Health Psychology

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Health Psychology

• Lecture 7
• Cardiovascular Disease and Cancer

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Lecture 7 - Outline

• Part 1
• Cardiovascular disease
• Causes
• Treatment and Prevention
• Part 2
• Cancer
• Part 3
• Practice task for Tutorial Assignment 2

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Cardiovascular Disease

• Diseases of the heart and circulatory systems
  (arteries and veins)
• Cardiovascular disease (CVD) is the leading cause
  of deaths in Western countries
• 45

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Cardiovascular Disease

• Basic cardiac anatomy and function

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Types of Cardiovascular Disorder

• Arteriosclerosis
• Narrowing and hardening of arteries (loss of
  elasticity)
• Most common (all have to some degree)
• Atherosclerosis
• A form of arteriosclerosis
• Deposition of fatty plaques (arthomas) on inner
  lining of artery walls
• Plaques consist of cholesterol, lipids, cell
  debris and other substances

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Types of Cardiovascular Disorder

• Hypertension (high blood pressure)
• Essential hypertension (cause unknown, most
  common)
• Results from increased peripheral resistance
  and/or increased cardiac output (serious risk for
  CV Disease)
• Coronary Heart Disease (CHD)
• Disease of coronary arteries which feed the heart
  muscle itself (often caused by atherosclerosis in
  the coronary arteries)

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Types of Cardiovascular Disease

• Consequences of Arteriosclerosis/Atherosclerosis
• Angina Pectoris
• Severe heart pain arising from reduced blood flow
  (ischemia) to the heart muscle
• Relieved by Anginine which dilates coronary
  arteries
• Warning sign vulnerable to heart attack
• (Ischemia restriction of blood flow)

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Types of Cardiovascular Disease

• Consequences of Arteriosclerosis/Atherosclerosis
• Myocardial Infarction (heart attack)
• Infarct wedge-shaped area of tissue damage and
  death from blocking of an artery
• Loss of 02 to part of the heart, area becomes
  scarred and doesnt repair

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Types of Cardiovascular Disease

• Consequences of Arteriosclerosis/Atherosclerosis
• Cerebrovascular Accident (stroke)
• Caused by interruption of blood flow through an
  artery in the brain
• Can occur because of atherosclerosis, formation
  of a blood clot, and embolism (where a piece of a
  clot or atheroma breaks off and travels through
  the blood stream), rupture of an artery
  (aneurism).

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Measures of Cardiovascular Health

• Blood pressure
• Most common measure
• Electrocardiogram (ECG)
• Electrical activity of heart
• Abnormalities of heart beat but not plaque build
  up
• Stress test
• EEG during exercise
• Restriction of blood flow results in
  characteristic pattern
• Cardiac catheterization/angiography
• Most accurate, very uncomfortable procedure.

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Risk factors for CVD

• Risk factors can be divided into 2 groups
• 1. Non-modifiable risk factors
• Eg genetics, gender, age
• 2. Modifiable risk factors
• Eg hypertension

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Risk Factors for CVD

• Standard Risk factors for CVD include
• Genetics / Family History
• High serum cholesterol (blood)
• High blood pressure
• Smoking
• Low levels of exercise
• Diet

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Risk Factors for CVD

• Cholesterol
• Fat-like substance found in animal fats and oils
• Liver produces most of the bodys cholesterol
• The rest comes from dietary intake of animal
  products
• Cholesterol is present in blood attached to
  proteins (lipoproteins)

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Risk Factors for CVD

• Cholesterol transport
• Low density lipoproteins (LDL)
• transport cholesterol which can collect on
  arterial walls (bad type!)
• High density lipoproteins (HDL)
• contain more protein and less cholesterol
  (transport cholesterol to the liver where it is
  broken down protective type)
• Women have more HDL than men - ? CVD risk for men

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Risk Factors for CVD

• Psychosocial Risk factors for CVD include
• Low SES (workforce status, ethnicity, area of
  residence)
• Hostility (Type A component)
• Depression
• Low social support
• Chronic stress

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Psychological risk factors for CVD

• Type A personality (Friedman Rosenman, 1974)
• Competitive
• Impatient
• Sense of time urgency
• Achievement orientated
• Hostile
• Measured
• Rosenhans Structrured Interview
• Jenkins Activity Survey (Jenkins et al 1967)

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Acute and Chronic Risk Factors

• Acute risk factors
• Acute stress/anger, exercise, cardiovascular
  reactivity
• Chronic risk factors
• Standard (age, sex, family history, smoking,
  cholesterol, hypertension)
• Psychological (hostility, depression/exhaustion,
  low SES, low social support, chronic stress)

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Psychological Interventions for CVD

• Possible aims
• to enhance adherence with diet, weight loss,
  exercise, and use of medications
• to reduce BP to mild/moderate levels
• Relaxation training, stress management,
  biofeedback
• Effective among 75
• to promote coping, address anxiety/depression

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Psychological Interventions for CVD

• Some examples
• Gould et al. (1992) - Ss with angina
• Stress management / diet and exercise vs. control
• 15 months - 91 reduced angina frequency/duration
• Anderson Masur (1989) - Cardiac catheterization
• 5 conditions
• Modeling coping skills reduced anxiety before
  and during procedure.
• Psychology involved in prevention, preparation,
  and recovery

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Psychological Interventions for CVD

• Evaluation
• Meta-analysis of psychosocial interventions (37
  since 1974)
• 37 reduction in cardiac mortality
• 29 reduction in recurrence of MI
• Also have positive effects on blood pressure,
  smoking, weight, physical exercise, eating habits
  and cholesterol

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The potential role of psychology in CVD
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Term Paper 2 - Practice Exercise

• Decisions in the management of pain and anxiety
  in hospitals
• Imagine you are a Health Psychologist working at
  a large hospital. The CEO of the hospital asks
  you if you can reduce patients level of pain and
  anxiety during their hospital stay.
• There are a number of different approaches that
  might be taken to treatment and different goals
  that might be adopted. Briefly, as the
  psychologist, what goals and methods would you
  consider. What goal might you ultimately
  recommend to the CEO and why?

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Term Paper 2

• Decisions in the treatment of a mildly overweight
  client.
• Imagine you are a Health Psychologist who is
  consulted by a 35 year-old client who is mildly
  overweight. She is 56 (167.6cms) tall and
  weighs 11 stone 6 lbs (74 kgs)BMI 26.34.
  Since adolescence she has had an extensive
  history of repeated, unsuccessful dieting, and
  has sought assistance from you to lose weight.
  She is embarrassed about her weight and her
  husband says she is fat, and makes her run up and
  down the stairs in their house for 10 minutes
  each day. She believes losing weight will
  improve the quality of her relationship with her
  husband and make her happier. She tells you her
  weight goal is 60 kgs (132 lbs).
• There are a number of different approaches that
  might be taken to treatment and different goals
  that might be adopted. Briefly, as the
  psychologist, what goals and methods would you
  consider. What goal might you ultimately
  recommend to the client and why?

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Term Paper 2

• Decisions in the treatment of a mildly overweight
  client.
• Maximum Length 1000 words
• Due Date Monday, March 14, 2005
• References
• Sarafino, E. P. (2003). Health psychology
  Biopsychosocial interactions. (Chapter 8, pp.
  236-265). Wiley New York.
• Rosen, J. C., Orason, P., Reiter, J. (1995).
  Cognitive behavior therapy for negative body
  image in women. Behavior Therapy, 26, 25-42.