Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Management of acute coronary syndrome wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Baker Heart and Diabetes Institute wikipedia , lookup
Cardiac surgery wikipedia , lookup
Antihypertensive drug wikipedia , lookup
Saturated fat and cardiovascular disease wikipedia , lookup
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. . 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?