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THE HEART OF THE MATTER:
CARDIOVASCULAR DISEASE AND MENTAL HEALTH
Dr. Michael Knepp
Psychology and Neuroscience
University of Mount Union
12/8/15
PSYCHOLOGY AND THE HEART
Various personality traits linked with excess cardiovascular reactivity & disease (CVD)
 Type A cluster (Friedman & Rosenman, 1971)
 Anger and hostility (Everson-Rose & Lewis, 2005)
Anxiety may also confer increased CVD risk
 Epidemiologic studies (Barger & Sydeman, 2005; Haines et al., 1987; Kawachi et al., 1994 Shen et
al., 2008)
 Anxiety stronger predictor of CVD than anger or depression (Kubzansky & Kawachi, 2000)
 Trait worry in men associated with increased CVD risk (Kubzansky et al., 1997)
THEORETICAL MECHANISMS
Reactivity hypothesis of CVD
 Chronic large magnitude CV responses to stress: risk factor for CVD (Manuck, 1994; Rozanski et al.,
1999; Treiber et al., 2003)
 Anxiety not often studied within the reactivity framework
Clinical, trait, & state forms of anxiety associated with low cardiac vagal control
(Friedman, 2007)
 Poor vagal HR ‘‘braking’’ could support high CV reactivity
MODELS OF ANXIETY AND WORRY
Perseverative cognition hypothesis (Brosschot & Thayer, 1998)
 Hostile rumination sustains CV activation and delays CV recovery from provocation
Worry: aspect of anxiety in which verbal thought predominates
 Function: cognitive avoidance of threat (Borkovec et al., 1998)
 Persistent worry may keep negative affect in consciousness and prolong CV reactivity (Brosschot et al.,
2006)
EXPECTED FINDINGS
High trait worriers would show




Increased cardiovascular reactivity & delayed cardiovascular recovery to various lab tasks
Increased heart rate
Low vagal control of the heart
Effects would be magnified during any worry imagery task
 ‘Matching hypothesis’: best fit of person and experimental conditions likely to reveal individual differences in CV reactivity and
recovery (Engebretson et al., 1989)
MY PREVIOUS WORK IN THE FIELD
Mind Body Lab
 Examination of Laboratory Tasks
 Dissertation on Woe of Worry in Women
STATE project
 Worry as part of a larger context of psychosocial factors
Mount Union Physiology and Neuropsychology Labs
 The impact of trait worry and emotion regulation on heart rate variability
EARLIEST WORK
Study 1: 40 women
 Online Screening with Penn State Worry Questionnaire
 In-lab recording: Baseline, Task, Recovery
 6 Tasks
 Orthostatic, Supine, Hand Cold Pressor, Mental Arithmetic, Worry Imagery, Guided Relaxation
Study 2: 100 women
 Same Screening and Recording Measures
 Two shorter experiments (50 women in each)
 Orthostatic vs. Supine
 Hand Cold Pressor vs. Mental Arithmetic
STUDY 1 MAJOR FINDINGS
STUDY 2 FINDINGS
130
*= p<.05
+=p<.10
Systolic Blood Pressure
*
125
+
120
Low
115
110
105
Antic
Ortho Pre
Ortho Task
Ortho Post
Task Epoch
Supine Pre
Supine Task
Supine Post
High
Diastolic Blood Pressure Change Score (mmHg)
STUDY 2 MAJOR FINDINGS
8
6
4
2
0
Orthostatic Reactivity
-2
-4
-6
-8
-10
-12
Orthostatic Recovery
Supine Reactivity
Supine Recovery
Low Worry
High Worry
IMPLICATIONS OF FIRST TWO STUDIES
Chronic high HR: risk factor for all-cause mortality (Palatini & Julius, 1997)
 May index ‘‘general poor health and lack of vigor’’
 Possible factor in health risks of worry (Kubzansky et al., 1997)
 Mean anticipatory baseline HR in high worriers (81.3 bpm) approaches level marking increased heart
disease incidence (84 bpm) (Gillum et al., 1991)
 Biology/Chemistry issue: Can chronic high heart rate impact/change the function of pacemaker cells?
Blood pressure as a risk factor:
 Larger increases in blood pressure to stress tasks predicted earlier onset of hypertension (Matthews et
al., 2004).
 Parental history of hypertension is related to slow blood pressure recovery following a stressor task
(Gerin & Pickering, 1995).
STATE PROJECT INFORMATION
Collaborative Multi-Laboratory Project
 Substance Use, Temperament, Anxiety, Trauma, Emotion
 Heart Rate and Heart Rate Variability
 Right Frontal Neuropsyc Testing
All Psychology Students Eligible (Men and Women)
 800-900 Survey Tested
 180 Cardiac and Neuropsyc Recording
History (the effect, not department) Confounds
 Rating of anxiety/worry levels pre-post VT shootings
STATE PROJECT FINDINGS
MOUNT UNION RESEARCH WORK
The impact of trait worry and emotion regulation on heart rate variability
50 college students (36 women)
 Penn State Worry Questionnaire
 Emotion Regulation Questionnaire
 Both genders handled separately during creation of high and low groups
 Controlled for State Personality
 Disadvantage: First study performed by the undergraduate laboratory
Three task epochs
 Baseline: Neutral Task
 Stress task: Serial Subtraction
 Recovery Period: Rumination allowed as just an eyes closed session
Overall, groups were similar to previous studies in questionnaire means
MOUNT UNION STUDY 1 FINDINGS
MOUNT UNION CURRENT AND FUTURE WORK
Positive Psychology Influences on Autonomic Nervous System Activity
 120 subjects goal; finish data collection this week
 In this case, positive psychology traits are expected as buffers to the parasympathetic system
 Optimism, Resilience, Self-efficacy, Positive Moods, Satisfaction with Life, Stress-Related Growth Scale
 Could not find a good scale/measurement of “Grit” instead doing Life Orientation Test
Facets of Negative Trait Personality and HRV
 Sabbatical Project
 120-150 subjects needed
 Trait Personality: Worry, Emotion Regulation, Depression, and Anger
 State Personality: Depression, Anxiety, and Stress
 Baseline, Stressor, and Relaxation Periods
 This is the culmination of work across our physiology and neuropsychology laboratories
RELATED AREAS TO THINK ON
Higher Modified Beck Depressive Inventory Scores are Associated with Body, Eating,
and Exercise Comparisons but Decreased Exercise Amounts
 Publication from our neuropsychology wing
 Exercise Science-Sports Psychology Realm: Exercise decreased depressive symptoms
 Difficulty: Not much done on barriers to exercise
Study Findings
 Higher Depression group students:
 had lower right frontal activity based on a neuropsychological assessment test
 reported more comparisons to others on their body shape, eating and exercise habits
 reported less moderate and strenuous exercise
 In this way, depression itself as a negative facet of personality can impact the heart, however, it can
worsen the cardiovascular situation long-term by being a barrier to exercise
 Finalizing a similar manuscript related to aggression and health behaviors, however, the findings are
more limited than with depression
OTHER PSYCHOLOGICAL INFLUENCES
Mindfulness/Savoring
 Promotion of mindfulness meditation
 Breathing/respiration rates on baroreceptor response
Yogis
 Most work here is anecdotal
 New focuses on eastern/western approaches and what can be determined about voluntary control of
the autonomic nervous system
Biofeedback
 Using visual/auditory signals to learn about one’s own physiology (computer-real time setups)
 Neurofeedback as a treatment for spectrum disorders
 Can anything be learned here
REFERENCES
Barger, S. D., & Sydeman, S. J. (2005). Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? Journal
of Affective Disorders, 88, 87–91.
Borkovec, T.D., Ray, W.J, & Stober, J. (1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes.
Cognitive Therapy and Research, 22, 561–576.
Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health.
Journal of Psychosomatic Research, 60, 113–124.
Brosschot, J.F. & Thayer, J.F. (1998). Anger inhibition, cardiovascular recovery, and vagal function: a model of the link between hostility and cardiovascular disease. Annals
of Behavioral Medicine, 4, 326–332.
Engebretson, T.O., Matthews, K.A., & Scheier, M.F. (1989). Relations between anger expression and cardiovascular reactivity: Reconciling inconsistent findings through a
matching hypothesis. Journal of Personality and Social Psychology, 57, 513-521.
Everson-Rose, S. A., & Lewis, T. T. (2005). Psychosocial factors and cardiovascular diseases. Annual Review of Public Health, 26, 469–500.
Friedman, B. H. (2007). An autonomic flexibility-neurovisceral integration model of anxiety and cardiac vagal tone. Biological Psychology, 74, 185–199.
Friedman, M. & Rosenman, R. H. (1971). Type A behavior: its association with coronary heart disease. Annuals of Clinical Research, 3, 300–312.
Gerin, W. & Pickering, T.G. (1995). Association between delayed recovery of blood pressure after acute mental stress and parental history of hypertension. Journal of
Hypertension, 13(6), 603-610.
Gillum, R.F., Makuc, D.M., & Feldman, J.J. (1991). Pulse rate, coronary heart disease, and death: The NHANES I epidemiologic follow-up study. American Heart Journal, 121,
172–177.
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REFERENCES
Haines A. P., Imeson, J. D., & Meade, T. W. (1987). Phobic anxiety and ischaemic heart disease. British Medical Journal, 295, 297–99.
Kawachi, I., Sparrow, D.,Vokonas, P. S., & Weiss, S. T. (1994). Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation, 90, 2225–
2229.
Kubzansky, L. D., & Kawachi, I. (2000). Going to the heart of the matter: do negative emotions cause coronary heart disease? Journal of Psychosomatic Research, 48, 323–
337.
Kubzansky, L. D., Kawachi, I. Spiro, A., Weiss, S. T., Vokonas, P. S., & Sparrow, D. (1997). Is worrying bad for your heart? A prospective study of worry and coronary heart
disease in the Normative Aging Study. Circulation, 5, 818–824.
Manuck, S. B. (1994). Cardiovascular reactivity cardiovascular disease: “Once more unto the breach”. International Journal of Behavioral Medicine, 1, 4–31.
Matthews, K.A., Owens, J.F., Kuller, L.H., Sutton-Tyrrell, K., & Jansen-McWilliams, L. (1998). Are hostility and anxiety associated with carotid atherosclerosis in healthy
postmenopausal women? Psychosomatic Medicine, 60, 633–638.
Palatini, P., & Julius, S. (1997). Heart rate and the cardiovascular risk. Journal of Hypertension, 15, 3– 17.
Rozanski, A., Blumenthal, J. A., Kaplan, J. (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation,
99, 2192–2217.
Shen, B-J., Avivi, Y. E., Todaro, J. F., Spiro, A. III, Laurenceau, J-P, Ward, K-D, & Niaura, R. (2008). Anxiety characteristics independently and prospectively predict
myocardial infarction in men. Journal of the American College of Cardiology, 51, 113–119.
Treiber, F. A., Musante, L., Kapuku, G., Davis, C., Litaker, M., & Davis, H. (2001) Cardiovascular (CV) responsivity and recovery to acute stress and future CV functioning in
youth with family histories of CV disease: a 4-year longitudinal study. International Journal of Psychophysiology, 41, 65–74
FOLLOW-UP QUESTIONS
Before any discussion ideas, any particular questions?
DISCUSSION AREAS
What mechanisms across exercise science, psychology, biology, physics, and chemistry
should be included in comprehensive studies of the cardiovascular system?
Chicken-egg question: What drives the relationship from a developmental standpoint:
physiology->increasing anxiety or anxiety->changing physiology?
How does one promote treatments related to mental health, specifically geared
toward long-term cardiovascular health?
What are other approaches/variables that need explored between mental and
physical well-being?