Being diagnosed with diabetes means that you will need to eat differntly for the rest of your life. This is a major behavioral change, not just for the patient, but often for the family as well. Does the patient eat differently than everyone else (and somebody prepares two different meals), or does the whole family change the way they eat?
Not suprisingly, behavioral treatment has been shown to be an important aspect of effective diabetes control, and this is illlustrated in the following articles:
Steed, L., Cooke, D., & Newman, S. (2003). A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Education & Counseling, 51(1), 5-15.
Norris, S., Zhang, X., Avenell, A., Gregg, E., Bowman, B., Serdula, M., et al. (2004). Long-term effectiveness of lifestyle and behavioral weight loss interventions in adults with type 2 diabetes: a meta-analysis. American Journal of Medicine, 117(10), 762-774
Winkley, K., Landau, S., Eisler, I., & Ismail, K. (2006). Psychological interventions to improve glycaemic control in patients with type 1 diabetes: Systematic review and meta-analysis of randomised controlled trials. BMJ: British Medical Journal, 333(7558)
Icks, A., Rathmann, W., Haastert, B., Gandjour, A., Holle, R., John, J., et al. (2007). Clinical and cost-effectiveness of primary prevention of Type 2 diabetes in a 'real world' routine healthcare setting: model based on the KORA Survey 2000 (Structured abstract), Diabetic Medicine (pp. 473-480).
A number of studies have underscored the relationship between stress and heart disease. Dr. James A. Blumenthal and other researchers at Duke University Medical Center in Durham, North Carolina studied 107 patients with coronary vessel disease and ischemia. It was found that those patients who learned stress management had a lower risk of a future heart attack or of needing cardiac surgery than those who underwent exercise training or those who received standard cardiac rehabilitation care. The stress management training involved weekly group therapy sessions that taught the patients about the relationships between stress and heart disease. After a four month course of stress management training, patients were followed for five years.
The results found that overall the stress management group exhibited a 74% reduction in cardiac events. This consisted of death, heart surgery, angioplasty or myocardial infarction. Stress management training was also found to be associated with improvement in blood fat profiles and reduced ischemia.
SOURCE: Blumenthal JA, Jiang W, Babyak MA, Krantz DS, Frid DJ, Coleman RE, Waugh R, Hanson M, Appelbaum M, O'Connor C, Morris JJ. Stress management and exercise training in cardiac patients with myocardial ischemia. Effects on prognosis and evaluation of mechanisms. Arch Intern Med. 1997 Oct 27;157(19):2213-23.
In another study, Dr. Thomas W. Kamarck of the University of Pittsburgh linked extreme increases in blood pressure resulting from mental stress was found to be associated with a thickening of the carotid arteries which feed blood to the brain. These findings suggest that frequent and prolonged periods of high blood pressure during mental stress may increase the risk of a buildup of fatty deposits in blood vessels that could trigger heart attacks and strokes.
Dr. Kamarck and his team used difficult mental tasks to raise the stress level of subjects, and observed blood pressure and heart rate increases which varied from person to person. Later, the researchers obtained ultrasound images of their carotid arteries. Thickening of the carotid walls indicated atherosclerosis in these arteries and suggested that this disease occurs in other blood vessels as well.
The results found that increased cardiac reactivity to stress was associated with greater carotid artery wall thickness. This in turn is associated with an increased risk of heart disease.
Kamarck TW, Everson SA, Kaplan GA, Manuck SB, Jennings JR, Salonen R, Salonen JT. Exaggerated blood pressure responses during mental stress are associated with enhanced carotid atherosclerosis in middle-aged Finnish men: findings from the Kuopio Ischemic Heart Disease Study. Circulation. 1997 Dec 2;96(11):3842-8.
At the 1997 APA convention in Chicago, Sheldon Cohen PhD reported a very interesting study regarding the relationship between stress and the common cold. In his study, 276 healthy participants were exposed to one of five cold viruses or a saline solution. They were also administered a battery of psychological tests, and quarantined for five days.
The results found that the risk of contracting a cold was related to a number of psychosocial factors. One of the most interesting factors was the number of intimate social roles the person was engaged in, such as parent, spouse, close friend, and nine other roles. The risk of contacting a cold was also related to chronic stress and poor health habits. The findings included the following:
Dr. Cohen's research is summarized in the October 1997 issue of the American Psychological Association Monitor. Dr. Cohen is co-director of the Brain, Behavior and Immunity Center at the University of Pittsburgh Medical School.
In an article published in the Journal of the American Medical Association, 419 patients were found to have hypertension while at their doctor's office. These patients were then provided with portable blood-pressure monitoring devices that constantly measured their blood pressure levels outside of the office. The results found that 26% of the patients suffered from hypertension only while visiting their physician. They were able to stop taking their medication with no ill effects. This suggests that a good deal of the patients who are presently being treated for hypertension may not need to be medicated.
In theory, this may be an example of classical conditioning, like Pavlov's dog. This infamous mutt was conditioned to automatically drool at the sound of a bell. The White Coat syndrome is a more serious variant of this kind of psychophysiological connection, although probably less disgusting. An interesting research project would be to identify other situations or emotions that can lead to blood pressure spikes.
If you are taking medication for hypertension, you should of course continue until your physician recommends otherwise. However, these new out-of-office monitoring techniques may be very helpful in distinguishing White Coat syndrome from true hypertension. Patients should discuss these findings with their physician.
View Research Factoids
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PTI and Clinical Concerns - AAPM 2013
PTI Norms - AAPM 2013
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Predictors for Six Forms of Suicidality in Chronic Pain Patients - APS 2010
Pain Intolerance and Adverse Outcomes in Chronic Pain Patients - APS ????
Psychological Profiles of Rehab Patients Reporting Childhood Sexual Abuse - Paper - APA 1998
Psychological Profiles of Rehab Patients Reporting Childhood Sexual Abuse - Poster - APA 1998
Violent Ideation in Medical Patients in Four Insurance Systems - Paper - APA 1998
Violent Ideation in Medical Patients in Four Insurance Systems - Poster - APA 1998
Comparison of Two BHI Measures of Faking - APA 2000
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Lasting Effects of Childhood Maltreatment: Validation of a Biopsychosocial Model - APA 2012
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Diagnosis Specific Norms for the 0-10 Pain Scale - World Congress on Pain 1999
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