1. Health Psychology Lecture 7 Cardiovascular Disease and Cancer

2. Lecture 7 - Outline Part 1 –Cardiovascular disease –Causes –Treatment and Prevention Part 2 –Cancer Part 3 –Practice task for Tutorial Assignment #2

3. 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%

4. Cardiovascular Disease Basic cardiac anatomy and function

5. 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

6. 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)

7. 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)

8. 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 0 2 to part of the heart, area becomes scarred and doesn’t repair

9. 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).

10. 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.

11. 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

12. 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

13. Risk Factors for CVD Cholesterol –Fat-like substance found in animal fats and oils Liver produces most of the body’s cholesterol The rest comes from dietary intake of animal products –Cholesterol is present in blood attached to proteins (lipoproteins)

14. 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

15. 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

16. Psychological risk factors for CVD Type A personality (Friedman & Rosenman, 1974) –Competitive –Impatient –Sense of ‘time urgency’ –Achievement orientated –Hostile Measured… –Rosenhan’s Structrured Interview –Jenkins’ Activity Survey (Jenkins et al 1967)

19. 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)

20. 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

21. 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

22. 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

23. The potential role of psychology in CVD

24. 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?

25. 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 5’6” (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?

26. 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.