Lecture 11. Health Psychology and interventions to prevent or alleviate cardiovascular disease.

Lectures 10 & 11 Reading Usual texts. Also chapter by Krantz & Lundeman on Cardiovascular disorders in Johnston & Johnston good on interventions (& other parts of course). See also Krantz & McCeney Annual Rev Psychol : There is discussion of interventions in CHD in Schiederman, Antoni, Sabb & Ironson (2001) Health Psychology: psychosocial and biobehavioural aspects pf chronic disease management. Annual Rev Psychology, 52: Especially

Prevention Primary Modification of risk factors before disease develops Not related to stress or reactivity Secondary Arrest or reverse risk factors or disease processes when risk identified but disease may not be obvious Behavioural treatment of high blood pressure Tertiary Stop or inhibit progress of established disease CHD Type A modification (Friedman)

Patel,C,Marmot,MG,Terry,DJ,Carruthers,M,Hunt,B,Patel,M, (1985)Trial of relaxation in reducing coronary risk: four year follow up. British Medical Journal,290,1103,1106 Johnston,DW,Gold,A,Kentish,J,Smith,D,Vallance,P,Shah,D,Lea ch,G,Robinson,B,(1993) Effect of stress management on blood pressure in mild primary hypertension. British Medical Journal, 306,963,966, Schneider,RH,Staggers,F,Alexander,CN,Sheppard,W,Rainfort h,M,Kondwani,K,Smith,S,King,CG,(1995) A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension,26,820,827

Friedman,M,Thorensen,CE,Gill,JJ,Powell,LH,Ul mer,D,Thompson,L,Price,VA,Rabin,DD,Breall,W S,Dixon,T,Levy,R,Bourg,E( 1984) Alteration of Type A behaviour and reduction in cardiac recurrences in postmyocardial infaction patients American Heart Journal,108,237,248

Recurrent Coronary Prevention Project (RCPP- Friedman & Thoresen, 1985) Questions Can Type A behaviour be reduced? Does reducing Type A reduce risk of recurrent MI Design Patients who had experienced an MI Type A Change + cardiac care (592) Cardiac care only (270) Outcomes Type Behaviour New MI

Menu (cont.) Risk factors Emotion effects of MI Recovery Period Additional investigations

Johnston M, Foulkes J, Johnston DW, Pollard B, Gudmundsdottir H. (1999) The impact on patients and partners of inpatient and extended counseling and rehabilitation: a controlled trial: Psychosomatic Med 61,