Cardiovascular Disease and Anxiety

White, Kamila S.

doi:10.1007/978-0-387-74753-8_11

Cited by 7 publications

(10 citation statements)

References 175 publications

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“…These findings show that an important subgroup of patients with NCCP show an exaggerated attention to cardiac-congruent sensations, particularly those with psychiatric comorbidity. It remains unclear if the cardiac-congruent hypervigilance and fear identified herein translates to an increase in long-term cardiovascular risk – perhaps through reduced cardioprotective behaviors (i.e., exercise, physical exertion) and/or increased risk behaviors (e.g., sedentary behaviors, social withdrawal; White, 2007). Clinical research examining disease-related risk in this patient group is necessary and timely, particularly because existing data regarding medical outcomes for these patients show a mixed prognosis (Bodegard et al, 2004; Eslick & Talley, 2008; Lichtlen et al, 1995).…”

Section: Discussionmentioning

confidence: 99%

“…Whereas some studies show a good prognosis for NCCP patients following a negative coronary angiography (Lichtlen, Bargheer, & Wenzlaff, 1995), other studies show a higher mortality rate than the normal population (Bodegard, Erikssen, Bjornholt, Thelle, & Erikssen, 2004) or a rate not different from those with cardiac chest pain (Eslick & Talley, 2008). Progress in understanding the syndrome of NCCP is slowed and complicated by the diagnostic classification of NCCP as a ‘diagnosis’ of exclusion (i.e., medical rule-outs) rather than diagnostic inclusion (White, 2007). Yet, longitudinal studies show that patients with NCCP experience chest pain from 1–11 years after the initial evaluation (Papanicolaou et al, 1986; Wielgosz et al, 1984), and nearly half of NCCP patients (44%–50%) continue to believe that they have a cardiac condition up to one-year after negative evaluations (Ockene, Shay, Alpert, Weiner, & Dalen, 1980; Potts & Bass, 1993).…”

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confidence: 99%

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Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders

White

Craft

Gervino

2010

Behaviour Research and Therapy

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We investigated body vigilance, cardiac anxiety, and the mediating role of interoceptive fear on pain in patients with non-cardiac chest pain (NCCP; a syndrome of chest pain in the absence of identifiable organic etiology). Patients were more attentive to cardiac-congruent sensations than cardiac-incongruent sensations (e.g., gastrointestinal, cognitive dyscontrol; p's < .001). Patients with a DSM-IV Axis I anxiety or mood disorder were more body vigilant compared to patients who did not have a disorder (p's < .05). Patients with anxiety disorders were particularly vigilant to and fearful of cardiac sensations relative to patients without anxiety disorders. Latent variable path models examined the extent that interoceptive fear mediated the association between body vigilance and cardiac anxiety on chest pain. Within each model, diagnostic status, body vigilance, and cardiac anxiety were exogenous and predicted interoceptive fear that in turn predicted pain. Separate models examined body vigilance and cardiac anxiety, and both models fit the data well. Findings showed partial mediation for the body vigilance factor, and full mediation for the cardiac anxiety factor. Interoceptive fear played a mediating role in both models. The syndrome of NCCP may persist partly due to conscious hypervigilance to and fear of cardiac-congruent body sensations, particularly among anxious patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders

White

Craft

Gervino

2010

Behaviour Research and Therapy

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“…More than half of patients referred for coronary angiography suffer chest pain that is not cardiac in origin (Papanicolau et al, 1986), and many chest pain patients do not receive a medical explanation for their pain (Kroenke & Mangelsdorff, 1989; Mayou, Bryant, Forfar, & Clark, 1994). Non-cardiac chest pain (NCCP) is the experience of angina-like chest discomfort in the absence of coronary artery disease or other apparent cardiac etiology – sometimes regarded as the sensitive heart because of the abnormal cardiac pain perception in this pain population (Cannon, 2009), for review (White, 2007). With few exceptions (Bodegard, Erikssen, Bjornholt, Thelle, & Erikssen, 2004; Eslick & Talley, 2008), the prognoses of patients with NCCP following a normal coronary angiography have a better prognosis than patients with coronary artery disease (CAD) (Lichtlen, Bargheer, & Wenzlaff, 1995; Papanicolaou et al, 1986).…”

Section: Introductionmentioning

confidence: 99%

Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain

White

McDonnell

Gervino

2011

Journal of Behavior Therapy and Experimental Psychiatry

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The aim of this study was to examine independent and combined influences of alexithymia and anxiety sensitivity on chest pain and life interference in patients with non-cardiac chest pain (NCCP). Theories of NCCP posit a central role for emotion in the experience of chest pain, however, studies have not examined how alexithymia characterized by a difficulty identifying or verbalizing emotions, may influence this relationship. This study examined 231 patients (56% female, M age = 50 years) with chest pain seeking cardiac evaluation who showed no abnormalities during exercise tolerance testing. Forty percent (40%) scored at or above the Moderate range of alexithymia. Whereas health care utilization was associated with elevated alexithymia among men, health care utilization was associated with elevated anxiety sensitivity among women. Hierarchical regression analyses revealed that alexithymia and anxiety sensitivity were both uniquely and independently associated with pain severity and life interference due to pain. Alexithymia-pain links were stronger for men compared to women. Secondary analyses conducted with a subsample suggest that alexithymia may be increasingly stable over time (i.e., 18 month follow-up). Findings are largely congruent with theoretical models of NCCP showing that personality and emotional factors are important in this medically unexplained syndrome.

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“…Each of these indicators of autonomic imbalance is associated with heightened CHD risk, cardiac events, and atherosclerosis. Low HRV and baroreflex dysfunction also have been linked to elevated phobic anxiety, panic, and general anxiety symptoms (White, 2008) which may explain the link between anxiety disorders and CVD.…”

Section: Physiological Mechanismsmentioning

confidence: 99%

“…Individuals with anxiety disorders and elevated anxiety symptoms appear to have higher cholesterol and blood pressure, even when controlling for confounding lifestyle factors (White, 2008). Cholesterol levels have been shown to be elevated up to three times more often in individuals with anxiety disorders compared to controls, and that association held even when accounting for avoidance of exercise due to anxiety and differences in diet (Peter, Goebel, Müller, & Hand, 1999).…”

Section: Cvd Risk Factorsmentioning

confidence: 99%

Psychological Co-morbidities of Physical Illness

Pagoto¹

2011

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except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) v Individuals with psychological disorders are disproportionately affected by chronic disease, which presents a significant health disparity that is underrecognized and underaddressed. Physical and psychological illnesses co-occur more often than not in clinical populations, and this co-occurrence is associated with greater impairment, lower adherence, poor treatment response, lower quality of life, increased healthcare costs, and higher mortality rates. This book is the first comprehensive resource regarding psychological co-morbidities of physical illness. It serves as both a handbook for clinicians who care for patients with co-morbidities as well as a call for research that increases our understanding of the connection between physical and psychological illness, with the ultimate goal of improving the health of people with psychological disorders.A constellation of behavioral, pharmacological, and physiological factors play a role in the increased risk for disease among individuals with psychological disorders. Behavioral factors include higher rates of smoking, obesity, and unhealthy behaviors. Psychopharmacology has also been implicated given that many drugs promote weight gain and metabolic syndrome. Physiological processes of psychological distress, including hypothalamic-pituitary-adrenal axis dysfunction, inflammation, and autonomic dysfunction, can also manifest in the development of chronic disease. In addition to identifying the most prevalent psychological co-morbidities of physical illness, this book explores how behavioral, pharmacological, and physiological factors converge to put individuals with psychological disorders at greater risk for disease.This book is firmly rooted in the philosophy of evidence-based practice and was designed to help narrow the existing research to practice gap. One of the most commonly cited reasons by clinicians for not using evidence-based treatments is that randomized clinical trials do not reflect their consumers who have multiple co-morbidities. Traditionally, randomized clinical trials, by having a disease-specific focus...

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Cardiovascular Disease and Anxiety

Cited by 7 publications

References 175 publications

Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders

Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders

Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain

Psychological Co-morbidities of Physical Illness

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