BackgroundAnger and stress can trigger episodes of atrial fibrillation (AF) in patients with a hi... 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.
This study investigated changes over time in adolescents’and parents’memories for how they felt w... 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.
Cognitive deficits are common among individuals on haemodialysis (HD). The degree of dysfunction ... 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...
Forty-two patients with mild-to-moderate hypertension between the ages of 35 and 65 (23 men, 19 w... 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.
Small case-series suggest the possibility of “adrenergically-mediated” atrial fibrillation (AF) i... more Small case-series suggest the possibility of “adrenergically-mediated” atrial fibrillation (AF) in humans, and pharmacological autonomic manipulations can alter atrial electrophysiology. Whether AF...
Jim Henry wrote extensively about emotional expressive styles, such as alexithymia which is chara... 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 ...
The purpose of the present study was to test the effectiveness of a cognitive-behavioral interven... 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...
Differential effects of fructose and glucose preloads on carbohydrate metabolism and later food i... 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.
Pain is a universal human experience; every person, with the exception of the unfortunate few tha... 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.
BackgroundAnger and stress can trigger episodes of atrial fibrillation (AF) in patients with a hi... 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.
This study investigated changes over time in adolescents’and parents’memories for how they felt w... 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.
Cognitive deficits are common among individuals on haemodialysis (HD). The degree of dysfunction ... 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...
Forty-two patients with mild-to-moderate hypertension between the ages of 35 and 65 (23 men, 19 w... 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.
Small case-series suggest the possibility of “adrenergically-mediated” atrial fibrillation (AF) i... more Small case-series suggest the possibility of “adrenergically-mediated” atrial fibrillation (AF) in humans, and pharmacological autonomic manipulations can alter atrial electrophysiology. Whether AF...
Jim Henry wrote extensively about emotional expressive styles, such as alexithymia which is chara... 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 ...
The purpose of the present study was to test the effectiveness of a cognitive-behavioral interven... 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...
Differential effects of fructose and glucose preloads on carbohydrate metabolism and later food i... 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.
Pain is a universal human experience; every person, with the exception of the unfortunate few tha... 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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