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Biomedical subjects

W Linden

Publications and source records attributed to W Linden.

At least 19 recordsLinked to original sources
PubMed2005

Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors.

Comprehensive cardiac rehabilitation reduces mortality and morbidity but is utilised by only a fraction of eligible cardiac patients, with the participation rate of women being only about half that of men. This quantitative review assesses 32 studies meeting inclusion criteria, describing 16,804 patients, 5882 of whom were female. It was found that the main predictor of referral to a cardiac rehabilitation programme was the physician's endorsement of the effectiveness of such a programme. Patients were more likely to participate in rehabilitation programmes when they were actively referred, educated, married, possessed high self efficacy, and when the programmes were easily accessible. Patients were less likely to participate when they had to travel long distances to participate in a cardiac rehabilitation programme, or experienced guilt over family obligations. Women were less often referred and participated less often even after referral. In conclusion, many of the observed predictors, including those particular to women, are potentially modifiable with the help of health professionals.

Angioplasty, Balloon, Coronary↗
PubMed2001

Individualized stress management for primary hypertension: a randomized trial.

OBJECTIVE: To test the efficacy of individualized stress management for primary hypertension in a randomized clinical trial with the use of ambulatory blood pressure (BP) measures. METHODS: Men and women aged 28 to 75 years with mean ambulatory BP greater than 140/90 mm Hg received 10 hours of individualized stress management by means of semistandardized treatment components. They were randomly assigned to immediate treatment (n = 27) or a wait list control group (n = 33). Participants on the wait list were subsequently offered treatment. Six-month follow-up data were available from 36 of the 45 participants who completed treatment. Measures were 24-hour ambulatory BP, lipid levels, weight, and psychological measures. RESULTS: Blood pressure was significantly reduced in the immediate treatment group and did not change in control subjects (-6.1 vs +0.9 mm Hg for systolic and -4.3 vs +0.0 mm Hg for diastolic pressure). When the wait list control group was later treated, BP was similarly reduced by -7.8 and -5.2 mm Hg, and for the combined sample, total change at follow-up was -10.8 and -8.5 mm Hg. Level of BP at the beginning of treatment was correlated with BP change (r = 0.45 [P<.001] and 0.51 [P<.001], respectively), and amount of systolic BP change was positively correlated with reduction in psychological stress (r = 0.34) and change in anger coping styles (r = 0.35-0.41). CONCLUSIONS: Individualized stress management is associated with ambulatory BP reduction. The effects were replicated and further improved by follow-up. Reductions in psychological stress and improved anger coping appear to mediate the reductions in BP change.

Adaptation, Psychological↗
PubMed2000

How often do office blood pressure measurements fail to identify true hypertension? An exploration of white-coat normotension.

BACKGROUND: The often-observed differences between ambulatory (ABP) and office blood pressure (OBP) measurements have brought attention to the problem of misdiagnoses. Although there has been much focus on white-coat hypertension (elevated OBP with normal ABP means), few studies have examined "white-coat normotension" (WCN; normal OBP with elevated ABP means). OBJECTIVES: To describe patients with WCN in terms of prevalence and quantitative differences between ABP and OBP; to identify psychological and demographic features that discriminate them from true normotensive patients; and to offer possible corrections for diagnostic limitations of OBP measurements in clinical practice. DESIGN AND METHODS: Five OBP measurements and 10- to 12-hour daytime ABP monitoring in 319 presumed healthy participants. RESULTS: Prevalence rates of WCN were 23% for systolic BP and 24% for diastolic BP. Participants with WCN were more often male, past smokers, and older and consumed more alcohol. Increasing the number of office readings and discarding the first office reading did not improve the accuracy of OBP measurements. Participants with BP of 10 mm Hg above or below the 140/90 office reading cutoff showed the lowest accuracy, with more than 50% of normotensive diagnoses being incorrect. CONCLUSIONS: Office measures of BP lack sensitivity, missing a sizable portion of individuals who have hypertensive mean ABP measurements. Subjects with WCN differ from true normotensive subjects on several demographic and lifestyle variables. Only those office readings averaging 20 points above or below the 140/90 cutoff represent safe diagnostic information.

Adolescent↗
PubMed2000

Defensiveness status predicts 3-year incidence of hypertension.

OBJECTIVE: A growing body of research indicates that defensive personality styles (in particular, self-deception) may be related to higher resting blood pressure and stress reactivity levels. This study is the first, however, to examine the value of defensiveness as a prognostic indicator for the development of clinical hypertension. METHODS: Participants were 127 initially normotensive male and female adults who completed a comprehensive protocol including psychological testing, assessment of smoking, physical activity and body fat levels, and 8-12 h ambulatory blood pressure monitoring. Participants returned 3-years later for an identical follow-up protocol. Defensiveness was assessed using the Balanced Inventory of Desirable Responding. RESULTS: At 3-year testing, 15 of 127 participants (12%) met criteria for hypertension (i.e. ambulatory mean blood pressure > 140/90). Comparisons between defensiveness groups showed that 12 of 60 (20%) high defensiveness participants met hypertension criteria, whereas only three of 67 (4.5%) low defensiveness participants were hypertensive. Logistic regression equations adjusted for age, alcohol usage, bodyfat, self-reported exercise levels, smoking, and year-1 ambulatory blood pressure, revealed that membership in the high defensiveness group was associated with more than a sevenfold risk of 3-year hypertension (adjusted risk ratio, 7.5; 95% confidence interval, 1.5-39.2). CONCLUSIONS: These findings link defensive characteristics to an increased prospective risk of hypertension using state of the art ambulatory monitoring techniques, and were robust after controlling for established risk factors. We conclude that the current results add to the hypertension literature by demonstrating associations between personality and clinically relevant blood pressure criteria.

Adult↗
PubMed2000

Psychological response styles and cardiovascular health: confound or independent risk factor?

Using results from 2 large cardiovascular studies, the authors examined the utility of treating psychological response styles as confounds (e.g., factors undermining relationships with other self-report variables) versus distinct personality traits in the prediction of cardiovascular health. Study 1 consisted of a 3-year prospective study of ambulatory blood pressure levels in healthy adults (N = 125). Study 2 comprised a 12-week drug treatment program for ischemic heart disease patients (N = 95). Participants completed measures of psychological factors and self-deception and impression management in each study. Results consistently favored using response styles as direct predictors. Self-deception scores predicted elevated 3-year diastolic and systolic blood pressure changes in Study 1 and poorer treatment outcomes in Study 2. Statistically controlling for response style effects within the psychological factors generally did not improve predictions. These findings argue against the conceptualization of response styles as stylistic confounds.

Adult↗
PubMed1999

Lifestyle modifications to prevent and control hypertension. 7. Recommendations on stress management. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

OBJECTIVE: To provide updated evidence-based recommendations for health care professionals concerning the effects of stress management on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: Alternatives to stress management include other nonpharmacologic interventions and medical therapy; these options are not mutually exclusive. OUTCOMES: The health outcome considered was reduction of blood pressure. There is little evidence to date that stress management prevents death or vascular events. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A systematic search of the literature (which yielded, among other sources, 3 meta-analyses) was conducted for the period 1966-1997 with the terms essential hypertension, treatment, psychological, behavioural, cognitive, relaxation, mediation, biofeedback and stress management. Other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by uncontrolled hypertension. BENEFITS, HARMS AND COSTS: The magnitude of the reduction in blood pressure obtained with multicomponent, individualized cognitive behavioural intervention for stress management was comparable in some studies to that obtained with weight loss or drugs; single-component interventions such as biofeedback or relaxation were less effective. The adverse effects of stress-management techniques are minimal, but the cost for effective interventions is substantial, similar initially to drug costs; continuing costs are probably minimal. RECOMMENDATIONS: (1) In patients with hypertension, the contribution of stress should be considered. (2) For hypertensive patients in whom stress appears to be an important issue, stress management should be considered as an intervention. Individualized cognitive behavioural interventions are more likely to be effective than single-component interventions. VALIDATION: These recommendations were reviewed by all of the sponsoring organizations and by participants in a satellite symposium of the fourth International Conference on Preventive Cardiology. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada.

Adult↗
PubMed1999

Differential effects of harassment on cardiovascular and salivary cortisol stress reactivity and recovery in women and men.

To explore the differential effects of harassment on cardiovascular and neuroendocrine stress reactivity and recovery, 28 men and 32 women were randomized to a harassment or no-harassment control condition (four groups in total). The harassment consisted of three scripted statements delivered during performance of a mental arithmetic stress task. The harassing statements were delivered on a fixed schedule during the task by a same-gender experimenter. Cardiovascular, salivary cortisol, and state affect measures were taken at baseline, immediately posttask, and throughout an extended recovery period. In comparison to the control condition, harassment accentuated the stress reactivity responses on all measures, physiological and self-report of subjective affect. In addition, several gender differences in response to the stressor and during the recovery period were observed. Harassed men had the largest reactivity on cortisol and diastolic blood pressure, whereas the harassed women showed a more pronounced response on heart rate and self-reported hostility. The harassed groups were the only ones to show significant cortisol responses. Within the harassed condition, comparison of effect sizes revealed that cortisol reactivity in men was twice that of women. Control groups did not exhibit significant cortisol changes. During the recovery period, harassed men exhibited attenuated return to baseline on cardiovascular indices and cortisol, whereas women, overall, tended to exhibit an overcompensation response on cardiovascular measures. These results contribute to showing a pathway that may link negative affect (i.e., hostile or angry feelings) with the development of cardiovascular disease.

Adolescent↗
PubMed1998

Well-being and morbid obesity in women: a controlled therapy evaluation.

OBJECTIVE: Morbidly obese individuals are unlikely to reach and maintain normative weights. Thus, interventions aimed at alleviating corollary problems, independent of attempts at weight loss, are appropriate. A cognitive group treatment program (CT) was developed which incorporated a nondieting approach, regular exercise, and use of alternative coping skills. Weight loss per se was not a focus of the intervention. The purpose of the current work was to evaluate this program in a controlled, comparative treatment outcome study. METHOD: Sixty-two obese women with a history of treatment failures were randomly assigned to the CT program, a behavior therapy weight loss program (BT), or a wait-list control group. RESULTS: For CT participants, depression, anxiety, and eating-related psychopathology decreased significantly over the course of treatment while perceptions of self-control increased; BT and control subjects showed no significant changes in these variables. Women in both active treatment groups lost significant amounts of weight, while members of the control group showed a nonsignificant increase in weight. At 6-month follow-up, treatment benefits were maintained. DISCUSSION: Findings suggest that interventions not directly aimed at weight loss can enhance psychological well-being and thus may be appropriate for some obese women.

Adaptation, Psychological↗
PubMed1998

A case for the usefulness of laboratory social stressors.

Although laboratory stress research is a popular and vibrant area of research activity, there is surprisingly little evidence that laboratory stress models are clinically useful (i.e. that they can explain and predict the development of disease). This article summarizes evidence that the usefulness of lab stress research can be improved with the use of social stressors. Two lines of evidence are presented in support of this argument: (a) studies comparing physiological reactivity to different lab stressors with ambulatory activity, and (b) a meta-analysis of investigations of cortisol responses to laboratory stressors. Further issues of importance in understanding social stressors are gender differences and the vulnerability (i.e. weak reliability) of social stressor impact to relatively small changes in the experimental protocol itself.

Cardiovascular Physiological Phenomena↗
PubMed1998

To eat or not to eat: affective and physiological mechanisms in the stress-eating relationship.

The current study aggregated methods from the cardiovascular reactivity and dietary restraint paradigms in an attempt to advance our understanding of stress-induced eating behavior. Seventy-seven female subjects completed a protocol consisting of distinct baseline, stress-induction, and recovery phases during which we monitored blood pressure, heart rate, and self-reported affect. Food was inconspicuously made available to participants during the recovery phase. Our results replicated the restraint x affect level interaction observed in the restraint literature, while showing that physiological measures could further explain distressed eating behavior. Physiological arousal was found reliably to predict reduced food consumption, but only among unrestrained eaters. Analysis of the recovery data showed that food consumption was associated with impaired physiological recovery rates for restrained but not for unrestrained participants. We believe that our results help to reconcile findings in the stress, eating, and dietary restraint fields and offer support for recently developed theories of stress-induced overeating.

Adult↗
PubMed1997

Physiological stress reactivity and recovery: conceptual siblings separated at birth?

This article discusses theoretical assumptions underlying physiological stress reactivity research. It examines early conceptualizations of activation and recovery and contrasts these with current practices in designing, analyzing, and reporting stress reactivity studies. Study protocols from four major journals covering the last 2 years of publication were examined for current practices. Of the 105 studies which tested physiological reactivity, 63% collected recovery data but only 23% reported the recovery data. We concluded that stress recovery issues are neglected and a renewed case is made for their conceptual and ecological importance. The case for studying recovery is further supported by a selective review of studies using recovery protocols that revealed positive findings not apparent in reactivity comparisons only. Finally, options for sound design of recovery protocols, statistical processing of resulting data, and interpretation of findings are presented.

Adaptation, Psychological↗
PubMed1997

Social determinants of experienced anger.

We investigated two social determinants (i.e., availability of social support and status differentials of the provocateur) for the degree of perceived anger in two populations. Because no suitable tool was available, the conceptual and psychometric development and validation of a new vignette-based measure for anger level (STandardized Experience of Anger Measure, STEAM) is described first. Two versions of STEAM were developed: one for students and one for community-living adults. Through a series of four studies, two sets of a 12-item vignette-based questionnaire were developed and validated. The resulting test had excellent test-retest stability and high internal consistency. Using the new STEAM measure, a variety of analyses were conducted to test the hypothesized influence of social determinants of anger. In the student sample, presence of social support was associated with lessened anger, and in both samples decreasing status of the provocateur also led to lessened anger arousal. In addition, findings in both samples revealed that social support reduced anger when the provocateur was of higher status relative to situations of equal and lesser status. In the community sample, the availability of support was associated with greater intensity of the anger experience in the lesser status condition than in the equal or greater status condition. No gender main effects or interactions were noted.

Adolescent↗
PubMed1996

Psychosocial interventions for patients with coronary artery disease: a meta-analysis.

BACKGROUND: Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence. OBJECTIVE: To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease. METHODS: We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies. RESULTS: The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of -0.34 [corrected], -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99). CONCLUSIONS: The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.

Coronary Disease↗
PubMed1996

Spouse-pair risk factors and cardiovascular reactivity.

Epidemiological research has identified increased risk for coronary heart disease in Type A men married to well-educated women. The present study examined mechanisms that may explain the increased risk associated with this specific spouse-pair combination. Cardiovascular and self-report responses to an individual, standardized laboratory stress task and a dyadic, interactive affect provocation task were assessed in Type A or B men married to women of either low ( < or = 13 years) or high ( > 13 years) educational levels. Type A men with highly educated spouses (i.e., the highest risk group) also reported the greatest anger-out tendency, high trait anger, and low anger control scores. These men further exhibited elevated diastolic blood pressure at baseline and greater diastolic reactivity specific to the dyadic task than did the men in the lower risk groups. These findings, based on a laboratory study of spousal interactions, support the epidemiological high-risk designation of the Type A man with a highly educated spouse and confirm earlier conceptions that Type A research benefits more from a social interaction approach rather than from an individual trait perspective.

Adult↗
PubMed1996

Alexithymia, defensiveness and cardiovascular reactivity to stress.

This article attempts to further our understanding of alexithymia by testing two conceptual questions about the construct: (a) Is alexithymia characterized by reduced autonomic activity? and (b) Can it be clearly distinguished from defensiveness? Eighty healthy university students completed a battery of personality scales including the Toronto Alexithymia Scale, measures of self-deception and impression management, depression, and anger-in. They also participated in three lab stress tasks: isometric handgrip; mental arithmetic; and a negative affect provocation task. Blood pressure and heart rate were monitored throughout the lab procedure. Analyses were conducted with tercile groups of low, medium, and high alexithymia scorers. The "high alexithymia" tercile showed smaller heart rate responses to the stress tasks and more anger-in behavior. Blood pressure responses did not differentiate the low/ medium/high alexithymia subgroups. Alexithymia scores were unrelated to defensiveness, that is, there was no relationship between alexithymia and impression management or self-deception, and alexithymia was unrelated to depression. We conclude that students defined as "high alexithymia" on the Toronto Alexithymia Scale are not self-deceptive nor do they try to leave a particular impression; they tend to be somewhat hypoaroused autonomically, and they report as many psychological distress symptoms as do subjects with lower TAS scores.

Adult↗
PubMed1995

The effect of social change on causal beliefs of mental disorders and treatment preferences in Ghana.

The present study investigated the associations between social change, personality, causal beliefs and treatment style and goal preferences of 375 Ghanaian teachers. The index of social change (ISC) was conceptualized as the average percentile rank of a person's income, education and acculturation. The self-report measures (greatly modified after two pilot studies) were subscales of the SuinnLew Acculturation Scale, the Depressive Experiences Questionnaire (dependency), the Sociotropy-Autonomy Scale (autonomy), the Symptom Checklist '90 (paranoid ideation), the Spheres of Control Scale, and the Cognitive Somatic Anxiety Questionnaire. Respondents also completed a questionnaire on causal beliefs and treatment preferences pertaining to mental disorders. Results indicated that beliefs and treatment preferences were affected by the index of social change (ISC) and were specific to type of disorder. High ISC teachers endorsed significantly higher ratings on belief in an internal cause for Depression and Dependent Personality Disorder, and indicated greater preference for participation in treatment than lower ISC teachers. Contrary to prediction, lower ISC teachers indicated a greater preference for greater individual goals in treatment for depression and schizophrenia. High ISC teachers also reported greater perception of interpersonal control and emotional support, less dependency and less interpersonal sensitivity than lower ISC teachers. Little support was found for the commonly observed somatization of distress among non-Western peoples.

Acculturation↗
PubMed1994

Autogenic training: a narrative and quantitative review of clinical outcome.

This review of controlled outcome research on Autogenic Training complements the literature by pooling narrative and quantitative approaches, by including only studies with experimental controls, by integrating the English and German literature, and by adding research findings published since the last review. Whereas previous reviews have already reported positive effects of Autogenic Training for migraine, insomnia, and test anxiety, additional supportive findings for angina pectoris, asthma, childbirth, eczema, hypertension, infertility, Raynaud's disease, and recovery from myocardial infarction are discussed here. The impact of protocol variations on outcome is described, and the specificity of Autogenic Training relative to other stress management techniques is highlighted. Quantitative findings suggested that Autogenic Training was associated with medium-sized pre- to posttreatment effects ranging from d = .43 for biological indices of change to d = .58 for psychological and behavioral indices thus matching effect sizes for other biobehavioral treatment techniques like biofeedback and muscular relaxation. Length of treatment did not affect clinical outcome. The discussion emphasizes how narrative and quantitative strategies complement one another.

Autogenic Training↗