Biomedical subjects

Wolfgang Linden

Publications and source records attributed to Wolfgang Linden.

At least 19 recordsLinked to original sources

PubMed2006

Influence of apologies and trait hostility on recovery from anger.

While there is growing evidence that quick recovery from stress is health-protective, relatively little is known about what factors affect recovery rates. We tested whether recovery from anger can be diffused with apologies. 184 participants performed a stress task involving verbal harassment and apologies. Participants were randomly assigned to one of four conditions: non-harassed control, good apology, pseudo-apology, or no apology. Measures of blood pressure and heart rate were taken at baseline, task and recovery periods. Participants scoring high in trait hostility displayed faster systolic blood pressure recovery when they received a genuine apology, but recovered more slowly when they received a pseudo-apology or no apology. Apologies did not influence subjective anger ratings. It was concluded that apologies may accelerate cardiovascular anger recovery among those with hostile personality predispositions.

Adaptation, Psychological↗

PubMed2006

Cognitive dietary restraint and cortisol: importance of pervasive concerns with appearance.

The purpose of this study was to elucidate the nature of the relationship between dietary restraint and physiological stress, by investigating which eating and body-related constructs are related to salivary cortisol and to perceived stress. Female undergraduates (N = 170) completed self-report measures on dietary restraint, appearance beliefs, body satisfaction variables, perceived stress, and eating self-efficacy. Participants also provided two saliva samples. The first sample was collected after awakening, and the second was collected 6-8 h later. A factor analysis was performed in order to reduce redundancy in the set of measures surrounding eating and body attitudes, which yielded three factors. The findings indicated that women with stronger beliefs about the importance of their appearance, as well as negative emotions and cognitions surrounding their body image, had higher levels of cortisol in the afternoon. These appearance and body-related constructs were also associated with higher levels of perceived stress. However, perceived stress was not associated with salivary cortisol. There were no significant relationships between any of the eating or psychological variables and morning cortisol levels. These results suggest that dysfunctional cognitions surrounding appearance and body image significantly contribute to the relationship between dietary restraint and elevations in cortisol excretion. Implications for interventions and women's health are discussed.

Adolescent↗

PubMed2006

The efficacy of behavioral treatments for hypertension.

Evidence is reviewed for the efficacy of behavioral treatments for hypertension. The format chosen here is a review of reviews given that numerous consensus committee reports and quantitative reviews on the topic have been published. Extensive evidence from over 100 randomized controlled trials indicates that behavioral treatments reduce blood pressure (BP) to a modest degree, and this change is greater than what is seen in wait-list or other inactive controls. Effect sizes are quite variable. The observed BP reductions are much greater when BP levels were high at pre-test, and behavioral studies tend to underestimate possible benefits because of floor effects in their protocols. Blood pressure measured in the office may be confounded with measurement habituation. Multi-component, individualized psychological treatments lead to greater BP changes than do single-component treatments. Among biofeedback treatments, thermal feedback and electrodermal activity feedback fare better than EMG or direct BP feedback, which tend to produce null effects. There continues to be a scarcity of strong protocols that properly control for floor effects and potential measurement confounds.

Behavior Therapy↗

PubMed2006

The effect of oral appliance therapy on blood pressure in patients with obstructive sleep apnea.

The objective of the study was to investigate the effects of oral appliance (OA) therapy on ambulatory blood pressure in patients with obstructive sleep apnea (OSA). Eleven OSA patients who received OA therapy were prospectively investigated. Ambulatory blood pressure was measured for 20 h from 4:00 P.M.: to 12:00 noon the next day using an ambulatory blood pressure monitor. The Respiratory Disturbance Index (RDI) was measured in the pretreatment and posttitration periods. The OA was titrated to reach a therapeutic jaw position over 2 to 8 months, and posttitration measurements were repeated. At posttitration, the RDI was significantly decreased from a mean (SD) of 24.7 (20.1) to 6.1 (4.5). Significant reductions in diastolic blood pressure (DBP) and mean arterial pressure (MAP) were found for the 20-h periods, and systolic blood pressure (SBP), DBP, and MAP while asleep. The mean values were 79.5 (5.5) to 74.6 (6.0) for DBP and 95.9 (5.4) to 91.2 (5.9) for MAP, for over a 20-h period, and 118.4 (10.0) to 113.7 (9.1) for SBP, 71.6 (8.0) to 67.2 (7.9) for DBP, and 88.4 (8.0) to 83.9 (7.5) for MAP, while asleep. This study suggests that successful OSA treatment with an OA may also be beneficial to lower blood pressure in OSA patients, as previously suggested for nasal continuous positive airway pressure therapy.

Activator Appliances↗

PubMed2006

The Extensive Lifestyle Management Intervention (ELMI) after cardiac rehabilitation: a 4-year randomized controlled trial.

BACKGROUND: Previous reports indicate risk factors and lifestyle behaviors may deteriorate early after completion of a cardiac rehabilitation program (CRP). We hypothesized that a modest risk factor and lifestyle management intervention after a CRP would significantly reduce overall cardiovascular risk using the Framingham risk score compared with usual care after 4 years. METHODS: Patients with ischemic heart disease (n = 302) were randomized after a CRP to either usual care or intervention (exercise sessions, telephone follow-ups, counseling sessions, and reports to the participants' family physicians). The Framingham risk score, risk factors, and lifestyle behaviors were compared after 4 years. RESULTS: Data were available for 130 intervention and 119 usual care participants. The intervention resulted in 15.5 hours of direct participant contact. Framingham score, total cholesterol, low-density lipoprotein cholesterol, and systolic blood pressure were significantly improved in the intervention group after adjusting for baseline factors. There were no significant differences with respect to lifestyle factors between the groups. CONCLUSIONS: A modest risk factor and lifestyle management intervention resulted in a significant reduction to global risk compared with usual care and should be considered after CRP.

Aged↗

PubMed2006

High cognitive dietary restraint is associated with increased cortisol excretion in postmenopausal women.

BACKGROUND: Cognitive dietary restraint (perceived ongoing effort to limit dietary intake to manage body weight) is common in women at all life stages. In young women, high dietary restraint has been associated with both increased excretion of cortisol (a stress hormone) and reduced bone mass. Whether this occurs in older women is unknown and is reported here for the first time. METHODS: Postmenopausal women (49-75 years old) with high (n = 41) or low (n = 37) dietary restraint were compared to examine differences in urinary cortisol excretion, body composition assessed by dual-energy x-ray absorptiometry (bone mineral density, % body fat), dietary intake, anthropometrics, current exercise, and perceived stress. RESULTS: Women with high or low dietary restraint did not differ in age, body mass index, waist-to-hip ratio, energy intake, perceived stress, current exercise, or measures of body composition. However, urinary cortisol excretion was higher in the high restraint group (248.2 +/- 61.7 nmol/d vs 204.3 +/- 66.1 nmol/d; p =.01). Multiple regression analysis indicated that restraint group (high or low) independently predicted 7.6% of the variance in cortisol excretion. CONCLUSIONS: Postmenopausal women with high dietary restraint excrete more cortisol than do those with low restraint, suggesting that dietary restraint may be a source of stress. Although this was not associated with negative health effects in this sample, further investigation is warranted.

Aged↗

PubMed2005

A new potential marker for abnormal cardiac physiology in depression.

The purpose of the study was to determine if a nonlinear estimate of dimensional complexity, Pointwise correlation dimension (Pd2), could be used to identify abnormal cardiac physiology associated with depression in primary care outpatients. The subjects were 22 medical controls and 30 general medical outpatients with depression who wore a cardiac monitor for 24 h. There was a significant difference between depressed and control subjects for Pd2 based on the entire cardiac time-series, with depressed subjects exhibiting higher Pd2 values. A cutoff score reflecting high dimensional complexity was selected, and an odds ratio was calculated demonstrating that patients with Pd2 values above the cut-off were 8.8 times more likely to fall in the depressed group than the control group. Additional research is needed to determine if Pd2 is useful for identifying physiological markers of depression.

Adult↗

PubMed2005

Development and validation of a psychosocial screening instrument for cancer.

BACKGROUND: We are reporting on the development of a psychosocial screening tool for cancer patients. The tool was to be brief, at a relatively low reading level, capture psychological variables relevant to distress and health-related quality-of-life in cancer patients, possess good reliability and validity, and be free of copyright protection. METHOD: Item derivation is described, data on reliability and validity as well as norms are reported for three samples of cancer patients (n = 1057; n = 570, n = 101). RESULTS: The resulting 21-item psychological screen for cancer (PSCAN) assesses perceived social support, desired social support, health-related quality-of-life, anxiety and depression. It has good psychometrics including high internal consistency (alpha averaging .83, and acceptable test-retest stability over 2 months (averaging r = .64). Validity has been established for content, construct and concurrent validity. CONCLUSION: PSCAN is considered ready for use as a screening tool and also for following changes in patient distress throughout the cancer care trajectory. It is freely available to all interested non-profit users.

Aged↗

PubMed2005

The importance of examining blood pressure reactivity and recovery in anger provocation research.

OBJECTIVE: We investigated the moderating relationship of hostility on emotional and physiological arousal due to acute anger provocation; stress reactivity and recovery were measured. METHOD: Forty-five participants completed a measure of trait hostility (CMHQ) and performed a mental arithmetic (serial 7s) task while receiving scripted comments at set intervals designed to provoke anger (harassment). The impact of trait hostility (high, medium or low) on arousal and recovery was examined. RESULTS: Participants low in self-reported hostility showed greater HR reactivity to the task but recovered quickly. Participants high in hostility showed noticeably slower recovery in SBP maintained after task completion. CONCLUSIONS: The findings underscore the importance of examining both reactivity and recovery data in anger provocation research because the apparent influence of trait hostility on cardiovascular functioning would have been missed if recovery had not been systematically studied.

Adolescent↗

PubMed2005

Curvilinear relationships of expressed anger and blood pressure in women but not in men: evidence from two samples.

OBJECTIVE: Early psychosomatic research proposed a hydraulic model for anger expression and blood pressure (BP); that is, people who express their anger were believed to have lower BP. Unfortunately, subsequent evaluations of this model have produced inconsistent results. In this paper, it is posited that weak methods of measuring BP, failure to address gender differences, and exclusive emphasis on linear models may have contributed to inconsistent results. DESIGN AND MEASURES: We investigated the possibility of curvilinear relationships between expressed anger and resting BP after controlling for traditional risk factors. PARTICIPANTS: Data from two samples of varying cardiovascular health status (one healthy, the other hypertensive) and ages were examined. RESULTS: Across both samples, very low and very high self-reported expressed anger was associated with the lowest diastolic BP in women. There was no equivalent finding in men. CONCLUSION: Women, but not men, have lower BP when they report to openly express their angry feelings. The results support the value of exploring curvilinear relationships and gender differences in anger expression effects on cardiovascular health.

Anger↗

PubMed2004

Stress management: what is it?

Stress management (SM) is a widely used term with a seemingly obvious meaning. The research literature contains many studies evaluating its effectiveness, but it is not clear how many different forms of SM exist and how efficacious they are for which target problem. One hundred and fifty-three studies on SM were analyzed to determine consensus in definitions and therapy protocols. Results showed that a typical delivery format exists (mostly group form, 8-10 sessions in length and multitechnique), but the number of techniques used was very large, techniques were inconsistently labeled are often poorly described. It is concluded that in outcome research, the term "stress management" is operationally defined with such variability that comparisons of SM outcome studies are not meaningful at this time.

Adaptation, Psychological↗

PubMed2004

Appearance versus health: does the reason for dieting affect dieting behavior?

This study investigated whether dieting out of concern for one's health, as opposed to for appearance reasons, is associated with the same negative consequences normally associated with chronic dieting. One hundred student and 96 community women dieters completed measures of various eating behaviors, psychological variables, and motivations behind their dieting. The findings indicated that individuals who were motivated to change their appearance through dieting were younger than those dieting to improve their health. They were also more likely to use drastic dieting strategies, and to score higher on measures of disinhibited eating, or lapses in restraint. On the other hand, dieting driven by health concerns was associated with fewer negative sequelae. These results suggest that not all dietary behavior labelled as "dieting" is equally harmful, and that the driving force behind the dieting is a more important factor to consider than dietary restrictions per se.

Adult↗

PubMed2004

Self-organizing neural network analyses of cardiac data in depression.

OBJECTIVE: To determine if an unsupervised self-organizing neural network could create a clinically meaningful distinction of 'depression' versus 'no depression' based on cardiac time-series data. DESIGN: A self-organizing map (SOM) was used to separate the time-series of 84 subjects into groups based on characteristics of the data alone. MATERIALS AND METHODS: Analyses included natural log transformations and two types of filtering to enhance characteristics of the data as well as classifications of unprocessed data. A Pearson chi(2) analysis was performed to determine if the SOM groups bore any relation to the binary clinical groups. RESULTS: Overall correct SOM classifications ranged from 54 to 70.2% with two classifications being clinically meaningful. CONCLUSIONS: SOM classifications of cardiac time-series data with enhanced ultradian variations and cardiac data recorded around the interval when a person was in bed were useful in differentiating clinically meaningful subgroups with and without depression.

Adult↗

PubMed2004

Anger response styles and blood pressure: at least don't ruminate about it!

BACKGROUND: Research on anger suggests a link with blood pressure (BP), but the findings are complex and highly variable; this is at least partly attributable to measurement issues. PURPOSE: In this study we used a new model of anger responding that comprises 6 independent anger response styles in 2 dimensions: Aggression, Assertion, Social Support Seeking, Diffusion, Avoidance, and Rumination. Linear and interactive relations between the anger response styles and resting and ambulatory BP were tested, controlling for traditional risk factors and level of hostility. METHODS: Data from 2 samples of different cardiovascular health status were examined. In Study 1, 109 healthy participants (45 men and 64 women) were recruited. Study 2 involved a sample of 159 hypertensive patients (90 men and 69 women). All participants provided demographic and health information; completed the Behavioral Anger Response Questionnaire, a hostility measure; and underwent resting BP measurement. Study 2 participants also provided 24-hr ambulatory BPs. RESULTS: Examination of linear effects revealed inconsistent associations between anger response styles and BP. The moderating effect of Rumination on the relationship between the other anger response styles and BP was examined next. Rumination had a deleterious influence on the relation between Avoidance and Assertion and resting and ambulatory BP levels. The moderating influence of Rumination on Social Support Seeking varied between the genders. CONCLUSIONS: Overall, the results suggest that rumination is a critical moderating variable in the relation of anger and BP.

Adaptation, Psychological↗

PubMed2003

The Extensive Lifestyle Management Intervention (ELMI) following cardiac rehabilitation trial.

AIM: Previous studies have reported lifestyle and risk factor deterioration following completion of a cardiac rehabilitation program (CRP). We report the results of a one-year Extensive Lifestyle Management Intervention (ELMI) aimed at preventing these adverse changes. METHODS AND RESULTS: A total of 302 men and women with ischaemic heart disease were recruited following completion of a CRP and randomized to either the ELMI (consisting of exercise sessions, telephone follow-ups and risk factor and lifestyle counselling) or usual care. The primary outcome was global cardiovascular risk using the Framingham and Procam risk scores. Secondary outcomes included risk factors and lifestyle behaviours. Baseline characteristics were similar between the two groups. Adherence to the ELMI was high. There was a non-significant trend in favour of the ELMI between for both the Framingham (6.6+/-3.1 to 6.2+/-2.9 vs 6.6+/-3.2 to 6.7+/-3.2, P=0.138) and Procam (20.0+/-20.0 to 20.6+/-19.5 vs 19.1+/-18.7 to 21.8+/-19.1, P=0.089) scores. There were no differences in secondary outcomes. CONCLUSIONS: A one-year multi-factorial post-CRP intervention results in modest, non-significant benefits to global risk compared to usual care. The absence of deterioration in the usual care group may be due to improved practices in usual care.

Angioplasty, Balloon, Coronary↗

PubMed2003

Type D personality is related to cardiovascular and neuroendocrine reactivity to acute stress.

OBJECTIVE: The relationship between Type D personality (the joint tendency towards negative affectivity [NA] and social inhibition [SI]) and laboratory indices of cardiovascular health was examined. METHOD: 173 undergraduates (86 male) completed a stress protocol involving a mental arithmetic task with harassment. Blood pressure, heart rate (HR), and salivary cortisol were measured both prior to and during the task. RESULTS: The relationships between personality and both resting and reactivity levels were examined. Results indicated that socially inhibited men demonstrated heightened blood pressure reactivity. NA was related to dampened HR change during the stress task in men. Correlational analyses indicated that both Type D dimensions were associated with greater cortisol reactivity to stress; however, results no longer remained significant in more stringent regression analyses. CONCLUSION: Findings are consistent with the noted relationship between Type D and cardiovascular disease (CVD), and suggest a possible pathway to disease via an association with physiological hyperreactivity.

Adult↗

PubMed2003

There is more to anger coping than "in" or "out".

There is growing dissatisfaction with a dichotomized "anger-in" versus "anger-out" view of anger coping. Three studies using student and community adultsamples revealed a broader understanding of the nature of anger coping styles and led to the development of the new Behavioral Anger Response Questionnaire (BARQ). The BARQ is empirically derived and factorially validated and has good psychometrics. Results suggest that dichotomizing anger responses as "in" versus "out" is too coarse and that a 6-factor model may be more appropriate. The 6 factors identified here are Direct Anger-Out, Assertion, Support-Seeking, Diffusion, Avoidance, and Rumination. Women reported use of a wider range of anger coping styles, especially more social support-seeking and more use of anger diffusion strategies than men.

Adaptation, Psychological↗

PubMed2003

Psychologic treatment for hypertension can be efficacious.

The traditional view of psychologic treatments and their efficacy for treating primary hypertension is that they may be of some benefit for borderline hypertension and that they can be potentially useful adjuncts to medical treatment. This review challenges such cautious conclusions by critically analyzing previous reviews and by also considering innovative, newer clinical trials. One reason for cautious conclusions has been selective reviewing and a lack of well-designed trials. Measurement and study protocol differences as well as differences in treatment modality have all been shown to have major effects on observed outcomes. Studies that promise better results have the following characteristics: 1) use of 24-hour ambulatory monitoring as an end point to rule out white coat hypertension that does not need treatment in the first place; 2) inclusion of patients with truly elevated blood pressure at pretreatment; and 3) multicomponent treatments that are tailored to individual patient needs.

Antihypertensive Agents↗