Coping With Coronary Heart Disease Research Paper

2. Antecedents Of CHD

2.1 Genetic And Biochemical Factors

CHD is more common among individuals who have a parental history of the disease. This is partially due to genetic predisposition and to family lifestyles that may include risk factors for CHD. Additionally, personality factors related to CHD (e.g., hostility) may be heritable. As one ages, environmental factors (i.e., lifestyle choices) play a more important role than genetics (Rice 1997). Furthermore, family history is an important unmodifiable factor in determining risk for CHD, as are age and gender (Rice 1997). Other risk factors, like lifestyle choices, can be modified.

2.2 Poor Lifestyles

Many behavioral health risk factors have been linked to the development of heart disease, including smoking, alcohol consumption, high serum cholesterol level, hypertension (high blood pressure), obesity, and a sedentary lifestyle. Review studies have shown that risk for CHD is doubled for inactive compared to active persons (Leon 1997). The incidence of heart attacks is directly related to the average number of cigarettes smoked, and smoking affects other risk factors: it results in increased cholesterol levels, in-creased heart rate, and increased blood pressure.

2.3 Stress

Selye (1976; as cited in Endler 1997) proposed his ‘General Adaptation Syndrome’ in which stress was defined as the body’s nonspecific response to any demands placed on it. Furthermore, Selye distinguished between good stress (eustress) and bad stress (distress).

There are both physical stressors, which include environmental factors, and psychological stressors. Situations that are stressful induce a physiological arousal that mobilizes a fight or flight reaction. This can be adaptive; however, under continued stress, this arousal can be harmful.

Heart rate accelerates when a person is under stress. Exposure to chronic stress has been linked to the development of CHD, and acute stressors have been found to precipitate heart attacks. The amount of stress one experiences at work (occupational stress) has been found to be related to the incidence of CHD. Job factors such as job strain, low job security, and high work pressure are related to increased risk for CHD (Taylor 1999).

2.4 Personality Factors

In the 1970s and 1980s, researchers thought that a particular behavioral style, the Type A behavior pattern, was related to the development of CHD. The Type A behavior pattern consists of a hostility component, a competitiveness component, and a need for everything to be done in a hurry (Friedman 1996). More recently, other researchers have concluded that it is the hostility component (a cynical form) of Type A behavior that is most strongly implicated in the development and progression of CHD (Taylor 1999). This cynical hostility consists of anger, suspiciousness, distrust towards others, and resentment. People who are hostile and have a defensive personality style have been shown to be at a particularly high risk for CHD. Other research has shown that it is the expression of hostile emotions that is related to CHD, not merely being in a hostile state. This research has been predominantly carried out in men, and the relationship between hostility and CHD in women has not yet been clearly established.

Hostile people manifest more physiological re-activity in response to stress. Stress causes both an increased heart rate and blood vessel shrinkage in some individuals, causing the heart to transfer more blood through narrower blood vessels. Other mechanisms of action include sympathetic nervous system activation resulting in the transfer of lipids into the bloodstream and hormonal based reactions. Alter-natively, hostility may not be related to CHD through cardiovascular reactivity, but rather through the relationship between hostility and poor lifestyle choices (i.e., smoking, consumption of alcohol, higher weight, higher lipid level, and hypertension).

Strong relations have also been found between CHD and negative emotional states other than hostility (i.e., anxiety, depression, and aggression). Additionally, optimism has been found to play a positive role. Individuals who are optimistic recover faster following surgery, have better adherence to the treatment regimen, and have better health outcomes (Irvine and Ritvo 1998).

3. Consequences Of CHD

3.1 Physical And Psychological Changes

CHD may result in mortality or disability leading to a restriction of activities. Individuals with CHD who have experienced a heart attack may be restricted in social and leisure activities and may be forced to quit working. These physical, social, and occupational changes may affect an individual’s self-concept, self-worth, and self-efficacy. There also may be an affect on interpersonal relationships.

4. Coping

4.1 Coping: General Styles vs. Specific Strategies

Coping mediates between antecedent stressful events and distressing consequences. A coping style is a typical manner of confronting a stressful situation and dealing with it. There are three basic coping styles: task-oriented, emotion-oriented, and avoidance-oriented (Endler 1997). Task-oriented coping consists of efforts aimed at solving the problem. Emotion-oriented coping involves emotional reactions; and avoidance-oriented coping involves activities and cognitions aimed at avoiding the stressful situation and can be of a distraction or social diversion nature. One can also conceptualize and investigate coping in terms of how individuals respond to specific stressful situations, such as coping with an illness.

4.2 Coping With Illness

There are four strategies that individuals use for coping with illness: (a) distraction coping involves attempts to think about anything other than the health problem or to engage in unrelated activities; (b) palliative coping involves strategies aimed at alleviating the unpleasantness of the illness; (c) instrumental coping involves a task-oriented approach such as seeking medical advice; and (d) emotional preoccupation coping consists of affective strategies such as ruminating about the health problem (Endler and Parker 2000).

5. Factors Influencing Coping

5.1 Personal And Situational Factors

The individual’s personality in a stressful situation affects how one copes with the event. Personality characteristics such as optimism, perceived control, and self-esteem, in part, determine how one copes with stressful situations. There are particular types of situations for which specific coping behaviors are more likely to be effective than others. External factors such as socioeconomic status, time, and social support also affect coping methods. Thus, persons, situations, and their interactions each affect coping styles.

5.2 Social Support Systems As Resources

Social support, a resource for coping, is important for adjustment. People seek advice from others, emotional support from others, and others provide opportunities for distracting activities. People with high levels of social support from family, friends, and/or the com-munity may experience less stress and cope more effectively than people without strong support net-works. Recovery from cardiac surgery is facilitated by social support (Schroder et al. 1997). In addition to social support, individuals with CHD should seek medical and possibly psychological support.

6. Rehabilitation And Prevention

6.1 Effective Coping Styles

Avoidance or distraction coping has been shown to be effective in the early stages of CHD, especially during the first few days following a heart attack. At later stages of CHD, avoidance-oriented coping strategies are not as effective. At this point, an instrumental or task-oriented coping approach is more adaptive (Zeidner and Endler 1996). Furthermore, individuals coping with a chronic illness who use a variety of coping strategies may cope better than those who use one predominant coping style (Taylor 1999).

6.2 Changes In CHD Risk Behavior

There are a number of lifestyle changes that result in decreased risk of CHD. These include: (a) changing to a low-fat diet, (b) quitting smoking and decreasing excessive drinking, (c) reducing stress, (d) exercising, and (e) psychological counseling.

The three primary CHD risk factors are hyper-tension, elevated cholesterol levels, and smoking (Rice 1997). Furthermore, the presence of these factors is of a synergistic nature. Fortunately, all three of these risk factors can be modified. Changes in diet and exercise have been found to reduce blood pressure and decrease cholesterol levels. Exercise tends to decrease heart rate, reduce blood pressure, and improve the overall efficiency of the heart (Leon 1997). Exercise also typically results in weight reduction, which consequently results in the reduction of cholesterol. To reduce blood pressure, the reduction of both salt intake and alcohol consumption are also indicated. The cessation of smoking, which may not be easy, also reduces the risk of CHD substantially.

Cognitive-behavioral stress reduction programs have been found to modify personality factors which contribute to CHD (Johnston 1997). Stress and pain management techniques have been shown to be effective in reducing angina and may be part of a rehabilitation program. Rehabilitation programs are directed at both altering risk factors for and reducing symptoms of CHD. These programs include medical evaluation, prescribed exercise, education regarding risk factors, and counseling (Leon 1997). Further-more, medication such as beta-blocking agents, ACE inhibitors, calcium channel blockers, or diuretics may be prescribed to control blood pressure and for chest pain.

7. A Systems Model For Reducing Prevalence Of CHD

7.1 Stress, Anxiety, And Coping Interaction Model

The multidimensional interaction model of stress, anxiety, and coping is process-oriented and consists of person variables (e.g., heredity, cognitive style) which may interact with one another and with situation variables (e.g., illness, hassles). The interaction of person and situation variables leads to a perception of threat and consequent changes in state anxiety. Changes in state anxiety lead to a modification of physiological reactions and coping responses (Endler 1997).

Stress, anxiety, and coping with illness all involve complex processes that interact with one another. Therefore, it is important to consider all aspects of this process when facing a stressor, especially one as significant as CHD. Person variables interact with situation variables in determining the coping strategies used to face the stressor and affect the physiological arousal and illness experienced.

8. Conclusions

There are several factors that one cannot control in terms of risk for CHD (e.g., heredity) but many factors can be controlled, either in terms of prevention or for rehabilitation. The cessation of smoking, engaging in physical activity, and following an appropriate diet all decrease the risk for CHD. Furthermore, avoidance-oriented coping strategies appear to be more adaptive early on in the illness, while task-oriented coping strategies appear to be most adaptive later on. Psycho-logical counseling may be effective in reducing personality factors, such as hostility, which are related to increased CHD risk.

Bibliography:

1. Endler N S 1997 Stress, anxiety and coping: The multi-dimensional interaction model. Canadian Psychology 38: 136–53
2. Endler N S, Parker J D A 2000 Coping with Health Injuries and Problems (CHIP): Manual. Multi-Health Systems, Toronto, ON, Canada
3. Friedman M 1996 Type A Behavior: Its Diagnosis and Treatment. Plenum, New York
4. Irvine J, Ritvo P 1998 Health risk behaviour change and adaptation in cardiac patients. Clinical Psychology & Psycho-therapy 5: 86–101
5. Johnston D W 1997 Cardiovascular disease. In: Clark D M, Fairburn C G (eds.) Science and Practice of Cognitive Behaviour Therapy. Oxford University Press, NY, pp. 341–58
6. Leon A S (ed.) 1997 Physical Activity and Cardio ascular Health. Human Kinetics, Champaign, IL
7. Rice P L 1997 Health Psychology. Brooks Cole Publishing, Pacific Grove, CA
8. Schroder K E E, Schwarzer R, Endler N S 1997 Predicting cardiac patients’ quality of life from the characteristics of their spouses. Journal of Health Psychology 2: 231–44
9. Taylor S E 1999 Health Psychology, 4th edn. McGraw-Hill, Boston
10. Zeidner M, Endler N S (eds.) 1996 Handbook of Coping. Wiley, New York