Essential hypertension and social coping behavior

An Information-Processing Approach to Personal Problem Solving

An information-processing view of personal problem solving is presented, involving the way people take in information, process that information into plans for solutions to personal problems and carry out those plans. An abbreviated view of how we view the effect of some important individual differences is presented. We present a definition of problem, which we see as allowing research that can use methods analogous to those employed in research informal problem solving and in the study of 'experts.' We hope that such research will allow us to target interventions according to particular client weaknesses. We suggest some research directions that have promise of future pay off. Suggestions for counseling are made that derive from our experience in counseling college students.

Stress Coping

This article presents a two-pronged attempt to synthesize the research on stress coping: (1) a review of models and taxonomies of behaviors and resources related to stress coping and (2) a meta-analysis of recent experimental and quasi- experimental studies of stress coping. The review led to the construction of a taxonomy and, in conjunction with the meta-analysis, to a comprehensive model of stress coping in two parts (stress and coping). In the meta-analysis an unbiased effect size of .57 was obtained by comparing groups administered treatments to reduce stress with comparison groups. Social skills training, problem solving, cognitive restructuring, and relaxation training appeared to be among the more effective treatments. In comparing the frequency of treatments identified in the meta-analysis with those in the taxonomy, some treatment domains (such as problem solving) were well represented in the taxonomy but appeared infrequently in the meta-analysis. Implications for stress-coping treatment and research are offered.

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.

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.

Anger suppression, reactivity, and hypertension risk: gender makes a difference

The present study investigated gender-related differences in cardiovascular reactivity and the role of anger inhibition and risk for future hypertension. Tonic blood pressure served as an index of hypertension risk. Twenty-eight female and 26 male college students with high and low normal blood pressure were recruited on the basis of their mean arterial pressure. Continuous measures of heart rate and blood pressure were taken while participants carried out a series of behavioral manoeuvres including mental arithmetic, interpersonal challenge, a frustrating psychomotor test, and the cold pressor test. Participants also completed inventories assessing trait anxiety, trait anger, anger expression, and Type A. The results are in concordance with previous findings and show higher cardiovascular reactivity in men than in women and in subjects at risk for hypertension. Within the male group, a combination of hypertension risk and anger suppression led to the highest reactivity, whereas in female subjects, differences in anger-in had no effect on reactivity. The implications of these results are discussed in light of sex differences in cardiovascular morbidity and mortality.

Stress-management training for essential hypertension: a controlled study

Forty three patients with essential hypertension participated in a study on the effectiveness of stress-management training for essential hypertension. After 6-9 clinic and 48 self-measured readings of systolic and diastolic blood pressures (SBP and DBP), 22 patients were treated with a program based on education, relaxation, and problem-solving training; and another 21 patients were assigned to a waiting list control group. At post-treatment, mean reductions of clinic BP (17/13 mm Hg vs. 6.9/4.7 mm Hg for SBP/DBP), percentages of subjects who achieved at least a 5 mm Hg reduction (86/86% vs. 48/48% for SBP/DBP) and percentages of subjects who in addition achieved a normotensive level (59/68% vs. 29/14% for SBP/DBP) were significantly higher in the treated group than in the control group. Concerning self-measured BP, the effectiveness of the stress-management training was not so considerable (mean reductions of 3.6/2.4 mm Hg and percentages of subjects who achieved a 5 mm Hg reduction of 52/38% for SBP/DBP), but it was significant and maintained in a 4-month follow-up assessment (mean reductions of 4/2 mm Hg and percentages of subjects who achieved a 5 mm Hg reduction of 48/33% for SBP/DBP). It is suggested that stress-management training can be beneficial for treatment of essential hypertension.

Alexithymia in essential hypertensive and psychiatric outpatients: a comparative study

The purported association between alexithymia and essential hypertension was investigated in a sample of 114 hypertensive patients using the well-validated twenty-item Toronto Alexithymia Scale. Alexithymia was also assessed in a group of 113 general psychiatric outpatients and in a group of 130 normal adults. A rate of 55.3% of alexithymia was found in the hypertensive group compared with significantly lower rates of 32.7% in the psychiatric group and 16.3% in the normal controls. The results support the view that a high prevalence of alexithymia may be found among patients with disorders that were categorized in the past as "classical" psychosomatic diseases. It is hypothesized that a deficit in the cognitive processing and modulation of emotions may leave alexithymic individuals prone to states of heightened sympathetic arousal that are conducive to the development of essential hypertension.

Psychosocial factors in youth and at working age as predictors of blood pressure. A prospective study

This prospective study focused on childhood and adult psychosocial determinants of blood pressure (BP) measured at working age, including work factors, individual characteristics and socioeconomic factors. Data had been collected over 20 years ago from a sample representative of Finnish children. For this follow-up, 150 subjects responded to a questionnaire and attended a personal examination at the mean age of 37 yr. Hierarchical regression analyses were made for women and men. A split half procedure was applied for the control of possible chance associations. Work conditions and perceived health were not associated with BP. Social conditions in youth were powerful predictors of high adult BP for men. Poor living conditions in youth explained 16% of their diastolic BP and 9% of their systolic BP. The result may be regarded as strong evidence for early determinants of hypertension.

Family history of hypertension and cardiovascular changes during high and low affect provocation

The present study investigated whether subjects with a positive family history of hypertension would display differential responses in blood pressure and heart rate across different laboratory tasks. We also wanted to know whether subjects would display stable within-subject responses across different laboratory tasks. Twenty-three family history positive subjects and 23 with a negative family history participated in three tasks: 1) mental arithmetic, 2) a conversation about the weather (low affect task), and 3) a conversation about a recent upsetting, interpersonal event (high affect task). Positive family history was associated with elevated diastolic resting blood pressure and greater diastolic responsivity overall. For both groups, arithmetic was associated with the greatest heart rate changes, whereas the distressing conversation was accompanied by the greatest diastolic blood pressure response. Stability of cardiovascular activation across different tasks was present only for heart rate; it was weak for diastolic blood pressure, and completely absent for systolic blood pressure.

Understanding hypertensives' behaviour. II: Perceived social approval and blood pressure reactivity

The influence of perceived social approval on blood pressure reactivity was investigated in two stages. Initially, a new procedure was devised to measure the reaction to initial stimuli in subjects where base rate determination had not occurred. Minimal public self disclosure was shown to have a greater pressor effect for borderline hypertensives than normotensives. The two groups remained clearly distinguishable after exercise. Perceived level of social approval on physiological response in two groups of reactive borderline hypertensives was then investigated in the laboratory. Blood pressure level rose during an arithmetic task for all subjects. A large increase in blood pressure variability was specific to the self disclosure task and only for those who perceived low social approval. The ramifications are discussed.

Fear, alexithymia and cancer pain

The purpose of this study was to examine the differential role of fear, anxiety, alexithymia, family factors and coping in cancer pain. Twenty-seven patients with pain related to cancer, 26 patients with chronic non-cancer pain, 26 patients with chronic illness but no pain (hypertensives) and 24 healthy controls completed a set of questionnaires during an initial interview and recorded severity and duration of pain, pain interference with activities, thoughts, behaviors and physiological responses associated with fear of pain, and coping strategies using a diary once daily for 7 days. In general, cancer patients reported lower pain levels than patients with chronic non-cancer pain. Contrary to anecdotal reports, cancer pain patients did not report fear of pain. Cancer patients and patients with chronic non-cancer pain reported similar levels of trait anxiety which was higher than non-pain patients. Alexithymia, as a measure of emotional expression, was associated with increased duration of pain in the cancer pain patients. Cancer pain patients also reported less use of coping strategies than patients with chronic non-cancer pain. Cancer patients did not report higher levels of family modeling of pain complaints or family use of medication. The perceived family environment of the cancer pain patient did not differ significantly from the 3 other groups. These results do not support anecdotal impressions that the level of reported pain and fear of pain is significantly greater in cancer pain in contrast to non-cancer pain. The results do indicate the importance of emotional expressivity in the modulation of cancer pain where the ability to assess and express emotions was associated with reduced pain.

Checklists for measuring response style in hypertensives

The need for more clearly identifying the reporting behaviour of hypertensives was addressed. An objective method of measuring reporting behaviour was developed: the Life Concerns checklist. This checklist was able to discriminate subjects defined as introspective self-doubters from those who reported either psychosomatic disorders or who blamed the environment for their problems. This checklist was also able to verify that hypertensives do have lower report rates than normotensives. The Perception of Social Acceptability of Reporting Concerns Checklist (Persolac) measured the number of specific concerns perceived to be socially acceptable to report, of which there were less for males and which in all cases varied according to whom the concerns were to be disclosed. The two checklists are presented as adjuncts to other questionnaires for use in exploring the response of individuals with essential hypertension.

Essential hypertension and social coping behavior: experimental findings

The present study investigated the hypothesis that mild hypertensives display a distinctive response pattern to interpersonal stress that includes: inadequate social skills, negative cognitive set and cardiovascular hyperreactivity. After completing a set of questionnaires measuring anxiety and cognitive style, subjects monitored interpersonal stress in the natural environment. Following this, blood pressure and heart rate were recorded while subjects interacted with trained role-players in two types of role-play situations: individualized high distress and low distress situations. Hypertensives reported comparable anxiety and were evaluated as equally skilled when compared to normotensives. The cognitive reaction pattern however, discriminated between the groups with hypertensives perceiving less stress and displaying a 'repressive-defensive' cognitive style. Hypertensives displayed a hyperresponse on systolic blood pressure but not on heart rate. With regard to diastolic pressure, controls reacted according to prediction with high distress situations resulting in greater diastolic change than low distress situations. Hypertensives, however, showed the reverse of this pattern with no increase in diastolic pressure during the high distress situations.

Density of dormitory living and stress: mediating effects of sex, self-monitoring, and environmental affective qualities

Mediating effects of sex, self-monitoring, and environmental perception were examined in a study of the effects of social density on stress. Subjects were 53 male and 49 female dormitory residents living in single ( n=38) vs triple ( n=64) occupancy rooms. Measures of stress included blood pressure, heart rate, and psychosomatic symptomatology. It was hypothesized that the potential negative effects of high density would be greatest for males, low self-monitors, and persons judging their environment as relatively arousing and unpleasant. None of the major hypotheses were supported, and there was a tendency for singles to have higher mean systolic and diastolic blood pressure and greater diastolic variability.