Links between psychocials factors and cardiovascualr disease are not new. That we can do so much about them, is a great outcome.
"Many studies (on stress and heart disease) show risk gradients comparable or steeper than the risk gradients of cholesterol", as Joel Dimsdale (2008) has put it in his review of 'Psychological stress and cardiovascular disease'. Classically, increases in heart attacks after major events like earthquakes were studied -and seen, like here on the 17th Jan 1994 in Los Angeles.
One could argue, though, that such events lead to a sudden increase in physical activity (walking, running etc), which might result in coronary events. However, 'daily hassles' and the way we are sensitive to them and cope with them, may well be worse than earthquakes. Dimsdale quotes the Dutch internist Johannes Groen: "What's a man to do, where can he go if he is unhappy at work and at home?" Unsaid the answer was: "to an early grave". Indeed, as Rosengren et al. (2004) wrote in their Lancet paper, permanent stress like "feeling irritable, filled with anxiety, or as having sleeping difficulties as a result of conditions at work or at home" doubled the risk for myocardial infarct.
In their retrospective design, Steptoe et al. (2006) observed that depressed mood gave rise to a more than 4-fold increase in the risk of acute coronary syndrome.
Depression increases the occurence of diabetes type II by 30% (Knol et al., 2006) and is related to worse glycemic control and impaired clinical outcome (Lustman et al, 2006). Knowing that diabetes is a strong contributing factor to cardiovascular disease, diabetes may be one of the links between depression and increased cardiovascular disease.
Similarly, feeling disabled turned out te be an independant riskfactor for mortality after myocardial infarct (van der Vlugt et al, 2005). The so-called type D personality has been observed to be related to poor outcome after myocardial infarction, stent implantation ( Pedersen et al., 2004 ) and heart failure ( Schiffer et al., 2005 ). More recently, type D was found to predict unfavourable outcome after heart transplantation as well ( Denollet, 2007 ).
The "D" in type D stands for "distressed." Type D is a stable, broad personality trait marked by the combination of a high degree of negative affect coupled with inhibited self-expression in social interactions. The type D individual is reserved and insecure -even timid- anxious.
Evidently, this combination has resemblance with the descriptions on the psycho-oncology pages: repression, non-expression, non-sharing, loss of autonomy, lonership, façade like seeming stable and nice, all of these apparently ask their psychological and physical price and may put the body at risk. We are used to lowering cholesterol and te like, we should get used to work on lowering distress and improving our coping.
We all know, that our heart starts beating under stress; this we call adrenergic stress. Likewise, the heart may slow down and we may faint, when we are confronted with stressful situations; this is known as vagal stress. Both may induce heart rhytm disturbances, like atrial fibrillations. Psychomedical help may not be easy here, as the stress of a psychotherapeutic encounter might elicit an rhytm disturbance. I have had one encounter on a emergency department, where a woman spontaneously started to talk to me about her former husband, his disease and, finally, his death. Four times, she spoke about difficult moments, and during all four of them, the monitor showed that a normal sinusrhytm changed into atrial fibrillations. She spontaneously went 'in and out' with regard to these topics and with regard to the atrial fibrilation. Sharing the difficult moments in her life, seemed her way to cope with these events and to process them. Yet, it was evident that this was both a psychological as well as a physical stressor. Nevetheless, despite these risks and temporary aggravations, one would wish to clear up if particular life-situations or copingstrategies are constantly overloading a person, are involved in rhytm disturbances or other cardiologic disease, and need change. Like always in medicine, diagnostic procedures and treatment may have risks and side-effects.
Psychomedical therapies should foster autonomy and congruence, lower repression, improve awareness of emotional state and physical sensations, while supporting expression, sharing and new coping strategies. This basically brings us back to experiential and group dynamic techniques, mentioned elsewhere on this site.
These are overall categories. In each of our individual lives, we have to discover to what specific items these broad concepts relate. The following could be of help:
- Psychodrama with a specific physical complaint as point of leave.
- Time-relationships between certain events and the onset of physical disease.
- Physical experiences during certain activities, thoughts, intentions or otherwise mindsets.
- (if available) Dreams
