Health Psychology, 5th edition Shelley E. Taylor

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Health Psychology, 5th editionShelley E. Taylor

• Chapter Thirteen
• Heart Disease, Hypertension, Stroke, and Diabetes

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Coronary Heart Disease (CHD) Overview

• 1 Killer in the U.S.
• Accounts for 40 of all deaths
• A disease of modernization
• Alterations in diet
• Alterations in activity level
• CHD is also a major chronic disease
• Millions of Americans live with its symptoms

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Coronary Heart Disease (CHD) What IS CHD?

• A general term referring to illnesses caused by
  atherosclerosis,
• which is the narrowing of the coronary arteries,
  the vessels that supply the heart with blood.
• Angina pectoris
• Pain that radiates across the chest and arms
• Caused by temporary shortage of oxygen
• Myocardial infarction heart attack
• Ischemic event

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Risk Factors

• Uncontrollable
• Age
• Gender
• Genetics

• Controllable
• Stress/Hostility
• Diet
• Exercise
• Smoking
• Alcohol Use

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Coronary Heart Disease (CHD) Role of Stress

• Development of CHD is associated with
• Hostility
• Exposure to chronic stress
• Cardiovascular reactivity to stress
• Heart disease is more common in low SES
  individuals
• Mobile individuals are at higher risk than
  geographically stable individuals

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CHD Cardiovascular Reactivity and Hostility

• Type A Behavior Pattern
• A behavioral and emotional style marked by an
  aggressive, unceasing struggle to achieve more
  and more in less time
• often in hostile competition with other
  individuals or forces
• a risk factor for coronary artery disease
• Hostility appears to be especially implicated as
  the risk factor

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CHD Cardiovascular Reactivity and Hostility

• Cynical Hostility
• Particularly lethal type of hostility
• Characterized by suspiciousness, resentment,
  frequent anger, antagonism, distrust of others
• Have difficulty extracting social support from
  others
• Fail to make effective use of available social
  support
• Hostility combined with defensiveness is
  particular problematic

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CHD Negative Emotions and Risk Factors

• Strong Associations between
• Depression and heart attack
• Hopelessness and heart attack
• Anxiety and sudden cardiac death
• Recent research
• Social dominance may be related to all-cause
  mortality
• Vital exhaustion predicts the likelihood of a
  heart attack

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Coronary Heart Disease (CHD) Women and CHD

• Cardiovascular disease
• Leading killer of women in the U.S.
• Women seem to be protected at younger ages
  relative to men
• Higher levels of HDL premenopausal
• Estrogen diminishes sympathetic nervous system
  arousal

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CHD Modification of Risk-Related Behaviors

• People with high cholesterol
• Targeted for preventive dietary intervention
• People who smoke
• Programs to stop smoking
• Exercise recommendations
• Aerobic exercise in particular
• Modifying hostility
• Relaxation training speech style interventions

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CHD Management of Heart Disease The Role of
Delay

• Patients often delay before seeking treatment
• Unable to accept that they are having a heart
  attack
• Interpret the symptoms as a mild disorder
• Who is likely to delay?
• Older patients
• African-American patients
• Those with a history of angina or diabetes

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CHD Management of Heart Disease Cardiac
Rehabilitation

• An intervention program designed to help heart
  patients achieve their optimal
• Physical regular exercise
• Medical prevention of further progression
• Psychological reduce stress, depression and
  fear
• Social Increase engagement in social support
• vocational
• economic status
• Compliance Boosting
• Adherence is the key

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CHD Management of Heart Disease Cardiac
Rehabilitation

• Cardiac invalidism
• psychological state that can result after a
  myocardial infarction or diagnosis of coronary
  heart disease
• the perception that a patients abilities and
  capacities are lower than they actually are
• both patients and their spouses are vulnerable to
  these misperceptions.

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Hypertension Overview

• Hypertension
• Excessively high blood pressure
• Occurs when the supply of blood through the blood
  vessels is excessive, putting pressure on the
  vessel walls
• a risk factor for a variety of medical problems,
  including coronary artery disease and kidney
  failure

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Hypertension How is it measured?

• Sphygmomanometer measures blood pressure
• Systolic blood pressure
• Sensitive to the volume of blood leaving the
  heart
• Sensitive to the arterys ability to stretch to
  accommodate the blood
• Has greater value in determining hypertension

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Hypertension What Causes It?

• 5 is caused by failure of kidneys to regulate
  blood pressure
• 90 is essential hypertension
• This means the cause is unknown
• Risk factors
• Prior to age 50, men at greater risk
• After age 50, women at greater risk
• Higher among minorities (lower SES)
• Genetic factors play a role
• Emotional factors, negative affect

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Hypertension Relationship between Stress and
Hypertension

• Combination of high demand and low control
• Chronic social conflict
• Job strain
• unemployment
• Crowded, noisy locales
• Migration from rural to urban areas
• Women extensive family responsibilities

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Hypertension Relationship between stress and
hypertension

• Research Methods
• Bring people with hypertension into the lab to
  respond to stressful tasks
• Identify stressful circumstances and examine
  rates of hypertension
• Ambulatory monitoring in which a person wears a
  cuff which assesses blood pressure at intervals
  throughout the day

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Hypertension Personality Factors

• Originally
• Thought to be a constellation of personality
  factors
• Suppressed anger thought to be dominant
• Currently
• Personality is insufficient for developing
  hypertension
• Hostility may play a role

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Hypertension Personality Factors

• Particular medical problem among
  African-Americans
• Tied to stress of racial discrimination
• Dark-skinned African-Americans have higher rates
  of hypertension than lighter-skinned
  African-Americans
• Stressful neighborhoods hypertension
• Racial differences in neuropeptide and
  cardiovascular responses to stressors

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Hypertension Personality Factors

• John Henryism
• A personality predisposition to cope actively
  with psychosocial stressors
• may become lethal when those active coping
  efforts are unsuccessful
• the syndrome has been especially documented among
  lower income Blacks at risk for or suffering from
  hypertension.

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Hypertension Treatment

• Common treatments
• Low-sodium diet controversial because sodium
  depletion adversely affects the sympathetic
  nervous system
• Reduction of alcohol
• Weight-reduction in overweight patients
• Exercise
• Caffeine restriction

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Hypertension Treatment

• Drug Treatments
• Diuretics reduce blood volume
• Promote the excretion of sodium
• Adrenergic blockers vasodilators
• Adverse side effects lead to nonadherence
• Drug treatments have become controversial
• Blood pressure may be reduced but CHD likelihood
  may not be reduced

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Hypertension Treatment

• Cognitive-Behavioral Treatments
• Inducing a state of low arousal
• Biofeedback, progressive muscle relaxation,
  hypnosis, meditation
• Stress management programs
• Identify particular stressors and develop plans
  to deal with them
• Combination of diet, exercise, and behavioral
  strategies for weight loss

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Stroke Overview

• A condition that results from a disturbance in
  blood flow to the brain, often marked by
  resulting physical or cognitive impairments and,
  in the extreme, death.
• Third major cause of death in the U.S.
• A chief risk of stroke
• That more strokes will follow in its wake
• Aspirin reduces the risk of recurrent strokes

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Stroke Risk Factors

• Modifiable risk factors include
• High blood pressure
• Heart disease
• Cigarette smoking
• High red blood cell count
• Transient ischemic attacks
• Little strokes

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Stroke Consequences

• Stroke affects all aspects of life
• Personal
• Social
• Vocational
• Physical
• Motor, Cognitive, Emotional, and Relationship
  problems
• symptoms and problems differ depending on which
  side of the brain was damaged

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Stroke Types of Rehabilitative Interventions

• Four typical types
• Psychotherapy
• Includes treatment for depression
• Cognitive-remedial training
• To restore intellectual functioning
• Specific-skill development
• Use of structured, stimulating environments to
  challenge the patients capabilities

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Diabetes Overview

• A chronic disorder in which the body is not able
  to manufacture or utilize insulin properly.
• One of the leading causes of death in the U.S.
• Cells of the body need energy to function
• Glucose is the primary source of energy
• Insulin is a hormone produced by the pancreas
• Insulin acts as a key to permit glucose to
  enter the cells
• Without insulin, cells dont get the glucose they
  need

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Diabetes Types

• Type I Diabetes (10 of all diabetes)
• Abrupt onset of symptoms
• Immune system falsely identifies cells in the
  pancreas as invaders and destroys them
• Pancreas doesnt produce insulin
• Develops relatively early in life
• Type II Diabetes
• Cells lose ability to respond fully to insulin
  (known as insulin resistance)
• Pancreas temporarily increases insulin production
• Insulin-producing cells may give out

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Diabetes Health Implications

• Diabetes is associated with
• Thickening of the arteries due to buildup of
  wastes in the blood
• High rates of CHD
• Kidney failure
• Nervous system damage
• Pain and loss of sensation
• Leading cause of blindness among adults

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Diabetes Problems in Self-Management

• Ideal treatment
• Patient-centered
• Patient-directed
• Patients need to
• monitor glucose levels throughout the day
• Take immediate action when needed
• Adherence to self-management programs is low

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Diabetes Interventions with Diabetics

• Programs to improve adherence include
• Helping in self-injections
• More training in monitoring blood sugar levels
• Stress-management programs
• Weight control
• Improves glycemic control
• Reduces the need for medication

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Diabetes Special Problems of Adolescent
Diabetics

• Adolescents usually have Type I (more severe)
• Restrictions of diabetes interfere with
• Issues of independence and self-concept
• Peer culture may stigmatize those who are
  different
• When parents are actively involved in diabetes
  management tasks then there is better control of
  the disease