Transcript Chronic anxiety in ICD patients: A multi

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Disclosures
None
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Center of Research
on Psychology
in Somatic diseases
Laughter and other positive emotions on the heart
Susanne S. Pedersen, Professor of Cardiac Psychology
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Affiliations
Prof.dr. Susanne S. Pedersen
• CoRPS - Center of Research on
Psychology in Somatic diseases, Tilburg
University, The Netherlands
• Thoraxcenter, Erasmus Medical Center,
Rotterdam, The Netherlands
• Department of Cardiology, Odense
University Hospital & Institute of
Psychology, Southern University of
Denmark, Denmark
E-mail: [email protected]
www.tilburguniversity.nl/corps
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Overview
• Negative emotions and cardiovascular health
• Positive emotions: New kid on the block?
o
Positive emotions and cardiovascular health
o
Laughter and cardiovascular health
• Assessment of positive emotions
• Take home message
CoRPS
Overview
• Negative emotions and cardiovascular health
• Positive emotions: New kid on the block?
o
Positive emotions and cardiovascular health
o
Laughter and cardiovascular health
• Assessment of positive emotions
• Take home message
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Negative emotions and cardiovascular health
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Anxiety
Depression
Type D
Vital exhaustion
Type A
Social isolation
PTSD
Hostility
Stress
Anger
Depression
and
death/MACE:
Peripheral
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arterial disease
N = 257
Adjusted HR: 2.05 [95% CI: 1.16-1.86]
Cherr al. J Gen Intern Med 2008;23:629-34
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Depression and clinical and functional
status: Chronic heart failure
N = 155
Parissis et al. Heart J 2008;94:585-9
Depression
symptoms
and
mortality:
Atrial
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fibrillation
N=947 comorbid AF-CHF
• Rate-control (i.e., beta-blockers
and digoxin) versus rhythmcontrol (i.e., antiarrhythmic
medications and electrical
cardioversion)
• 32% had BDI-II scores 14 (mild
to moderate symptoms of
depression)
Frasure-Smith et al. Circulation 2009;120:134-40
Type D personality/high ICD pre implantation
concerns and mortality: ICD patients
N = 371
HR: 3.65; 95%CI: 1.57-8.45; p = .003
2-year mortality (%)
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20
18
16
14
12
10
8
6
18.2%
5.2%
4
2
0
Type D and concerns
Pedersen et al. Europace 2010;12:1446-52
None or one risk marker
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Impact of negative emotions on heart disease
•
•
•
•
•
•
•
Enhanced morbidity
Increased mortality (2-fold risk)
Decreased quality of life
Poor compliance
Doctor-patient communication
Attenuated health-care costs
Negative emotions cluster together  clustering
leads to worse prognosis
Pedersen SS et al. ESC TEXTBOOK OF CARDIOVASCULAR MEDICINE
(Chapter 37), 2nd edition. Oxford University Press, 2009.
Why
would
negative
emotions
be
bad
for
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the heart?
CAD
Healthrelated
behaviours
Elevated
blood
pressure
Hemostatic
changes
Endothelial
damage
Negative emotions
Activation
of the
HPA-axis
Release
of stress
hormones
Inflammation
Poor
prognosis
 HRV
Noncompliance
Risk factor
clustering
CoRPS
Overview
• Negative emotions and cardiovascular health
• Positive emotions: New kid on the block?
o
Positive emotions and cardiovascular health
o
Laughter and cardiovascular health
• Assessment of positive emotions
• Take home message
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Positive emotions and cardiovascular health
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Positive affect and anhedonia
Positive affect:
• Joy
• Cheerfulness
• Interest or pleasure in (almost) all
activities
Lack of positive affect (anhedonia):
• Markedly diminished interest or pleasure
in all, or almost all activities
Davidson et al. Eur Heart J 2010:31:1065-70
Rozanski et al. Psychosom Med 2005;67:47-53
Positive
and
negative
emotions
–
mutually
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exclusive or co-occurring?
1. Polar opposites and mutually exclusive
Negative affect
2. Separable and mixed feelings
High positive affect
Low negative
affect
High negative
affect
Low positive affect
Anhedonia
Tellegen et al. Psych Science 1999;10:297-303
Larsen et al. J Person Soc Psychol 2001:81:684-96
Positive affect
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Depression, anhedonia and
MACE/mortality: ACS patients
Two core symptoms of depression:
N = 453
(1) Depressed mood; (2) Anhedonia (lack of pleasure/interest)
HR:0.80 [95% 0.47-1.35]*
HR:2.17 [95% 1.26-3.73]*
The two symptoms are distinct with
differential impact on prognosis
* Adjusted HRs
Davidson et al. Arch Gen Psychiatry 2010;67:480-88
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Positive affect moderates the impact of high
negative affect on health status: PCI patients
N = 562
Versteeg, Pedersen et al. Qual Life Res 2009;18:953-60
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Reduced positive affect (anhedonia) and 2year MI/mortality: PCI patients
RESEARCH registry
N = 874
Denollet, Pedersen, van Domburg et al. J Intern Med 2008;263:203-11
Reduced positive affect (anhedonia) and 7year mortality: PCI patients
RESEARCH registry
N = 1206
Figure. Cumulative survival curve for all-cause mortality
P <.001
Stratified by anhedonia
100
22.7%
13.2%
Anhedonia
No anhedonia
p=.003
90
Survival (%)
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80
70
Adjusted* HR: 1.51 [95% CI:1.03-2.22]
60
50
0
2
4
6
8
Follow-up (years)
* Also for negative emotions!
Patients at risk
Anhedonia
286
262
235
205
No anhedonia
920
893
850
732
Damen, van Domburg, Pedersen et al. Eur J Prev Cardiol
2012; Epub ahead of print January 16
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Positive and negative emotions and
mortality: ICD patients
25
P = 0.111
20
N = 591
P < 0.001
15
P = 0.002
Dead (n = 96)
Alive (n = 495)
10
5
0
GMS - NA
GMS - PA
BDI - total
van den Broek, Denollet et al. Int J Cardiol 2011 Sep 29. [Epub
ahead of print]
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Enjoyment of usual activities and mortality:
Medical inpatients
N = 572
HADS item # 1: “I still enjoy
things that I used to enjoy”
Anhedonia
Scherer et al. Gen Hospital Psychiatry 2009;31:8-13
Optimism
and
progression
of
carotid
disease:
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Healthy women
N = 209
Figure 1. Percent increase in IMT during 3 years according to quartiles of LOT scores at study entry 10.4
years earlier where highest quartile is most pessimistic and the lowest quartile is most optimistic. Linear
trend, p < .002; quadratic trend, p < .06
Matthews et al. Psychosom Med 2004;66:640-4
The
heart’s
content:
Positive
emotions
and
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cardiovascular health – a review
Positive psychological well-being - individuals who
function well in their life and evaluate their life favorably
Keywords: Life purpose, personal growth, positive emotions, life
satisfaction, happiness, optimism
Boehm & Kubzansky. Psychol Bulletin 2012:E-pub ahead of print
April 16.
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Main findings - review
Positive psychological well being associated with:
↓ risk of incident CVD
o ↓ progression of CVD
o
independent of traditional risk factors and ill-being
Across both healthy and patient populations, optimism is the
most reliably associated with a reduced risk of cardiac events
Boehm & Kubzansky. Psychol Bulletin 2012 April 16 [E-pub ahead of
print]
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Laughter and cardiovascular health
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Effects of laughter
Short-term effects
• Lighten load mentally
• Enhances intake of oxygen-rich air
• Stimulates heart, lungs and muscles
• Increases endorphins released by the brain
• Activate and relieve stress response  good and relaxed
feeling
Long-term effects
• Improve immune functioning
• Release of neuropeptides that help fight stress and illnesses
• Pain relief – body producing its own natural painkillers
• Increase personal satisfaction
• Make it easier to cope with difficult situations
http://www.mayoclinic.com/health/stress-relief/SR00034
Mirthful
laughter
and
vascular
function
in
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a healthy population
N = 17
Figure 2. Relative (percent) changes (∆) from baseline in brachial artery FMD (A)
and carotid arterial compliance (B) in response to watching a documentary
(closed circles) or a comedy (open circles). * p < 0.05 versus baseline.
Sugawara et al. Am J Cardiol 2010;106:856-9
Overt
expression
of
humour
(laughter)
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and lung function in COPD patients
Amount of air
remaining in
lungs after
normal
exhalation (
in COPD)
N = 22
Increased
hyperinflation
and air trapping
Lebowitz et al. Heart & Lung 2011;40;310-9
Effects
of
laughter
therapy
on
depression
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and cognition in the elderly
Therapy – 1 hour x 4 (weekly)
Ko et al. Geriatr Gerontol Int 2011;11:267-74
N = 109
Effects
of
laughter
therapy
on
sleep
in
the
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elderly
N = 109
Clinical relevance
Ko et al. Geriatr Gerontol Int 2011;11:267-74
CoRPS
Overview
• Negative emotions and cardiovascular health
• Positive emotions: New kid on the block?
o
Positive emotions and cardiovascular health
o
Laughter and cardiovascular health
• Assessment of positive emotions
• Take home message
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Assessment of positive emotions
Scale name
Items Item example
Satisfaction with Life Scale
5
“In most ways my life is close to my ideal”
Positive and Negative Affect Schedule
10
“Enthusiastic”
Subjective Happiness Scale
4
“In general, I consider myself a very happy person”
Personal Growth Scale
3
“I have the sense that I have developed a lot as a
person over time.”
Purpose in Life Scale
3
“I have a sense of direction and purpose in my life”
Self-Acceptance Scale
3
“I like most parts of my personality”
Environmental Mastery Scale
3
“In general, I feel I am in charge of the situation in
which I live”
Life Orientation Test (optimism)
8
“In uncertain times, I usually expect the best”
Boehm & Kubzansky. Psychol Bulletin 2012 April 16 [E-pub ahead of
print]
CoRPS
Overview
• Negative emotions and cardiovascular health
• Positive emotions: New kid on the block?
o
Positive emotions and cardiovascular health
o
Laughter and cardiovascular health
• Assessment of positive emotions
• Take home message
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Take home message
• Negative and positive emotions likely form two separate
constructs and not opposite ends of a continuum
• Negative emotions (e.g. depression) are associated with
incident CVD and CVD progression while positive emotions
(e.g. optimism) seem to have protective effects
• Difference between presence and absence of positive
emotions  e.g. optimism = protective; lack of positive
emotions = risk
• Association likely influenced by assessment tool and
outcome
• Current literature is plagued by methodological
shortcomings – particularly studies on laughter
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Unresolved issues:
• Different positive emotions (covert and overt) and multifaceted
• Unclear what levels of positive emotions are required to
detect associations with cardiovascular health:
o
o
o
Are moderate levels sufficient?
Are high levels or extremely high levels even better?
Is there a dose-response relationship?
• Curvilinear trends in positive emotions are rarely
examined - plausible that manic states or extremely high
levels may not be beneficial to health
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Don’t worry,
be happy!