1. © 2012 McGraw-Hill Companies, Inc. All rights reserved.McGraw-Hill/Irwin© 2012 McGraw-Hill Companies, Inc. All rights reserved. Health Psychology 8 th edition Shelley E. Taylor Chapter Thirteen Heart Disease, Hypertension, Stroke, and Type II Diabetes

2. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-2 Coronary Heart Disease What is Coronary Heart Disease (CHD)? - a general term referring to illnesses caused by atherosclerosis, the narrowing of coronary arteries, the vessels that supply the heart with blood - may be caused by inflammatory processes, high blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol level and low levels of physical activity

3. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-3 Coronary Heart Disease (cont.) Role of stress: - chronic and acute stress have been linked to CHD - CHD more common in individuals low in socioeconomic status (SES) - job factors linked to CHD - balance of demand and control in daily life is associated with CHD - social instability tied to higher rates of CHD

4. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-4 Coronary Heart Disease (cont.) Women and CHD: - leading killer of women in the U.S.; women seem to be protected at younger ages relative to men - higher levels of HDL - estrogen diminishes sympathetic nervous system arousal - higher risk of cardiovascular disease after menopause

5. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-5 Coronary Heart Disease (cont.) Cardiovascular reactivity, personality and CHD: - anger and hostility are risk factors for CHD Hostile people often have: - developmental antecedents - difficulty expressing vs. harboring hostility - hostility within social relationships - reactivity - mechanisms linking reactivity and psychological factors

6. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-6 Coronary Heart Disease (cont.) Depression and CHD: - depression can lead to development and progression of CHD - there is a link between depression and metabolic syndrome - depression is tied to elevated C-reactive protein, a marker of inflammation

7. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-7 Coronary Heart Disease (cont.) Other psychological risk factors and CHD: - vigilant coping - anxiety (implicated in sudden cardiac death) - helplessness, pessimism and a tendency to ruminate over problems - attempting to dominate social interactions - vital exhaustion

8. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-8 Coronary Heart Disease (cont.) Modification of CHD risk-related behavior: - dietary intervention - programs to stop smoking - aerobic exercise in particular Modifying hostility: - relaxation training - speech style interventions

9. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-9 Coronary Heart Disease (cont.) Management of heart disease: - role of delay: - patients often delay before seeking treatment - initial treatment: - cardiac rehabilitation: - process by which patients attain their optimal physical, medical, psychological, social, emotional, vocational and economic status

10. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-10 Coronary Heart Disease (cont.) Management of heart disease (cont.): - treatment by medication: - Beta-adrenergic blocking agents - Aspirin is commonly prescribed - Statins - diet and activity level - stress management - targeting depression - evaluation of cardiac rehabilitation - problems of social support

11. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-11 Hypertension Hypertension: – high blood pressure or cardiovascular disease (CVD) How is hypertension measured? - levels of systolic and diastolic pressure are measured by a sphygmomanometer What causes hypertension? - 90% is essential (unknown) - 5% is caused by failure of the kidneys - genetic factors - emotional factors

12. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-12 Hypertension (cont.) Relationship between stress and hypertension: - combination of high demand/low control - chronic social conflict - job strain - associated with: - crowded, noisy locales - migration from rural to urban areas - women – extensive family responsibilities

13. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-13 Hypertension (cont.) How do we study stress and hypertension? - bring people with hypertension into labs to respond to stressful tasks - identify stressful circumstances (such as high pressure jobs) and examine rates of hypertension - ambulatory monitoring

14. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-14 Hypertension (cont.) Psychosocial factors and hypertension: - originally: - thought to be a constellation of personality factors - suppressed anger thought to be dominant - currently: - personality insufficient for developing hypertension - expressed anger and the potential for hostility - number of conflict-ridden interactions in daily life

15. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-15 Hypertension (cont.) Stress and hypertension among African-Americans: - tied to stress of racial discrimination - stressful locales - dark-skinned African Americans have higher rates of hypertension than lighter-skinned African Americans - especially prevalent in lower-income African- Americans - African Americans more likely to be obese

16. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-16 Hypertension (cont.) John Henryism: - a personality predisposition to cope actively with psychosocial stressors - may become lethal when active coping efforts are unsuccessful - syndrome especially documented among lower income and poorly educated African- Americans

17. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-17 Hypertension (cont.) Treatment of hypertension: - overview: - low-sodium diet - reduction of alcohol - weight-reduction in overweight patients - exercise - caffeine restriction

18. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-18 Hypertension (cont.) Drug treatments: - diuretics - Beta-adrenergic blockers & vasodilators - central adrenergic inhibitors Cognitive-behavioral treatments: - relaxation - stress management - exercise - anger management

19. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-19 Hypertension (cont.) Evaluation of cognitive-behavioral interventions: - seem to be very successful - reduce drug requirements - sometimes the combination of cognitive-behavioral techniques and drugs appears to be the best approach

20. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-20 Hypertension (cont.) Problems in treating hypertension: - “the hidden disease”: - often symptomless, so diagnosis occurs during standard medical examinations - early detection is important - untreated hypertension: - lowers quality of life - compromises cognitive functions - related to fewer social activities - adherence is essential

21. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-21 Stroke Stroke: - condition that results from a disturbance in blood flow to the brain - third major cause of death in the U.S. Risk factors for stroke: - overlap with those for heart disease - high blood pressure, heart disease, cigarette smoking, high red blood cell count and transient ischemic attacks - negative emotions, sudden change in posture to a startling event and psychological distress

22. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-22 Stroke (cont.) Consequences of stroke: - stroke affects all aspects of life: personal, social, vocational and physical: - motor problems - cognitive problems - emotional problems

23. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-23 Stroke (cont.) Types of rehabilitative interventions: - psychotherapy - cognitive-remedial training - movement therapies - use of structured, stimulating environments to challenge capabilities

24. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-24 Type II Diabetes -1.6 million new each year -233,619 deaths in 2005 -68% of deaths dues to heart disease and stroke -21.4 million Americans currently have Type II diabetes -Now considered a pandemic

25. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-25 Type II Diabetes (cont.) Health implications of diabetes: - leading cause of blindness among adults - kidney failure - foot ulcers - eating disorders - nervous system damage Stress and Diabetes: - Type II diabetics are sensitive to stress

26. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-26 Type II Diabetes (cont.) Problems in self-management (cont.): - managing Type II Diabetes: - often unaware of health risks they face - must reduce sugar and carbohydrate intake - encouraged to achieve normal weight - encouraged to exercise -helps use up glucose in the blood - improving adherence

27. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-27 Type II Diabetes (cont.) Interventions with Diabetics: - cognitive-behavioral interventions to improve adherence to their regimen - weight control improves glycemic control - self-management and problem-solving skills - social skills training - behavior modification - pharmacological therapy

28. © 2012 McGraw-Hill Companies, Inc. All rights reserved.13-28 Type II Diabetes (cont.) Diabetes prevention: - Diabetes is a major public health problem - lifestyle intervention and medication can greatly reduce the incidence of diabetes