BackgroundAnger and stress can trigger episodes of atrial fibrillation (AF) in patients with a history of AF.Objective:To determine whether beta-blockers can protect against emotionally-triggered AF.MethodsIn this prospective, controlled,... more
BackgroundAnger and stress can trigger episodes of atrial fibrillation (AF) in patients with a history of AF.Objective:To determine whether beta-blockers can protect against emotionally-triggered AF.MethodsIn this prospective, controlled, electronic-diary-based study of emotions preceding AF, patients with a history of paroxysmal or persistent AF, (N=91), recorded their rhythm on event-monitor at the time of AF symptoms, and completed a diary entry querying mood states (eg, anger, stress) for the preceding 30 minutes (pre-AF “case period”) for one year. Also, patients underwent monthly 24-hour holter-monitoring, during which they were prompted to complete a diary entry twice per hour. Diaries recorded during sinus comprise the controls. Patients’ exposure to each emotion was compared between the pre-AF case period and control periods using GEE modeling, and interactions between beta-blocker use and emotion tested.ResultsSixty percent were prescribed beta-blockers. 163 symptomatic AF episodes (in 34 patients) and 11,563 holter-confirmed sinus rhythm control periods had associated diary data. Overall, the likelihood of an AF episode was significantly higher during anger or stress. This effect however, was significantly attenuated in the patients on beta-blockers. (OR = 22.5, 95% CI 6.7–75.4, p<0.0001, for non-beta-blocked, versus OR = 4.0, 95% CI 1.7–9.5, p = 0.002 for those prescribed beta-blockers, p =0.02 for the interaction.) Exclusion of patients on sotalol did not impact findings.ConclusionsAnger or stress can trigger AF, but use of beta-blockers greatly attenuates this deleterious physiological response.
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This study investigated changes over time in adolescents’and parents’memories for how they felt when they learned of the terrorist attacks on September 11, 2001. Adolescents recalled having felt less negative emotion than parents did both... more
This study investigated changes over time in adolescents’and parents’memories for how they felt when they learned of the terrorist attacks on September 11, 2001. Adolescents recalled having felt less negative emotion than parents did both 3 months and 8 months after the attacks. Moreover, the intensity of negative emotion recalled decreased over time for adolescents but increased for parents. Parental anxiety and stress at 3 months predicted adolescent reactions at 8 months, and there was no evidence of bidirectional effects. Adolescents (but not parents) appraised the attacks as having less impact on themselves than on others. Appraising the attacks as having less impact predicted lower recalled negative emotion and fewer posttraumatic stress symptoms. The results suggest that adolescents’tendency to view themselves as less vulnerable than others, which can lead to risky behaviors, may also serve a protective function when adolescents confront distant traumatic events.
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Cognitive deficits are common among individuals on haemodialysis (HD). The degree of dysfunction may shift over the course of the interdialytic interval. To use ecological momentary assessment (EMA) to examine the relationship between the... more
Cognitive deficits are common among individuals on haemodialysis (HD). The degree of dysfunction may shift over the course of the interdialytic interval. To use ecological momentary assessment (EMA) to examine the relationship between the length of the interdialytic interval and reports of cognitive dysfunction. A quantitative study whereby each patient's cognitive functioning was measured during both short and long interdialytic intervals. Adults maintained on HD (Female n = 15, Male n = 11; M = 42.7 ± 15.8 years) were drawn from a standalone HD unit within a large university medical centre. Tests of baseline neurocognitive functioning were undertaken (Mini-Mental Status Examination, Digit Span, California Verbal Learning Test, Benton Visual Retention Test, Trail-Making Test) and smartphone-based electronic diary reports of cognitive impairment were made around six times each day for one week. Cognitive function and aptitude in this sample, although low, did not reflect clinic...
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Forty-two patients with mild-to-moderate hypertension between the ages of 35 and 65 (23 men, 19 women) were studied to determine whether psychological characteristics can help differentiate between responders and nonresponders to diuretic... more
Forty-two patients with mild-to-moderate hypertension between the ages of 35 and 65 (23 men, 19 women) were studied to determine whether psychological characteristics can help differentiate between responders and nonresponders to diuretic (hydrochlorothiazide 25 mg and triamterene 50 mg). To qualify for inclusion in the study, the subjects were required to have a mean unmedicated clinic diastolic blood pressure (DBP) between 95 and 110 mm Hg. Positive response to diuretic was defined as a reduction in clinic DBP &lt; or = 90 mm Hg. Of the 42 subjects, 22 were responders to diuretic, achieving a BP level of 129/86 mm Hg, a reduction of 16/11 mm Hg from their unmedicated level. Nonresponders achieved a reduction of 8/4 mm Hg. Compared with nonresponders, responders were characterized by slightly lower initial BP levels and significantly lower scores on the Buss-Durkee Hostility Inventory and several subscales of this test. The pattern of results indicated higher levels of suppressed hostility in the nonresponders. Ambulatory BP data paralleled the clinic BP changes.
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Small case-series suggest the possibility of “adrenergically-mediated” atrial fibrillation (AF) in humans, and pharmacological autonomic manipulations can alter atrial electrophysiology. Whether AF...
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Jim Henry wrote extensively about emotional expressive styles, such as alexithymia which is characterized by reduced awareness of one's own or others' feelings and emotions, and their relation to cerebral hemispheric asymmetries.... more
Jim Henry wrote extensively about emotional expressive styles, such as alexithymia which is characterized by reduced awareness of one's own or others' feelings and emotions, and their relation to cerebral hemispheric asymmetries. The repressive coping style is a stable individual characteristic, which is marked by reduced and minimized reports of stress coupled with higher levels of autonomic, somatic, and behavioural responsivity. The apparent dissociation between subjective and physiological response may be associated with a functional disconnection between the two cerebral hemispheres and with greater cerebral lateralization. To test this hypothesis, we reexamined data from a study in which emotional and neutral slides were presented unilaterally to the left and right hemisphere. Exposure duration was 200 ms. Subjects were divided into four different coping styles based on their defensiveness and anxiety scores. Repressive copers were the only group to show a significant ...
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The purpose of the present study was to test the effectiveness of a cognitive-behavioral intervention as an adjunctive treatment of hypertension. To qualify for the study, subjects had to have an unmedicated clinic diastolic blood... more
The purpose of the present study was to test the effectiveness of a cognitive-behavioral intervention as an adjunctive treatment of hypertension. To qualify for the study, subjects had to have an unmedicated clinic diastolic blood pressure > or = 95 mm Hg. After qualification, minimal drug requirements were established using a diuretic and a beta-blocker to control blood pressure at < or = 90 mm Hg. Subjects were then randomized into a 6-week cognitive-behavioral intervention or a measurements-only control group. After the treatment phase, medication levels were reduced in all subjects by means of a systematic stepdown procedure. Subjects were followed for 1 year after the stepdown was completed. Addition of the cognitive-behavioral intervention was twice as effective as the control procedure in reducing drug requirements. At 12-months follow-up, 73% of the treatment group were at lower levels of medication than at the time of randomization, compared to 35% in the control grou...
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Differential effects of fructose and glucose preloads on carbohydrate metabolism and later food intake were examined in both lean and obese subjects. In study 1, a preload of either 50 g of fructose or glucose was administered in... more
Differential effects of fructose and glucose preloads on carbohydrate metabolism and later food intake were examined in both lean and obese subjects. In study 1, a preload of either 50 g of fructose or glucose was administered in solution, and food intake at a buffet lunch presented 2.25 h after preload was assessed. Significant differences in caloric intake were observed between load conditions with the fructose group consuming fewer calories than the glucose group. Obese subjects demonstrated significantly greater insulin responses to the preload compared with lean subjects, and insulin levels of obese subjects at 15, 30, and 45 min after preload were found to correlate significantly with amount consumed. Incorporation of fructose or glucose into a mixed meal format in study 2 revealed no differences in subsequent caloric intake as a function of either type of preload or percent overweight. Differing insulin levels are discussed as a possible mechanism for differential food intake.
Research Interests: Engineering, Obesity, Humans, Glucose, Female, and 5 moreMale, Fructose, Eating, Energy Intake, and Medical and Health Sciences
Pain is a universal human experience; every person, with the exception of the unfortunate few that are born with congenital pain perception deficiencies (Sternbach, 1963), experiences severe pain in his/her lifetime. Bonica (1981)... more
Pain is a universal human experience; every person, with the exception of the unfortunate few that are born with congenital pain perception deficiencies (Sternbach, 1963), experiences severe pain in his/her lifetime. Bonica (1981) estimates that sixty-five million Americans suffer from chronic pain of such severity as to cause them to seek therapy by physicians and other health professionals. Given the impact that pain imposes on our lives, it is disturbing to find that the dimensions of pain have not been clearly defined and that the assessment of pain has not been standardized. Sternbach (1978) and Wolff (1978, 1980) argue that our current pain measurement techniques are inadequate, while Hendler (1981) suggests that pain is not a measurable experience.
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This study sought to test predictions made from disregulation and systems theories regarding self-deception and pain responsivity. Sixty-four subjects completed the L-scale of the Eysenck Personality Inventory and, based on their scores,... more
This study sought to test predictions made from disregulation and systems theories regarding self-deception and pain responsivity. Sixty-four subjects completed the L-scale of the Eysenck Personality Inventory and, based on their scores, were categorized as either High, Medium, or Low Deceptors. Both sensory threshold and three levels of affective pain judgments were determined using electrocutaneous nociceptive stimulation applied to the forearm. Results indicated that there were no differences among groups in their sensation thresholds. However, large differences in affective pain judgments emerged between High and Low Deceptors. High Deceptors differed significantly from Low Deceptors at the Tolerance (9.4 vs. 5.2 mA, p less than 0.001), Pain threshold (7.9 vs. 3.8 mA, p less than 0.001), and Discomfort (4.4 vs. 2.2 mA, p less than 0.01) judgment levels. These findings are consistent with a systems model of pain perception and are discussed in terms of the role of pain in mediating the relationship between cognitive coping patterns and recovery from illness and surgery. A possible opiate-peptide hypothesis of repressive coping &amp; disregulation of pain is proposed.
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Ambulatory blood pressure and heart rate responses were obtained in 33 male paramedics during a 24-hour work shift to examine the effects of episodes of occupational stress on cardiovascular reactivity and subjective reports of stress.... more
Ambulatory blood pressure and heart rate responses were obtained in 33 male paramedics during a 24-hour work shift to examine the effects of episodes of occupational stress on cardiovascular reactivity and subjective reports of stress. The aim of this study was to determine how individual differences in cynical hostility and defensiveness interacted with situational demands to affect cardiovascular responses in a natural setting. Defensiveness was found to interact significantly with cynical hostility in predicting subjects&#39; heart rate responses in different work contexts. Specifically, in a hospital setting involving interpersonal conflict, subjects who were high in both defensiveness and hostility showed heart rate responses approximately 10 bpm higher than subjects who were high in hostility but low in defensiveness. The same pattern of relationships was obtained for diastolic blood pressure. High and low hostile subjects were also found to differ from each other in their daily mean levels of ambulatory blood pressure during awake and sleep periods. These findings obtained in a natural setting lend further support to the significance of cynical hostility for cardiovascular reactivity. The results for defensiveness suggest the need for further research on the role of conflicting attitudes in the pathophysiology of cardiovascular diseases.
Research Interests: Anger, Individuality, Job Satisfaction, Cardiovascular disease, Humans, and 15 moreBlood Pressure, Male, Defense Mechanisms, Heart rate, Cardiovascular Reactivity, Arousal, Adult, Occupational Stress, Hostility, Individual Difference, Blood Pressure Monitors, Ambulatory Blood Pressure, Diastolic Blood Pressure, Allied Health Personnel, and Medical and Health Sciences
This study examined the role of personality factors in differences between three methods of assessing blood pressure (clinic, self, ambulatory) in 45 patients with mild hypertension. The data were obtained after the patients were... more
This study examined the role of personality factors in differences between three methods of assessing blood pressure (clinic, self, ambulatory) in 45 patients with mild hypertension. The data were obtained after the patients were withdrawn from antihypertensive medications and had achieved stable clinic diastolic blood pressure levels of 95 to 110 mm Hg, averaged over three visits in 2 to 4 weeks. Significant differences were obtained in systolic blood pressure (SBP) and diastolic blood pressure (DBP) as a function of method of assessment. These differences in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were associated with individual differences in the total score and several subscales of the Buss-Durkee Hostility Inventory (Assault, Resentment, Guilt), but not in anxiety, depression, or other characteristics. High hostile subjects had consistently high blood pressure values in both clinic, self, and ambulatory recordings. Low hostile subjects were significantly lower in self-recorded blood pressure readings taken at home and in ambulatory recordings, compared with clinic values. Implications of these findings for &amp;amp;quot;white coat hypertension&amp;amp;quot; are discussed.
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Thirty years ago, Donald Oken raised basic questions about psychophysiological research strategies for the study of the &quot;psychological stress response&quot; in the laboratory. Is it possible to simulate in the laboratory the... more
Thirty years ago, Donald Oken raised basic questions about psychophysiological research strategies for the study of the &quot;psychological stress response&quot; in the laboratory. Is it possible to simulate in the laboratory the situations one normally encounters? Do laboratory stimuli provoke affective arousal? Are different classes of stress stimuli associated with specific physiological response patterns? How do one&#39;s characteristic &quot;defenses&quot; and coping styles modulate one&#39;s responses? This paper describes a novel ambulatory research strategy in which the laboratory is moved into the natural setting. The advantages of this strategy are exemplified in studies of paramedics in whom 24-hour recordings were made of ambulatory blood pressure and heart rate. The ambulatory physiological data were then related to information about specific work location and subjective ratings of stress made in a diary at the time of each reading, objective assessments of the different stressful situations encountered, and the role of individual differences in anger expression and defensiveness in modulating these relationships. The findings illustrate the ability of real-life stressors to bring out relationships not typically obtained in the laboratory. Moreover, the natural setting permits individuals to respond to behavioral challenges using their preferred mode of coping with stress, as opposed to the constraints imposed on them in the laboratory. This research strategy has also helped uncover the significance of conflict about the expression of hostility, rather than hostility per se, as a key factor in the &quot;stress response.&quot;
Research Interests: Research Design, Anger, Occupational Health, Psychosomatic Medicine, Humans, and 15 moreBlood Pressure, Female, Male, Defense Mechanisms, Heart rate, Arousal, Psychological Tests, Psychosomatic, Adult, Hostility, Life Change Events, Conflict Psychology, Psychology and Cognitive Sciences, Allied Health Personnel, and Medical and Health Sciences
INTRODUCTION It is well documented that cigarette smoking is a classic risk factor for cardiovascular disease (CVD), in both men and women. Although the overall smok-ing prevalence in the United States has decreased from approximately 42%... more
INTRODUCTION It is well documented that cigarette smoking is a classic risk factor for cardiovascular disease (CVD), in both men and women. Although the overall smok-ing prevalence in the United States has decreased from approximately 42% in the mid-1960s to a current rate of 26% ...
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This study asked whether individual differences in four personality traits (cynical hostility, anger out, anxiety, and defensiveness) would predict waking and sleeping ambulatory blood pressure and heart rate and whether information about... more
This study asked whether individual differences in four personality traits (cynical hostility, anger out, anxiety, and defensiveness) would predict waking and sleeping ambulatory blood pressure and heart rate and whether information about these traits would provide a source of racial and gender differences in these measures. Ambulatory blood pressure and heart rate were recorded over a 24-hour period in 58 black and 86 white college students equally divided by gender. Waking and sleeping values were examined as a function of gender, race, and personality factors. Independent of personality factors, women had lower ambulatory blood pressure and higher heart rate than men, and black subjects had higher blood pressure levels and less of a decrease in heart rate from waking to sleeping than white subjects. The above differences were associated with personality factors. Black subjects scoring high on cynical hostility had elevated daytime and nighttime systolic pressure. Black subjects scoring high on both anxiety and defensiveness had higher waking diastolic blood pressure. Additional effects were shown for heart rate as a function of anger out, anxiety, and defensiveness. Given the special significance of ambulatory blood pressure for cardiovascular disease, these findings underscore the importance of personality factors for cardiovascular risk and their relevance for race and gender differences in this risk.
Research Interests: Anger, Individuality, Anxiety, Humans, Blood Pressure, and 15 moreFemale, Male, Defense Mechanisms, Heart rate, African Americans, Arousal, Psychosomatic, Adult, European Continental Ancestry Group, Hostility, ANXIETY, Blood Pressure Monitors, Personality Inventory, Psychology and Cognitive Sciences, and Medical and Health Sciences
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In this study, we examined the combined effects of anger/hostility and defensiveness on reactivity to three stressors (math, handgrip, cold pressor) and how these effects are moderated by gender and family history of hypertension. The... more
In this study, we examined the combined effects of anger/hostility and defensiveness on reactivity to three stressors (math, handgrip, cold pressor) and how these effects are moderated by gender and family history of hypertension. The subjects were 209 college students. Low compared with high Spielberger anger-out scores were associated with greater diastolic blood pressure (DBP) reactivity in low- but not high-defensive women with a negative family history. High compared with low hostility scores were associated with greater heart rate reactivity in low-defensive men with an opposite effect in high-defensive men. Gender, family history, and defensiveness each affected differential DBP reactivity to the three tasks. Combined study of biological factors and coping styles can improve our understanding of cardiovascular reactivity and disease.
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D. Shapiro et al. should be included in a publication to enable the reader to eval- uate the adequacy of the BP measurement techniques and asso- ciated procedures. Attention is given to potentially confounding factors that may ...
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On 4 days, in everyday situations, 21 female and 26 male smokers used an electronic diary to record situations and moods at times of smoking and at control nonsmoking occasions. Self-reports of particular locations, activities, posture,... more
On 4 days, in everyday situations, 21 female and 26 male smokers used an electronic diary to record situations and moods at times of smoking and at control nonsmoking occasions. Self-reports of particular locations, activities, posture, consumption, social context, moods, and internal states were specifically associated with smoking. Real-time assessments in everyday situations provide useful information about the interplay of environmental factors and internal states in smoking. The findings suggest that conditioning and learning processes play a role in smoking and should be considered in smoking cessation programs.
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Research Interests: Marketing, Demography, Humans, Carbon Monoxide, Smoking, and 15 moreNicotine, Female, Male, adult ADHD, Clinical Sciences, Prevalence, Saliva, Adult, Public health systems and services research, Combination drug therapy, Methylphenidate, Cotinine, Attention deficit disorder with hyperactivity, Central nervous system stimulants, and reinforcement psychology
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Epidemiological investigations of mood and smoking have relied largely on retrospective self-reports, with little research on real-time associations. We examined the relationship of mood states to contemporaneous smoking urges and to... more
Epidemiological investigations of mood and smoking have relied largely on retrospective self-reports, with little research on real-time associations. We examined the relationship of mood states to contemporaneous smoking urges and to subsequent smoking and also assessed the effects of smoking on subsequent mood. For 2 days, 25 female and 35 male smokers aged 18-42 made three prompted diary entries per hour plus pre- and post-smoking entries (6882 entries). Data were analyzed with generalized estimating equations. We found significant positive associations between smoking urge and anger, anxiety, and alertness in women and men; fatigue in men only; sadness more strongly in men than women; and happiness in women only. Decreased alertness and increased anxiety predicted subsequent smoking in men only. Smoking was followed by decreased anger levels in men and women and decreased sadness in men only. In men with lower overall anger episodes, increased anger was associated with subsequent increased smoking. These findings suggest that smoking is related to negative affect and energy level, more clearly in men, and has palliative effects on sadness in men and on anger in men and women. These data demonstrate that ambulatory research can reveal targets for early intervention and smoking cessation.
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Research Interests: Marketing, Public Opinion, Adolescent, Child Behavior, Humans, and 15 moreChild, Smoking Cessation, Smoking, Tobacco Use, Female, Male, Risk factors, Clinical Sciences, Intervention Studies, Public health systems and services research, Risk Factors, Adolescent Behavior, Public Policy, Affective symptoms, and Tobacco use disorder
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Research Interests: Personality Assessment, Social Support, Adolescent, Anxiety, Activities of Daily Living, and 15 moreAffect, Software, Humans, Smoking, Female, Male, Microcomputers, Peer group, ANXIETY, Medical Records, Amer, The American, Motor activity, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Comparative Study, Linear models, Activities of Daily Living, Affect, Humans, and 15 moreChild, Female, Male, Comparative Analysis, Context Effect, Middle Aged, Diary Study, Adult, Medical Records, Emotional Response, Logistic Models, Ecological Approach, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, and Medical and Health Sciences
We compared psychophysiological stress recovery and directed attention restoration in natural and urban field settings using repeated measures of ambulatory blood pressure, emotion, and attention collected from 112 randomly assigned young... more
We compared psychophysiological stress recovery and directed attention restoration in natural and urban field settings using repeated measures of ambulatory blood pressure, emotion, and attention collected from 112 randomly assigned young adults. To vary restoration needs, ...