1. Stress, emotion and the heart

2. Basic Reading This course is not organised around a textbook. I shall refer primarily to material in journals. Also consult basic health psychology texts such as EP Sarafino 2006 Health Psychology: biopsychosocial interactions (5 th Edition) S Taylor (2006) Health Psychology (6 th Edition) The is also an excellent by old book on the topic A Steptoe (1981) Psychological factors in cardiovascular disorders. Steptoe has also written a very good chapter on Psychophysiological bases of disease in Johnston & Johnston, Health Psychology, volume 8 of Bellack & Hersen Comprehensive Clinical Psychology ( find under Bellack & Hersen)

3. Definition Health Psychology The study of psychological process in health, illness and health care

5. John Hunter famous 18 th century Scottish surgeon & anatomist of the 18th century My life is in the hands of any rascal who chooses to annoy or tease me Died after argument at St George hospital medical school (over student admissions) 1897, William Osler - dominant figure in internal medicine - described the typical heart disease patient as "a keen and ambitious man, the indicator of whose engine is always at 'full speed ahead.

6. Patients beliefs about causes of MI. Percentage considering factor a possible cause At discharge 2month 6 months 12 months Stress70726161 Smoking59554753 Worry58553328 Will of God27219 2 Gudmunsdottir, Johnston, Johnston & Foulkes, (2001) BJHP, 6, 81-96.

7. Brod. Mental arithmetic leads to increase in cardiac output (blood pumped by heart). Decrease in peripheral resistance, but blood pumped bigger effect in this case so blood pressure increases.

8. Heart Rate increased by stress. Decreases again with exposure but less so in hard but not impossible condition. Obrist. Hard condition involves active coping

10. Guest lecturer speaking to this class last year. HR high before and during lecture. Took at least an hour to get back to normal

11. Coronary Heart Disease and Acute Coronary Syndromes 1.A slow process of arterial deterioration 2.An acute process that triggers a clinical event

12. The Reactivity Hypothesis Stress (and some emotions) leads to altered physiological responses in some people and these responses are harmful to the arteries. A stress diathesis (vulnerability) model.

13. Studies in Health populations Kuper Marmot & Hemingway (2002), Seminars in Vascular Medicine,2, 267-313 Psychological processpositive/no. of studies Type A / Hostility6/18 Depression15/22 Anxiety 4/8 Work characteristics10/13 (Social Support 6/9) Studies in Populations with Cardiovascular Disease Type A/Hostility 2/15 Depression 18/34 Anxiety 8/18 Work characteristics 2/4 (Social Support 14/21) Seen as positive support overall By K,M & H

15. Johnston,M, Foulkes J, Johnston, D, Pollard, B, Gudmundsdottir, H (1999) Psychosomatic Medicine, 61, 225-233 Depression reduced in patients after MI by simple Counselling intervention

16. Johnston,M, Foulkes J, Johnston, D, Pollard, B, Gudmundsdottir, H (1999) Psychosomatic Medicine, 61, 225-233 Depression reduced in partners of MI patients who received counselling