Lectures 2, and 3

1
Lectures 2, and 3 Are Risk factors
Causal? Biological Plausibility cardiovascular
Reactivity
2
General reading in Health Psychology To make the
most of this course you should read the relevant
sections in one of the recommended introductory
texts, either Taylor or Sarafino. In Taylor you
should read Chapter 2 Systems of the body Pages
17-31 (nervous, endocrine and Cardiovascular
systems). Chapter 6 Stress Complete Chapter
(pages 152-182). Chapter 7 Moderators of the
stress experience (pages 183-211) (Combined as
Stress Coping in earlier editions. In
Sarafino the equivalent chapters are essentially
Chapter 2 pages 31-40, 49-51, and Chapters 3, 4
5 (pages 61-138).
3
More Reading Another good general book is Baum,
Gatchel and Krantz An introduction to Health
Psychology, Chapters 2, 3 and 5. For those who
wish to find out more about of Obrist and Brod
(mentioned in Lecture 2) the references are
below. Not required reading. Obrist,PA,Gaebelein
,CJ,Teller,ES,Langer,AW,Grignolo,A,Light,KC, McCub
bin,JA,(1978) The relationship among heart rate,
carotid dp/dt and blood pressure in humans as a
function of the type of stress Psychophysiology,15
,102-115 Brod J Fencl, V, Hejl, Z, Jirka, J
(1959). Circulatory changes underlying blood
pressure elevation during acute emotion stress
(Mental arithmetic) in normotensive and
hypertensive subjects. Clin Sci, 18, 269-279.
4
Cardiovascular Reactivity Some reading The most
cited reference on the topic of CV reactivity is
Krantz DS Manuck SB (1984). Acute
psychophysiologic reactivity and risk of
cardiovascular disease a review and
methodological critique. Psychol. Bull., 96,
435-464. While old it is an important paper. It
is demanding reading. The sections on CV disease
will be relevant to later lectures. It can be
found on PsycArticles in library Metalab There
was special section of Psychosomatic Medicine
devoted to Cardiovascular Reactivity in 2003.
Read Linden WL, Gerin Davidson K (2003)
Cardiovascular reactivity Status Quo and a
research agenda for the New Millennium.
Psychosomatic Medicine, 65, 5-8
5
CV Reactivity Kamarck TW Lovallo WR (2003)
Cardiovascular reactivity to psychological
challenge conceptual and measurement issues.
Psychosomatic Medicine, 65, 9-21. When
discussing appraisal I shall lean heavily on the
studies reported in Tomaka, Blascovich, Kelsey
Leitten (1993) Subjective, physiological and
behavioral effects of threat and challenge
appraisal. J. Per. Soc. Psychol., 65,
248-260. Tomaka, Blaskovich, Kibler Ernst
(1997). Cognitive and physiological antecedents
of threat and challenge appraisal J. Per. Soc.
Psychol, 73, 63-72 Blascovich Tomaka present a
fuller account of their views in Blascovich
Tomaka (1996) The biopsychosocial model of
arousal regulation. Adv. Exp. Soc. Psychol., 28,
1-51.
6
References on social support and cardiovascular
reactivity Kamarck T (1992) Recent developments
in the the study of cardiovascular reactivity
contributions from psychometric theory and social
psychology. Psychophysiology, 29, 491-503. Lapore
SJ et al, (1993) Social support lowers
cardiovascular reactivity to an acute stressor.
Psychosomatic Medicine, 55, 518-524. Lapore SJ
(1995). Cynicism, social support and
cardiovascular reactivity. Health Psychology,
14, 210-216.
7
When is a risk factor casual
Temporality Strength of relationship Consistenc
y Biological gradient Biological
Plausibility Coherence Outcome
Specificity Intervention evidence
8
Causality (cont) Temporality are there
prospective studies demonstrating that x precedes
development of disease? Strength of relationship
How much of the variance in disease incidence
explained by x? Consistency Are studies
consistent in their findings? Biological
gradient is severity and/or frequency of x
associated with increasing risk of disease?
Biological plausibility what pathogenic
mechanisms link x to disease?
9
Causality 3 Coherence Does evidence for the
relation between x and disease come from
different samples (population, patient, animal
models)? Outcome specificity Is the risk
associated with x exclusive to one
disease? Intervention Effects Is the disease
prevented if x is treated early enough?
10
Basic Model The Reactivity Hypothesis excessive
cardiovascular response to stress is a risk
factor for cardiovascular disease.
11
Simplified model of the cardiovascular (i.e.,
heart and blood vessels) system
12
CV system
13
(No Transcript)
14
(No Transcript)
15
Cardiovascular measures
Heart Rate (HR) Number of cardiac cycles per
minute Systolic Blood Pressure (SBP) Maximum
blood pressure in a cardiac cycle Diasystolic
Blood Pressure (DBP) Minimum blood pressure in a
cardiac cycle Mean Arterial Pressure (MAP)
Average blood pressure over a cardiac cycle
16
Cardiovascular measures (cont.)
Stroke Volume (SV) Amount of blood pumped in a
cardiac cycle Cardiac Output (CO) Amount of
blood pumped in unit of time CO SV x
HR Total Peripheral Resistance (TPR) The total
resistance in circulatory system to the flow of
blood. MAP CO x TPR
17
One participant from Brod 1959
18
Participants from Brod 1958 split into cardiac
and vascular responders
19
Obrist et al, 1978. Hard but not impossible
produces Active Copying
20
Obsrist et al 1978. Active Coping (RT, Reaction
time task) has larger cardiac effect than Passive
Coping (CP cold pressor) or watching
pornographic film. NB. Effect of Active Coping
much reduced by Beta Blocking drug which largely
removes effect of sympathetic nervous system on
the heart.
21
Obrist et al 1978. Carotid dp/dt measure of
force of heart contracting. Large effect of
Active Coping.
22
Manuck. Comparison of Cardiac Vascular
Reactors on Mental arithmetic (active coping
task, cf Brod)
23
Manuck. All subgroups similar on mirror tracing
task
24
Lazarus Transactional Model of Stress Coping.
Most influential model of stress that underpins
Tomaka Blascovich studies
25
Tomaka Blascovich, following Lazarus
Folkman 2 common stress related
appraisals Threat perception of danger greater
than perception of coping abilities Challenge
perception of danger less than perception of
coping Threat associated with negative emotions -
However challenge associated with more CV
activation (Obrist Active passive distinction)
Tomaka Blascovich attempt to clarify
this. Task Mental arithmetic (Active
Coping) Threat rating of threat greater than
rating of ability to cope (Primary/Secondary). Cha
llenge rating of coping greater than rating of
threat. After task ratings of experienced stress
obtained.
26
3 studies, Study 1 preliminary. Study 2. Mental
arithmetic. Subjects classified into threatened
or challenged. Results Subjective
Behavioural Threat group More Stress 3.85 v 2.85
on 7 point scales Threat group performed less
well 2.19 v 2.85 (self ratings) and produced
less correct answers, 10.5 v 14.00 NB results
most clear cut first time tasks carried
out. Physiological .
27

Challenge has cardiac effects, threat vascular.
NB Pre-ejection period relates to force that
heart contracts. It shortens with challenge and
more usual to show changes as negative
28
(No Transcript)
29

• Tomaka et al (1997) Cont.
• They attempted to test causality of appraisal by
• Manipulating appraisal.
• Threat emphasis on speed, accuracy.
• Challenge See task as challenge and yourself
  as someone who can do it. (see next slide)
• 2. Manipulating physiological response (reverse
  causality)
• Exp 2. Alter CO with exercise- no effect on
  appraisal
• Exp 3. Alter TPR with cold pressor- no effect on
  appraisal

30
Experimental manipulation of threat and challenge
has predicted effects
31
Social Support reduces risk of heart disease.
Does it affect reactivity? Is effect of social
support a main effect or does it buffer effect of
stress?
32
Presence of friend reduces CV response.
33
Effect of social support only clear under high
threat. Buffering?
34
Lepore (1993) study of Social Support. Presence
of non-supportive person increases BP
35
Effects of Social support may depend on
personality of recipient
36
Study by Kamarck of social support (or a related
process?) in real life.
37

• Cardiovascular Reactivity (CR).
• Things that should be true if CR is a risk factor
• Is it an individual difference variable?
• Is it reliable?
• Is it one factor?
• Does it generalise?

38
Steptoe Vogele 1991 Reliability of CV response
to mental stress testing Test-retest
correlations HR .62 SBP .52 DBP .30
39

• Cardiovascular Reactivity. Issues.
• Is it an individual difference variable?
• Is it reliable?
• Is it one factor?
• Does it generalise?

40
Kamarck 1992 again. Most corr. large and
positive
41

• Cardiovascular Reactivity. Issues.
• Is it an individual difference variable?
• Is it reliable?
• Is it one factor?
• Does it generalise?

42
Anastasiades Johnston (1991)
43
(No Transcript)
44
Median split on laboratory reactivity HR
Control HR Tutorial Low Reactors 81.4 88
.6 High Reactors 78.7 96.6 Johnston, 2004.
HR response to presenting in Tutorial
45
High Reactors
Low Reactors
Johnston, 2004, Relationship between subjective
arousal HR in HI and LO cardiac reactors
46
Does CR to stress generalise. Appears to
generalise to a range of stressful situations
Suggests that people who are vulnerable and
produce large CV response may be at risk if
exposed to stress, i.e., Stress and diathesis (or
vulnerability) model