heart Disease • What is Coronary Heart Disease (CHD)? • Psychological factors and CHD • Psychological Management • Changing CHD risk-related behaviors • Management / Cardiac Rehabilitation Master in Behavioral Health Health Psychology Module, Spring 2005

3. Coronary Heart Disease • Coronary Heart Disease (CHD) • A general term referring to illnesses caused by atherosclerosis • Atherosclerosis • Narrowing of the coronary arteries (blood vessels that supply the heart with blood • Two primary clinical manifestations: • Angina pectoris (pain that radiates across the chest and arm) • Myocardial infarction (heart attack) Master in Behavioral Health Health Psychology Module, Spring 2005

4. Coronary Heart Disease and Health Psychology • Familial (genetic & environmental) & lifestyle-related risk factors • Risk factors: • Genes, high blood pressure, diabetes, high serum cholesterol, smoking, obesity, low level of physical activity, stress, personality Master in Behavioral Health Health Psychology Module, Spring 2005

5. Psychological Risk Factors of CHD • Personality • Type A Personality • Hostility • Negative Emotions • Stress • Health-Compromising Behaviors • Smoking • Obesity • Lack of physical activity • High serum cholesterol • Diet • Physical activity Master in Behavioral Health Health Psychology Module, Spring 2005

6. Type A Behavior • An emotional and behavioral pattern characterized by: • Time urgency • Hostility • Competitiveness • Assessment of Type A Behavior Pattern Master in Behavioral Health Health Psychology Module, Spring 2005

7. Master in Behavioral Health Health Psychology Module, Spring 2005

8. Master in Behavioral Health Health Psychology Module, Spring 2005

9. Hostility • A component of Type A personality that is believed to be the culprit • Cynical hostility • Hostility and reactivity • Harboring versus expressing hostility • Gender difference in relation to CHD • Mechanisms linking hostility with reactivity and CHD • Stress reactions • Vasorestriction + accelerated heart rate • Effect of fluctuation of level of catecholamines on blood pressure variability • Blood pressure variability may have adverse effects on endothelial tissue of coronary arteries and may promote plague formation • Greater interpersonal stress • Social support • Hostility as a reflection of underlying physiological reactivity Master in Behavioral Health Health Psychology Module, Spring 2005

10. Hostility • Hostility may increase the likelihood of other risk factors of CHD • Health-impairing behaviors • Expressed hostility related to higher total cholesterol and higher LDL • Lower adherence Master in Behavioral Health Health Psychology Module, Spring 2005

11. Negative Emotions • Depression, hopelessness, anxiety, and aggression are also found to be related to CHD • Underlying mechanism unknown • Vital exhaustion • Mental state characterized by extreme fatigue, a feeling of being dejected or defeated, enhanced irritability • Predicts likelihood of heart attack and of second heart attack after initial recovery • Exhaustion and depression hypothesized to represent a reactivation of latent viruses and concomitant inflammation of coronary vessels Master in Behavioral Health Health Psychology Module, Spring 2005

12. Depression and CHD • Among those who were initially free of cardiovascular disease : • Those with a history of depression were 4 times more likely to suffer a myocardial infarction in the next 14 years • Rate of depression among hear attack survivors: 1 in 3 • People with cardiovascular disease who are depressed have an increased risk of death after MI compared to those who are not depressed (four times more likely to die in the next six months) Master in Behavioral Health Health Psychology Module, Spring 2005

13. Stress • Chronic stress • CHD more common among those of low SES • Occupational stress • Job strain: high work demands and low job control • Low job security • High work pressure • Stress due to social instability • Occupational, residential and social mobility • Acute stress • Differential effect of stress among women • Lower physiological reactivity to stress • Effect of estrogen • Increased rate of CHD after menopause Master in Behavioral Health Health Psychology Module, Spring 2005

14. Psychological Contributions I. Modification of CHD Risk Factors • Modification of Type A Behavior and Hostility • Changing health behaviors II. Management ofHeart Disease • Reducing delay • Cardiac rehabilitation Master in Behavioral Health Health Psychology Module, Spring 2005

15. Dealing with Type A Behaviours • Engage in more social activities with family and friends • Ask a family member what he or she did that day, and actually listen to the answer • Read books – literature, drama, fiction…but not the ones on business or on climbing the corporate ladder • Get up earlier to sit and relax • Leave home earlier to avoid rush-hour jams • Don’t do two things at once. Avoid scheduling too many appointments back-to-back • Use breaks to relax. Limit intake of stimulants like caffeine. Try decaffeinated coffee • Set aside some time for yourself: for music, a hot bath, exercise, relaxation Friedman and Ulmer (1984); Suinn (1982, 1995) Master in Behavioral Health Health Psychology Module, Spring 2005

16. Dealing with Hostility • Tell your family that you love them • Make some new friends • Let your friends know that you stand ready to help them • Don’t get into discussions on topics about which you know that you and the other party hold divergent and heated opinions • Express appreciation for the help and encouragement of others • Say “Good morning” in a cheerful manner • Stop cursing so much Friedman and Ulmer (1984) Master in Behavioral Health Health Psychology Module, Spring 2005

17. Intervention for Reducing Hostility • Relaxation training • Modification of speech style • Speed • Loudness Master in Behavioral Health Health Psychology Module, Spring 2005

18. Management of CHD • Reducing delay • Cardiac rehabilitation • Active and progressive process by which individuals with heart disease attain their optimal physical, medical, psychological, social, vocational, and economic status Master in Behavioral Health Health Psychology Module, Spring 2005

19. Cardiac Rehabilitation • Goals: • Relief from symptoms • Reduce severity of disease • Limit further progression of disease • Promote psychological and emotional adjustment Master in Behavioral Health Health Psychology Module, Spring 2005

20. Cardiac Rehabilitation • Important psychological aspects • Improving adherence • Enhancing sense of mastery and self-efficacy • Behavior change • Stress management • Improving emotional adjustment to illness Master in Behavioral Health Health Psychology Module, Spring 2005