Several trials investigated the effects of psychological interventions to of evidence on the efficacy of psychological interventions for acute pain. Studies have also addressed the psychological consequences of exposure to war .. Evidence suggests that a chronically activated, dysregulated acute stress . Heart rate reactions to acute psychological stress were negatively associated with symptoms of depression five years later: Evidence from a large community study. Second, a meta-analysis of 11 relevant studies found.
Studies Acute Evidence from Psychological
This is an update of a Cochrane review previously published in Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences.
Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention control in adults undergoing open heart surgery for pain, pain medication, psychological distress, mobility, and time to extubation.
We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We checked lists of references of relevant articles and previous reviews. We also contacted the authors of primary studies to identify any unpublished material. In addition, we wrote to all leading heart centres in Germany, Switzerland, and Austria to check whether they were aware of any ongoing trials.
Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. Our future as individuals and as a species depends on our ability to adapt to potent stressors.
At a societal level, we face a lack of institutional resources e. At an individual level, we live with the insecurities of our daily existence including job stress, marital stress, and unsafe schools and neighborhoods. These are not an entirely new condition as, in the last century alone, the world suffered from instances of mass starvation, genocide, revolutions, civil wars, major infectious disease epidemics, two world wars, and a pernicious cold war that threatened the world order.
Although we have chosen not to focus on these global threats in this paper, they do provide the backdrop for our consideration of the relationship between stress and health. It is clear that all of us are exposed to stressful situations at the societal, community, and interpersonal level. How we meet these challenges will tell us about the health of our society and ourselves.
In contrast, if stressors are too strong and too persistent in individuals who are biologically vulnerable because of age, genetic, or constitutional factors, stressors may lead to disease. This is particularly the case if the person has few psychosocial resources and poor coping skills. In this chapter, we have documented associations between stressors and disease and have described how endocrine-immune interactions appear to mediate the relationship.
We have also described how psychosocial stressors influence mental health and how psychosocial treatments may ameliorate both mental and physical disorders. There is much we do not yet know about the relationship between stress and health, but scientific findings being made in the areas of cognitive-emotional psychology, molecular biology, neuroscience, clinical psychology, and medicine will undoubtedly lead to improved health outcomes.
National Center for Biotechnology Information , U. Annu Rev Clin Psychol. Author manuscript; available in PMC Oct Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Annu Rev Clin Psychol. See other articles in PMC that cite the published article. Abstract Stressors have a major influence upon mood, our sense of well-being, behavior, and health.
Variations in Stress Responses Certain characteristics of a situation are associated with greater stress responses. Chronic Stress Responses The acute stress response can become maladaptive if it is repeatedly or continuously activated Selye Upper Respiratory Diseases The hypothesis that stress predicts susceptibility to the common cold received support from observational studies Graham et al.
Human Immunodeficiency Virus The impact of life stressors has also been studied within the context of human immunodeficiency virus HIV spectrum disease. Inflammation, the Immune System, and Physical Health Despite the stress-mediated immunosuppressive effects reviewed above, stress has also been associated with exacerbations of autoimmune disease Harbuz et al.
Inflammation, Cytokine Production, and Mental Health In addition to its effects on physical health, prolonged proinflammatory cytokine production may also adversely affect mental health in vulnerable individuals. Morbidity, Mortality, and Markers of Disease Progression Psychosocial intervention trials conducted upon patients following acute myocardial infarction MI have reported both positive and null results.
Cardiovascular changes during naturally elicited fighting behavior in the cat. Psychosocial influences on ovarian, endocrine and ovulatory function in Macaca fascicularis.
A dual pathway model of daily stressor effects on rheumatoid arthritis. Angst J, Vollrath M. The natural history of anxiety disorders. Cognitive behavioral stress management intervention buffers distress responses and elevates immunologic markers following notification of HIV-1 seropositivity. Cognitive-behavioral stress management reduces distress and hour urinary free cortisol output among symptomatic HIV-infected gay men. Inflammation, depressive symptomatology, and coronary artery disease.
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Association between depression and elevated C-reactive protein. Where do we stand? Psychiatric morbidity following Hurricane Andrew. Acute stress enhances while chronic stress suppresses cell-mediated immunity in vivo: A meta-analysis of psychoeducational programs for coronary heart disease patients. Psychosocial risk factors for coronary heart disease in women.
Psychosocial modulation of antibody to Epstein-Barr viral capsid antigen and herpes virus type-6 HIV-1 infected and at-risk gay men. Recent life events and panic disorder. Mood disorders and dysfunction of the hypothalamic-pituitary-adrenal axis in multiple sclerosis: Effects of an early structured psychiatric intervention, coping and affective state on recurrence and survival 6 years later. Immune parameters in a longitudinal study of a very old population of Swedish people: Types of stressful life events and the onset of anxiety and depressive disorders.
Psychosocial treatments for posttraumatic stress disorder: Social support, depression, and mortality during the first year after myocardial infarction. Towards an understanding of the psychological impact of natural disasters: Alteration of type A behavior and its effects on cardiac recurrences in post myocardial patients: Resiliency and vulnerability to adverse developmental outcomes associated with poverty. Evidence for a shift in the Th-1 to Th-2 cytokine response associated with chronic stress and aging.
High blood pressure after battle. Stress and acute respiratory infection. Psychosocial research in traumatic stress: Traumatic stress and disaster: Mak FL, Nadelson C, editors. International Review of Psychiatry.
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The war experience and psychosocial development of children in Lebanon. Acute post-traumatic stress disorder in victims of a natural disaster.
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Habituation of the electrodermal response — A biological correlate of resilience? Current approaches to quantifying resilience make extensive use of self-reported data. Problematically, this type of scales is plagued by response distortions—both deliberate and unintentional, particularly in occupational populations. The aim of the current study was to develop an objective index of resilience. The study was conducted in 30 young healthy adults. Acoustic stimuli consistently provoked transient skin conductance SC responses, with SC slopes indexing response habituation.
Our key finding of the connection between habituation of the skin conductance responses to repeated acoustic startle stimulus and resilience-related psychometric constructs suggests that response habituation paradigm has the potential to characterize important attributes of cognitive fitness and well-being—such as depression, anxiety and resilience. Therefore, poor cardiovascular recovery following psychological stress might be more relevant for the development of stress-related pathology than stress reactivity itself, as further suggested by a recent meta-analysis Panaite et al.
Notably, a large population-based longitudinal study found that cardiovascular blood pressure and heart rate responses to acute psychological stress were negatively associated with depressive symptomatology 5 years later Phillips et al.
Stressful life events are an important cause of psychopathology. Humans exposed to aversive or stressful experiences show considerable inter-individual heterogeneity in their responses.
However, the majority does not develop stress-related psychiatric disorders. The dynamic processes encompassing positive and functional adaptation in the face of significant adversity have been broadly defined as resilience. Traditionally, the assessment of resilience has been confined to self-report measures, both within the general community and putative high-risk populations.
Although this approach has value, it is highly susceptible to subjective bias and may not capture the dynamic nature of resilience, as underlying construct. Recognizing the obvious benefits of more objective measures of resilience, research in the field has just started investigating the predictive value of several potential biological markers.
This review provides an overview of theoretical views and empirical evidence suggesting that individual differences in heart rate variability HRV , a surrogate index of resting cardiac vagal outflow, may underlie different levels of resilience towards the development of stress-related psychiatric disorders.
Following this line of thought, recent studies describing associations between regional brain morphometric characteristics and resting state vagally-mediated HRV are summarized. Existing studies suggest that the structural morphology of the anterior cingulated cortex ACC , particularly its cortical thickness, is implicated in the expression of individual differences in HRV. These findings are discussed in light of emerging structural neuroimaging research, linking morphological characteristics of the ACC to psychological traits ascribed to a high-resilient profile and abnormal structural integrity of the ACC to the psychophysiological expression of stress-related mental health consequences.
We conclude that a multidisciplinary approach integrating structural brain imaging with HRV monitoring could offer novel perspectives about brain-body pathways in resilience and adaptation to psychological stress.
State anxiety has also been found to be positively associated with BP responses to the cold pressor and anger recall tests Pointer et al. Conversely, other studies have shown a blunted cardiovascular response to acute stress tests [e.
Although the MAST has been utilized to assess the effects on cortisol and subjective levels of stress, affect, and anxiety Smeets et al. Physiological and Subjective Responses in Anticipation, and Post-stress. The aim of this study was to use the MAST procedure to elicit strong autonomic and subjective stress responses that can be quantified in terms of systolic and diastolic blood pressure, pulse rate PR , and state anxiety ratings.
Interestingly, the presentation of instructions alerting participants to the procedure resulted in significant elevation of both SBP and DBP above baseline. However, BP measurements prior to test initiation were not as high as those measured immediately after the MAST procedure. PR data showed limited variability across time points. Self-reported state anxiety increased dramatically from baseline to immediately following the MAST procedure.
Further, individuals who reported higher levels of depression and stress were more likely to demonstrate larger increases in SBP in response to the MAST. Together, these results support the use of the MAST as a useful tool to activate both acute physiological and subjective measures of the stress response in healthy adults lasting up to 30 min. Trait anxiety predicts the response to acute psychological stress. Jan Acta Psychol Sin.
Background Little is known about the role of physiological stress responses in metabolic syndrome MetS. Logistic regressions included clusters and interaction between clusters and sex as independent variables, controlling for relevant covariates. Results using a continuous measure of MetS were generally consistent with these findings. Conclusion Among older participants with CAD or other noncardiovascular disease, hyperreactivity to stress was associated with greater prevalence of MetS, particularly in women.
Consistent with emerging literature, women who showed blunting or activation of parasympathetic responses to stress were similarly at greater risk. Stress reactivity research has traditionally focused on the idea that exaggerated responses to stress may have adverse effects on health.
Accumulating evidence suggests that attenuated responses to stress and delayed recovery may also be problematic. This review focuses on the role of the stress response of the hypothalamic-pituitary-adrenocortical HPA axis, the endogenous opioid system EOS , and the cardiovascular system in hypertension, pain perception, and addictive behaviors. Results from multiple methods of assessment and stress paradigms conducted in our laboratory over the past two decades are integrated with research from other investigators and with existing theories.
Research indicates that exaggerated biological and physiological responses to stress and attenuated pain perception are associated with hypertension and risk for cardiovascular diseases. This research complements work linking reduced stress responses with enhanced pain sensitivity and discomfort.
Multiple studies have also demonstrated that an attenuated stress response is linked to exacerbation of withdrawal symptoms and relapse in nicotine addiction. Evidence indicates important moderators i. We integrate these findings in a conceptual model emphasizing that robust stress responses in the context of addiction and relapse should be considered as a marker of resiliency. A blunted stress response may indicate long-term physiological dysregulation that could usher harmful consequences for cardiovascular disease, pain perception and addictive disorders.
The impact of dysregulation is influenced by multiple individual and situational factors that should be considered in evaluating the clinical significance of stress response dysregulation. Temporal stability and drivers of change in cardiac autonomic nervous system activity.
This study determined temporal stability of ambulatory measured cardiac autonomic activity for different time periods and investigated potential drivers of changes in this activity. Autonomic temporal stability was determined across 2, 4, and 6year intervals.
We subsequently examined the association between sociodemographics, lifestyle, mental health, cardiometabolic health, and the use of antidepressant and cardiac medication with change in cardiac autonomic activity.
The most important determinants for increase in HR were increase in smoking, increase in body mass index BMI and starting the use of antidepressants. Decrease in RSA was associated with age, smoking and starting antidepressant use. Cardiac autonomic measures were rather stable over 2years, but stability decreased with increasing time span. Determinants contributing to cardiac autonomic deterioration were older age, increase in smoking and BMI, and starting the use of antidepressants.
Starting the use of cardiac medication improved autonomic function. Pre-ejection period reactivity to reward is associated with anhedonic symptoms of depression among adolescents. Apr Dev Psychobiol. Pre-ejection period PEP reactivity to reward has been posited as a specific index of behavioral approach and incentive motivation, suggesting it might be uniquely associated with the affective and motivational deficits of anhedonia.
This study evaluated PEP reactivity to a reward task as a predictor of depressive symptoms among adolescents, examining global depressive symptoms as well as specific anhedonic and nonanhedonic symptoms clusters.
This study found marginal support for an association between PEP reactivity to reward and concurrent anhedonia symptoms, but no association with nonanhedonic or the global scale. Findings are discussed in terms of potential associations between peripheral psychophysiological measures and dopaminergic functioning and also the utility of this measure for future research on anhedonia.
Stress and Cardiovascular Reactivity. The response of the cardiovascular system to stressful situations has long been considered to have implications for health outcomes.
Both exaggerated and diminished cardiovascular reactivity to acute psychological stressors have serious consequences for health. This chapter will compare and discuss research on both high and low cardiovascular responses to psychological stress. Exaggerated reactions are associated with the development of hypertension, markers of systemic atherosclerosis, and cardiovascular disease.
Blunted or low reactivity is related to depression, obesity, and a range of addictions. The objective of this chapter is to explore cutting-edge research on the pathways to the development of disease via alterations in stress reactivity. It will also highlight some of the key environmental, social, and mechanistic pathways from high and low cardiovascular reactivity to health and ill health in later life and potential research and clinical implications. Because individuals with alcohol dependence AD have shown blunted cortisol responses to psychological stress, we assessed whether they also show attenuated cardiovascular responses.
Heart rate HR , stroke volume, cardiac output, total peripheral resistance, mean arterial pressure, systolic blood pressure, and diastolic blood pressure during orthostasis and public speaking were assessed by use of impedance cardiography and Dinamap blood pressure monitoring in 20 AD subjects abstinent for 21 to 28 days and in 10 age-matched controls. Orthostasis consisted of standing, whereas public speaking involved preparing and presenting two speeches. Self-reported mood state was also assessed during the tasks.
AD subjects had significantly lower resting BP compared with controls. Cardiovascular responses to orthostasis were similar between groups. AD subjects had attenuated HR during public speaking but reported similar anxiety responses to controls.
Comparable cardiovascular responses to orthostasis in controls and AD subjects suggest intact reflex control of circulation. AD subjects had blunted HR responses to public speaking; this is consistent with the attenuated cortisol responses observed in this sample and in previous studies. This suggests a possible alteration in limbic system regulation of hypothalamic and brainstem responses to psychological stress.
Cardiovascular responses of AD subjects that are inconsistent with subjective accounts of tension and anxiety suggest a disconnection between perception of threat and resulting physiologic responses in AD subjects. Blood pressure measuring devices: Mar Br Med J. There is a large market for blood pressure measuring devices not only in clinical medicine but also among the public where the demand for self measurement of blood pressure is growing rapidly.
For consumers, whether medical or lay, accuracy should be of prime importance when selecting a device to measure blood pressure. However, most devices have not been evaluated for accuracy independently using the two most widely used protocols: Because most blood pressure devices have not been independently validated, only a fraction of the many devices available have been surveyed.
Devices that have been validated recently for which results have not yet been published were not included, but this shortcoming should be addressed in future. Summary points Two manual sphygmomanometers have been validated, one is recommended Five devices for clinical use in hospitals have been validated, two are recommended 23 devices for self measurement of blood pressure have been validated, five are recommended 24 devices for ambulatory measurement of blood pressure have been validated, 16 are recommended Validations and recommendations will be updated on the BMJ's website.
How we react physiologically to stress has long been considered to have implications for our health. There is now persuasive evidence that individuals who show large cardiovascular reactions to stress are at increased risk of developing cardiovascular disease, particularly hypertension.
By implication, low reactivity is protective or benign. However, there is recent evidence that low reactivity may predict elevated risk for a range of adverse health outcomes, such as depression, obesity, poor self-reported health and compromised immunity. In addition, low cortisol and cardiovascular reactivity may be a characteristic of individuals with addictions to tobacco and alcohol, as well as those at risk of addiction and those who relapse from abstinence.
Our ideas about reactivity may have to be revised in the light of such findings. It might seem that following people over time provides the best indication of how people change with age, Sample attrition can undermine that assumption. This study describes the impact of health impairment, and depression on attrition in the Notional Survey of Families and Households. It analyzes the impact of that attrition on estimates of the age-specific changes in depression over a six-year period In doing so, it illustrates methods for assessing and perhaps correcting the effects of attrition.
Results show that the cross-sectional relationship of baseline depression to age differs sharply for those who later drop out compared with those who stay in Much Of the difference, but not all, vanishes with adjustment for health and impairment. The probability of dropping out increases with poor health, impairment and depression at baseline. The impact of impairment and depression on attrition increases with age.
Panel models that ignore the attrition imply that depression decreases in old age. Models that adjust for the hazard of attrition imply that depression riser by an amount that increases with age.
Psychological stress and the progression of carotid artery disease. Jan J Hypertens. We examined the relation between cardiovascular reactivity the response of the cardiovascular system to psychological stress and the severity and progression of carotid atherosclerosis.
Using duplex ultrasonography, we measured the change in the area of all detectable plaques in the extracranial carotid arteries during 2 years. Cardiovascular reactivity was assessed by measuring changes in hemodynamics during a frustrating cognitive task the Stroop Color Word Interference Task.
Established risk factors for atherosclerosis were measured by interviewing patients, a physical examination, and blood assays for subjects with a wide range of types of atherosclerotic disease. These results support the hypothesis that hemodynamic responses under conditions of mental stress may influence the progression of atherosclerosis. HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: Data from five independent studies were reanalyzed in order to investigate the impact of age and gender on HPA axis responses to an acute psychosocial laboratory stress task.
The total sample consisted of healthy subjects with 30 older adults mean age: Results showed that the ACTH response to stress was higher in younger adults compared to older adults main effect: In sum, the stressor induced significant HPA axis responses in all age and gender groups. The observed ACTH response patterns in young and elderly adults may suggest that a heightened hypothalamic drive in young men decreases with age, resulting in similar ACTH responses in elderly men and women.
Alternative interpretations are also discussed. The data also supports the idea of a greater adrenal cortex sensitivity to ACTH signals in young females. Free salivary cortisol responses were elevated in elderly men compared to elderly women, an effect which cannot be explained by gender differences in perceived stress responses to the TSST. May Alcohol Clin Exp Res. This study tested cortisol responses to a psychological stressor in controls CT versus patients who were diagnosed as alcohol dependent AD or alcohol and stimulant dependent ADSD by DSM-IV criteria and who were abstinent for 3 to 4 weeks from alcohol and illicit drugs.
Alcohol increases cortisol secretion acutely and during withdrawal. However, there is little information about abnormalities of hypothalamic-pituitary-adrenocortical HPA reactivity in recovering alcoholics. Accordingly, we tested HPA function in the laboratory between 7: Stress consisted of a min public speaking challenge with preparation and delivery of two short speeches, ostensibly evaluated for quality of delivery, whereas control involved relaxing for the same period.
Cortisol was measured in saliva collected at baseline, stress or control, and recovery period, and also at home at 9: The three groups did not differ in diurnal patterns of cortisol secretion on the rest day and 9: Cortisol values were not accounted for by covariates such as depression, posttraumatic stress disorder, glucose metabolism, or anthropometric or demographic characteristics.
The apparent stress hyporesponsiveness of the AD and ADSD patients suggests a persistent disruption of HPA function, perhaps due to incomplete recovery from prior abuse, or to a preexisting alteration in neural systems that regulate HPA responses to stress. Jun Acta Psychiatr Scand. ABSTRACT— A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder.
It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments. Association between smoking status and cardiovascular and cortisol stress responsivity in healthy young men.
Acutely, cigarette smoking stimulates increases in blood pressure BP. This relation was assessed in 86 healthy male firefighters, age 19 to 31, comprising 52 nonsmokers and 34 smokers.
Measures of BP, HR, salivary free cortisol, breathing pattern, and self-reported stress and alertness were obtained while subjects performed nonverbal mental arithmetic and a socially evaluative speech task. Systolic and diastolic BP were higher at rest in nonsmokers than smokers, and a consistent difference in stress responsivity was also found.
BP, HR, and cortisol responses to mental arithmetic were significantly smaller in smokers than nonsmokers, with mean changes in BP adjusted for body weight averaging There were no effects of smoking status on task performance or subjective stress responses and no differences between groups in family health history, health-related behaviors, or psychological characteristics that might account for the reactivity difference.
Possible explanations of the results are discussed, and methodological implications for cardiovascular stress reactivity studies are outlined.
We examined respiratory sinus arrhythmia RSA , emotion regulation ER , and prospective depressive symptoms in children at risk for depression and controls.
STRESS AND HEALTH: Psychological, Behavioral, and Biological Determinants
Personality and physiological reactions to acute psychological stress although the evidence relating personality to biological stress reactivity is inconclusive. Psychological; Aged; Anxiety Disorders; Blood Pressure; Cohort Studies; Female . This article reviews the role of psychological factors in the development of Based on a review of the scientific evidence, a set of 10 principles that have relevant goals Recent studies of patients with chronic pain have. The present study examined the relationship between personality traits and the response to acute psychological stress induced by a.