Expectancies mediate the relationship between perceived injustice and return to work following whiplash injury: A 1-year prospective study

BACKGROUND

Emerging evidence suggests that perceived injustice is a risk factor for work disability in individuals with whiplash injury. At present, however, little is known about the processes by which perceived injustice impacts on return to work. The purpose of this study was to examine whether expectancies mediated the relationship between perceived injustice and return to work in patients with whiplash injury.

METHOD

One hundred and fifty-two individuals (81 men, 71 women) with a primary diagnosis of whiplash injury completed self-report measures of pain intensity, perceived injustice and return-to-work expectancies following admission to a rehabilitation programme. Work status was assessed 1 year after discharge.

RESULTS

Consistent with previous research, high scores on a measure of perceived injustice were associated with prolonged work disability. Results indicated that high perceptions of injustice were associated with low return-to-work expectancies. Causal mediation analyses revealed that expectancies fully mediated the relationship between perceived injustice and return to work.

CONCLUSION

The findings suggest that intervention techniques designed to target expectancies could improve return-to-work outcomes in patients with whiplash injury. Discussion addresses the processes by which expectancies might impact on return-to-work outcomes and the manner in which negative return-to-work expectancies might be modified through intervention.

SIGNIFICANCE

The study confirms that expectancies are the mechanism through which perceived injustice impacts return to work following whiplash injury. The findings suggest that interventions designed to specifically target return-to-work expectancies might improve rehabilitation outcomes in patients with whiplash injury.

Applied tension may help retain donors who are ambivalent about needles

BACKGROUND

Vasovagal symptoms can discourage people who might otherwise give blood on many occasions. However, the effects of symptoms on donor retention as well as the effects of treatments to reduce vasovagal symptoms on donor retention are probably moderated by a person's confidence that they can tolerate the procedure.

METHODS

Data from a study on the effects of the muscle tensing technique applied tension (AT) on donor retention were examined to determine if (1) the degree of donor ambivalence about needles influenced the impact of vasovagal symptoms on subsequent return and (2) ambivalence about needles moderated the effect of learning AT on donor return. One-year follow-up data on 614 people who had previously given blood and were randomly assigned to either a no treatment, donation-as-usual condition or one of two conditions involving AT were obtained. Self-reported degree of needle ambivalence and vasovagal symptoms were assessed during the initial blood donation.

RESULTS

Among participants in the no treatment group, increases in vasovagal symptoms were associated with decreases in donor return but only among people who expressed some fear of blood draws. Similarly, among people who expressed no fear of needles, learning AT had no effect on post-donation estimate of the likelihood they would give blood again or return rate. However, among people with some fear of blood draws learning AT led to both a higher estimate that they would give blood again as well as actual return rate.

CONCLUSIONS

The experience of vasovagal symptoms may not deter people who are generally confident in their ability to tolerate blood donation. However, among people who are ambivalent about needles, symptoms may 'confirm' pre-existing doubts about their suitability for blood donation and lead to drop-out. Targeted interventions that give the uncertain volunteer a sense of confidence that they might be able to realize their goal and become a regular blood donor may be useful.

The role of ischaemia and pain in the blood pressure response to exercise stress testing in patients with coronary heart disease

Silent myocardial ischaemia is a common phenomenon in patients with coronary heart disease. However, very little is known about the underlying mechanisms of silent ischaemia. One potential pathway that may contribute to this absence of pain is increased blood pressure. The main aim of the current study was to assess the associations among blood pressure, pain and ischaemia in patients undergoing a standard exercise stress test. We hypothesized that patients who experienced chest pain during exercise would have lower baseline and peak blood pressures compared to those who did not experience chest pain. A total of 1,355 patients (418 women) who underwent a single-photon emission computed tomography treadmill exercise stress test and had not experienced a cardiac event in the past 2 weeks participated in the current study. Myocardial perfusion defects were assessed at rest and during the stress challenge. Systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR) and rate pressure product (RPP) were assessed during rest and at peak exercise. There were no main effects of either pain or ischaemia on the baseline cardiovascular variables. Peak exercise data revealed main effects of pain on SBP, RPP and HR, and main effects of ischaemia on SBP and RPP, controlling for age, sex, baseline level, medication status and cardiac history. These findings suggest that acute rather than chronic increases in blood pressure may be one mechanism to explain the phenomena of silent myocardial ischaemia in cardiac patients, and may potentially provide a target for future treatment strategies.

Prevalence, disclosure and interpretations of sexual activities in a sample of Canadian college-aged blood donors

This study assessed the prevalence, level of disclosure, and interpretations of sexual activities in a sample of 123 college-aged blood donors in Montreal, Quebec. Within six months of their donation, participants completed an anonymous questionnaire designed to assess sexual definitions, levels of disclosure to sexual partners, as well as prevalence of various blood safety behavioural risks. Responses indicated that (1) there was a lack of consensus regarding what constitutes 'sex', (2) levels of sexual disclosure varied widely, and (3) participants engaged in numerous blood safety behavioural risk activities. These results are discussed with respect to their implications for how people think about sex, particularly in the blood donation context. Suggestions to improve specific blood donor screening questions are also presented.

Interpersonal behavior and resting blood pressure in college women: a daily monitoring study

Psychological factors have long been implicated in the development of hypertension. Most studies exploring this relationship employed questionnaires administered on only one occasion.

OBJECTIVE

to evaluate the relation between blood pressure and social behavior in the natural environment over an extended period of time.

METHOD

40 healthy young adult women at varying risk for hypertension were asked to record their behavior and affect following social interactions, three times a day for 32 days. Behaviors were representative of the interpersonal circumplex: dominance, submissiveness, agreeableness, and quarrelsomeness.

RESULTS

Casual blood pressure was significantly correlated with submissive behavior (r=.45, P<.05) and inversely correlated with agreeable behavior (r=-.35, P<.05). ANOVAs confirmed these findings and further revealed that offspring of hypertensives with relatively elevated blood pressure were most quarrelsome.

CONCLUSION

These results concur with the literature on the relationship between hostility and blood pressure but also suggest the importance of submissiveness in college women.

Cardiopulmonary baroreflex stimulation and blood pressure-related hypoalgesia

Results from both experimental animals and humans suggest that baroreflex stimulation may be involved in blood pressure-related hypoalgesia. However, most of this research, especially in the area of human experimentation, has focused on sinoaortic baroreceptors. Cardiopulmonary baroreflex stimulation may also be an important moderator of pain. Sixty-six healthy male undergraduates varying in risk for hypertension participated in an experimental protocol in which painful mechanical finger pressure was presented three times in a counterbalanced fashion. One pain stimulus was preceded by 6 min of supine rest, another by a period of rest interspersed with periodic Valsalva manoeuvres, and another by a period in which cardiopulmonary baroreceptors were stimulated by passive leg elevation. Significantly lower pain was reported by men with relatively elevated systolic blood pressure following leg elevation but not the other conditions. Cardiopulmonary baroreflex stimulation was documented by increased forearm blood flow and other data obtained via impedance cardiography. These results suggest that blood pressure related hypoalgesia may be at least partially related to cardiopulmonary baroreflex stimulation.

Risk for hypertension and diminished pain sensitivity in women: autonomic and daily correlates

Research suggests an association between risk for hypertension and decreased pain sensitivity. However, few studies have utilized non-behavioral indices of pain to corroborate subjective reports or sought to generalize these findings to women. Furthermore, it has not been established whether results obtained using well-controlled laboratory pain stimuli extend to naturalistic pain. In Study 1, 80 young adult women with (N = 40) and without (N = 40) a parental history of hypertension and with either normatively low or high resting systolic blood pressure (SBP) were exposed to two experimental pain stimuli, finger pressure and the cold pressor test. In addition to behavioral pain measures, respiratory sinus arrhythmia (RSA) reactions to pain were also assessed. Women with a parental history of hypertension and/or normatively high resting SBP experienced significantly less pain, as assessed by both behavioral and RSA measures. In Study 2, 37 of the participants from Study 1 monitored their behaviors, affect, and physical symptoms, three times a day for 32 days. Laboratory pain sensitivity was significantly correlated with daily reports of pain but not gastrointestinal symptoms. The present results confirm an association between risk for hypertension and hypoalgesia in women and suggest generalizability of this relationship to everyday life.

Risk for hypertension and pain sensitivity in adolescent boys

Reduced pain perception has been observed in many studies of spontaneously hypertensive rats and human hypertensive patients. To determine whether a reduced sensitivity to pain could be observed in a group of clearly normotensive individuals who may be at risk for hypertension, a mild to moderate pain stimulus was administered to 177 14-year-old boys. Boys with a normatively elevated resting systolic blood pressure tolerated mechanical finger pressure significantly longer than boys with lower blood pressure. As well, boys with both normatively elevated resting systolic blood pressure and a parental history of hypertension reported significantly less pain during finger pressure than lower risk participants. These findings could not be explained by personality factors and suggest that hypertension-related hypoalgesia is associated with processes involved in the development of the disorder.

Risk for hypertension and pain sensitivity in adolescent boys

Reduced pain perception has been observed in many studies of spontaneously hypertensive rats and human hypertensive patients. To determine whether a reduced sensitivity to pain could be observed in a group of clearly normotensive individuals who may be at risk for hypertension, a mild to moderate pain stimulus was administered to 177 14-year-old boys. Boys with a normatively elevated resting systolic blood pressure tolerated mechanical finger pressure significantly longer than boys with lower blood pressure. As well, boys with both normatively elevated resting systolic blood pressure and a parental history of hypertension reported significantly less pain during finger pressure than lower risk participants. These findings could not be explained by personality factors and suggest that hypertension-related hypoalgesia is associated with processes involved in the development of the disorder.

Psychophysiological effects of interviews about emotional events on offspring of hypertensives and normotensives

Normotensive individuals with a parental history of hypertension have been found to exhibit greater cardiovascular reactivity to a variety of laboratory stressors than offspring of normotensives. To examine the possible generalization of these differences to real-life stressors, subjects were administered four brief interviews about different emotional events in their lives. Regardless of emotional content, offspring of hypertensives displayed greater systolic blood pressure responses to the non-verbal recollection and verbal description of personal emotional events, but not to the imagination of standardized emotional scenes or reading a non-emotional advertisement. This suggests that group differences in reactivity may generalize to real-world situations. Evidence of significantly greater vasoconstriction during interviews about sad topics was also observed, contributing to the literature on the physiological differentiation of emotional states.

A one-hour active coping stressor reduces small bowel transit time in healthy young adults

OBJECTIVE

To examine the effect of a prolonged active coping stressor on the transit of a substance from the mouth through small intestine in normal human volunteers.

METHOD

Twelve healthy undergraduate males were administered 10 g of the nonabsorbable carbohydrate lactulose in two experimental sessions. In normal individuals, lactulose produces hydrogen gas upon exposure to bacteria residing in the colon. Repeated measurements of breath hydrogen were obtained for 2 hours. In one session, subjects rested quietly for the 2-hour period. In the other counterbalanced session, subjects avoided mild electric shocks by playing videogames for the first hour.

RESULTS

Stress produced a statistically and clinically significant reduction in mean transit time, from 79 to 55 minutes. The magnitude of stress-induced reduction in small bowel transit time was significantly correlated with change in an index of cardiac sympathetic activity, pulse transit time.

CONCLUSIONS

A prolonged active coping stressor with minimal motor requirements produced a decrease in small bowel transit time comparable with that observed in several studies of the effects of physical exercise and in comparisons between normal controls and patients with diarrhea-predominant irritable bowel syndrome.

Empirical contributions

To evaluate the possible negative association between risk for hypertension and pain sensitivity by in women 24 healthy young adult women with a parental history of hypertension and 24 without a parental history of hypertension participated in 2 laboratory sessions in which electric shock and the cold-pressor test were administered To assess the possible role of stress-induced analgesia in blood pressure-related hypoalgesia, the sessions were identical with the exception of the fact that participants were exposed to a stressful 20-min videogame before the pain stimuli on one occasion and a nonstressful control task on the other. Women with a parental history of hypertension and high blood pressure reactivity to the videogame displayed a reduced sensitivity to electric shock on both days, suggesting that risk for hypertension is associated with reduced sensitivity to at least some pain stimuli in women. Blood pressure reactivity to stress-associated baroreceptor stimulation was not implicated as a mediator of decreased pain perception. However, other analyses revealed an effect of family history on shock pain only among women who report relatively high anxiety, suggesting that other aspects of the stress response may be involved in this phenomenon.

Psychophysiological response of ADHD children to reward and extinction

In this study, we examined heart rate and skin conductance levels of 18 children with attention-deficit hyperactivity disorder (ADHD) and 18 normal children as they performed a repetitive motor task during reward and extinction conditions. Fowles (1980, Psychophysiology, 17, 87-104; 1988, Psychophysiology, 25, 373-391) suggested that psychophysiological responsivity reflects activity in two of Gray's (1982, The neuropsychology of anxiety, Oxford University Press; 1987, The psychology of fear and stress, Cambridge University Press) motivational systems; heart rate reactivity during reward reflects activity in the behavioral activation system, and skin conductance reactivity during extinction reflects activity in the behavioral inhibition system. As predicted, control children showed increased heart rate when reward was present and increased skin conductance when reward was removed. Compared with controls, ADHD children failed to show increased skin conductance levels during extinction, suggesting a weak behavioral inhibition system. ADHD children also displayed faster heart rate habituation to reward.

Family history of hypertension and vasovagal symptoms during blood donation

Vasovagal reactions during blood donation were assessed in 185 individuals with and 298 individuals without a parental history of hypertension. It was predicted that individuals at genetic risk for hypertension would be less likely to faint or suffer pronounced vasovagal reactions, presumably by virtue of altered baroreflex sensitivity. A relationship between a parental history of hypertension and vasovagal responses was observed, albeit modified by blood donation experience and sex. Nurses obtaining blood from inexperienced donors without a parental history of hypertension were significantly more likely to recline the subject's chair than those obtaining blood from inexperienced donors with a parental history of hypertension or experienced donors. Questionnaire data were consistent with these findings. These results may be an interesting reflection of group differences in baroreflex sensitivity and have implications for screening potential donors.

Autonomic reactivity and alcohol-induced dampening in men at risk for alcoholism and men at risk for hypertension

Both sons of male alcoholics with multigenerational family history of male alcoholism (MFH) and sons of essential hypertensives (HTs) exhibit elevated psychophysiological reactivity to stress when compared with male controls (FH-). MFHs also demonstrate a significant baseline heart rate increase and stress-response dampening following alcohol consumption. The present study investigates the specificity of this alcohol-induced psychophysiological response pattern by testing these two risk groups in a shock response paradigm, both sober and alcohol-intoxicated. A repeated measures analysis of variance on sober and alcohol-intoxicated heart rate reactivity yielded a significant risk by alcohol interaction, indicating that alcohol consumption led to a greater decrease in reactivity in the MFH group compared with the HT and FH- groups. Similar results were obtained for muscle tension measures. MFHs also displayed greater increases in resting baseline heart rate and muscle tension when alcohol intoxicated. The results may reflect a sensitivity to negatively and positively reinforcing effects of alcohol specific to individuals with multigenerational familial histories of alcoholism.

Cardiovascular reactions to blood donation in offspring of hypertensives and normotensives

Blood pressure and heart rate reactions of 182 confirmed offspring of normotensive (110 female, 72 male) and 112 offspring of hypertensive (66 female, 46 male) individuals to the stressor of blood donation were examined. Subjects were tested at two sites, one in the United States and one in Canada. Although influenced by site, young normotensive offspring of hypertensives generally exhibited significantly greater blood pressure levels in anticipation of donating blood than offspring of normotensives. The higher reactivity of offspring of hypertensives observed in stressful laboratory settings may generalize to more ecologically valid settings, even those which, like blood donation, require passive coping efforts.

Family history of hypertension and pain during blood donation

Parental history of hypertension was associated with significantly lower venipuncture pain ratings in women with little or no blood donation experience. Healthy men (N = 288) and women (N = 434) presenting at Red Cross blood donor clinics provided pain ratings in response to an initial blood sample and venipuncture for blood donation. Analyses were restricted to 460 individuals with and without a confirmed parental history of hypertension (N = 188 and 272, respectively). There were no significant gender or parental history effects on initial blood sample pain ratings. Significantly lower venipuncture pain ratings were observed 1) for men vs. women, 2) for more experienced blood donors, and 3) among subjects with 0-1 previous donations, for women with vs. women without a parental history of hypertension. Although pain ratings were positively correlated with subjective anxiety throughout donation, there were no significant differences in anxiety ratings between women with and without a parental history of hypertension. The results provide suggestive evidence of an association between genetic risk for hypertension and decreased pain sensitivity.

Familial influences on heart rate, blood pressure, and self-report anxiety responses to stress: results from 100 twin pairs

Two hundred healthy adolescent to middle-aged individuals (12-44 years, M = 20 years) were tested in a standardized stress protocol. These individuals comprised 20 monozygotic female, 20 monozygotic male, 20 same-sex dizygotic female, 20 same-sex dizygotic male, and 20 opposite-sex dizygotic twin pairs. Familial influences on heart rate, blood pressure, and self-report anxiety responses to four different kinds of stressors (Visual-Verbal Test for Conceptual Thought, mental arithmetic, isometric handgrip, cold pressor) were assessed using biometrical genetic model fitting. Evidence of significant genetic effects on resting heart rate and blood pressure was obtained, providing heritability estimates of .65, .63, and .58 for resting heart rate and systolic and diastolic blood pressure, respectively. Cardiovascular reactivity to the Visual-Verbal Test, mental arithmetic, and the cold pressor test appeared to be primarily influenced by genetic and idiosyncratic (nonfamilial) environmental factors, whereas reactivity to handgrip was more related to effects of the family environment. The results of multivariate model fitting suggested that the genetic effects on reactivity were relatively independent of those affecting resting heart rate and blood pressure and that there was significant overlap of genetic influences on heart rate and blood pressure responses to the two active coping tasks.

The effects of sodium loading on blood pressure and pain responses to the cold pressor test

Two cold pressor tests were administered to 18 healthy normotensive males on two occasions, after 2 weeks of dietary sodium loading and after 2 weeks of maintaining their normal diet. While the addition of an extra 10 g/day of sodium to the diet had no overall effect on resting cardiovascular activity, it produced significantly greater diastolic blood pressure and smaller heart rate responses to the pain stimuli. As well, consistent with the large animal literature indicating a relationship between high blood pressure and diminished pain sensitivity, pain ratings were found to be significantly lower during the sodium loaded testing session. The ratings were corroborated by evidence of lower skin conductance reactivity to the second cold pressor test in the sodium loaded condition. Information concerning an elevation of risk for hypertension, perhaps provided by baroreceptors, may lead to compensatory reactions with hypoalgesia as one effect.

Cardiovascular responses to the combination of caffeine and mental arithmetic, cold pressor, and static exercise stressors

The present study examined cardiovascular responses to the combination of caffeine (250mg) and mental arithmetic, cold pressor, and static exercise stressors in 48 healthy males. Subjects were tested in a within-subject, placebo-controlled, double-blind design. Repeated measurements of heart rate, finger temperature, respiratory sinus arrhythmia, forearm blood flow, and blood pressure were obtained during a pre-drug resting baseline, a post-drug resting baseline, the three stressor tasks, and a recovery baseline. The primary analyses were 2(Drug) x 5(Period) x 6(Stress Order) MANCOVAs using pre-drug baseline values as covariates. Significant period main effects were observed for all measures. Significant drug main effects were observed for blood pressure, finger temperature, respiratory sinus arrhythmia, and forearm blood flow. The significant changes in blood pressure and finger temperature produced by caffeine combined in an additive fashion with the effects produced by the stressors. Significantly greater increases in forearm blood flow and heart rate during mental arithmetic on the caffeine day suggested a potentiation of sympathetic, beta-adrenergic activity. Questionnaires administered during baseline periods to assess psychological responses to stress and caffeine revealed a potentiation of anxiety and anger responses to stress on the caffeine day.

Pain sensitivity in offspring of hypertensives at rest and during baroreflex stimulation

Healthy males with a parental history of hypertension (PH+) showed reduced pain sensitivity to a constrictive thigh-cuff pressure stimulus as compared to individuals without a parental history of hypertension. The protocol included eight trials in which a thigh-cuff was inflated until the subject reported the stimulus to be "painful." The PH+ group exhibited significantly lower pain sensitivity as indicated by (1) higher levels of constrictive pressure when pain was first reported and (2) lower subjective pain ratings at maximum constrictive pressure. To assess the role of baroreflex stimulation on pain sensitivity in these groups, four trials were administered concurrently with external carotid pressure stimulation. There were no significant differences in pain sensitivity in each group as a function of baroreflex stimulation. The results suggest that the hypoalgesia observed in hypertensives may predate the development of sustained elevations in blood pressure.

Baroreflex sensitivity at rest and during stress in individuals with a history of vasovagal syncope

The baroreflex sensitivity of healthy young adult males who reported some history of vasovagal syncope during emotionally stressful situations (e.g. blood donation) was compared to a control group of individuals who reported no such history. The baroreflex, which induces compensatory bradycardia and vasodilation in response to acute elevations of blood pressure, was examined as a possible mechanism underlying predisposition to vasovagal reactions. Changes in heart rate and vasoconstriction in response to baroreflex stimulation (negative external cervical pressure) at rest and during administration of a mental arithmetic task and a constrictive pain stimulus were assessed. Individuals with a history of vasovagal reactions displayed greater baroreflex sensitivity during the pain stimulus and at rest, but not during mental arithmetic. These findings suggest one mechanism of risk for syncope reactions, particularly in situations involving the experience of pain.

Exaggerated sympathetic nervous system response to extended psychological stress in offspring of hypertensives

The cardiovascular responses of 24 healthy young adult males with a parental history of hypertension and 24 males without a parental history of hypertension to an extended active-coping psychological stressor were compared under three drug conditions: placebo, the beta 1-blocking agent metoprolol, and the alpha 1-blocking agent prazosin. In the placebo condition, offspring of hypertensives exhibited significantly greater heart rate, blood volume pulse, and forearm blood flow responses to the task. They also exhibited a significantly greater initial decrease in forearm vascular resistance, which, in contrast to the offspring of normotensives, was no longer significantly different from baseline levels by the end of the session. No group differences in blood pressure response were observed. Metoprolol eliminated the differences in heart rate and forearm vascular resistance responses. Prazosin eliminated the difference in blood volume pulse response and elicited a sustained group difference in forearm vascular resistance. These results implicate the sympathetic nervous system in the exaggerated cardiovascular responsivity to psychological stress in individuals with a family history of essential hypertension. They also suggest that the pattern of increasing vascular resistance in response to this stressor observed in this and other studies in this laboratory reflects alpha-adrenergic activity and not neurohumorally independent autoregulation.

Carotid baroreflex sensitivity at rest and during psychological stress in offspring of hypertensives and non-twin sibling pairs

The baroreceptor reflexes of 38 young adult males were mechanically stimulated by negative external cervical pressure during a mental arithmetic task and pre-stress and post-stress relaxation periods. The subjects comprised 19 pairs of non-twin siblings. Baroreflex sensitivity was significantly less pronounced during arithmetic. Using non-invasive techniques, this finding replicates several others indicating a damping of the baroreceptor reflux during stress. More importantly, analyses of sibling similarities also revealed significant familiality of baroreflex sensitivity, independent of age, body mass, pressure applied and baseline heart rate. To examine the relationship between baroreflex sensitivity and parental history of hypertension, 21 young adult males with a parental history and 25 without participated in a second experiment. The two groups were not significantly different in resting baroreflex sensitivity. However, sensitivity was damped to a significantly greater degree during mental arithmetic in offspring of hypertensives, offering one possible explanation for their greater blood pressure reactivity to stress. These results suggest that familial influences may effect baroreflex sensitivity and, possibly as a result, blood pressure reactivity and risk for hypertension.

Individual differences in heart rate and peripheral vascular responses to an extended aversive task

Psychophysiological research on situations requiring active coping has to this point dealt primarily with cardiac responses. Recent studies of vascular responses to such stressors have found conditions in high cardiac reactors that are possible precursors to autoregulatory vasoconstriction. The present study exposed 32 healthy male undergraduates to a one-hour shock avoidance procedure, with avoidance made contingent on video-game performance. Subjects also participated in a separate counterbalanced baseline session. The relationships among individual differences in heart rate, forearm blood flow, forearm vascular resistance, and digital blood volume pulse responses at different points in the stress session were examined. Decreases in forearm vascular resistance were observed only among high and medium heart rate reactors. As the session progressed, however, forearm vascular resistance responses of the medium heart rate reactors were sustained whereas those of the high heart rate reactors habituated despite the fact that heart rate and forearm blood flow responses remained elevated. The potential implications of this pattern of results to an autoregulation theory of hypertension development are discussed. Heart rate reactivity was inversely related to performance on the video-game task but was unrelated to Type A or anxiety.

Risk for hypertension in female members of multigenerational male-limited alcoholic families

Cardiovascular hyperreactivity to psychological stress has been implicated as a risk factor for cardiovascular disease. Recent reports have suggested that male offspring of multigenerational male-limited alcoholic families display cardiovascular hyperreactivity to stress. Data concerning cardiovascular disease in 371 individuals from multigenerational male-limited alcoholic families and other family types of differing risk for alcoholism were subjected to chi 2 analyses. Results indicated a significantly greater incidence of hypertension in female members of multigenerational male-limited alcoholic families as compared to the other family types.

Cardiovascular responses to occupational stress and caffeine in telemarketing employees

Cardiovascular responses to the combination of caffeine and a challenging occupational activity were examined using a within-subject, double-blind design. Seventeen female and 11 male telemarketing employees received drinks that did and did not contain 250 mg of caffeine on two consecutive days, with order of presentation counterbalanced across subjects. Repeated measurements of systolic and diastolic blood pressure, heart rate, and digital blood volume pulse were obtained during a pre-drug resting baseline and a post-drug working period on each day. Repeated measures analyses of variance revealed significant main effects of Period on all measures of cardiovascular activity, indicating that occupational demands elicited significant cardiovascular adjustments. Only systolic blood pressure revealed a significant Drug X Period effect, indicating that responses were significantly greater on the caffeine versus placebo day. The changes in diastolic blood pressure and heart rate, although not significant, were consistent in direction with the results from previous laboratory studies. There were no significant differences between males and females in cardiovascular response to the combination of stress and caffeine.

Forearm blood flow responses of offspring of hypertensives to an extended stress task

The forearm blood flow and other cardiovascular responses of 10 healthy young men with a parental history of hypertension to an extended laboratory stressor were compared with the responses of 10 age-matched men with normotensive parents. To eliminate the effects of the anticipation of stress on baseline measures, all subjects participated in a separate 1-hour counterbalanced baseline session in which no stress was presented. There were no significant differences between the two groups in resting blood pressure, heart rate, blood volume pulse, forearm blood flow and vascular resistance, and self-report anxiety, although offspring of hypertensive parents exhibited marginally greater (p = 0.08) forearm blood flow at rest. During the stress session, subjects played video games for 1 hour and avoided mild electric shocks depending on performance. Offspring of hypertensive parents exhibited significantly greater heart rate (+19 +/- 6 vs. +3 +/- 2%), forearm blood flow (+52 +/- 14 vs. +9 +/- 4%), and self-report anxiety (+25 +/- 6 vs. +9 +/- 3%) responses to the task. There were no significant group differences in blood pressure response to the task. Significant positive correlations between forearm blood flow and heart rate responses to the task were observed. These findings extend earlier results that suggested healthy young offspring of hypertensive and normotensive parents may exhibit different patterns of hemodynamic response to stress in the absence of differences in resting blood pressure or blood pressure responsiveness to stress.

Spouse and parent-offspring similarities in cardiovascular response to mental arithmetic and isometric hand-grip

Thirty spouse pairs were recruited for a stress protocol consisting of alternating stress and relaxation periods. Repeated measurements of blood pressure, heart rate, and blood volume pulse were obtained. Spouse pairs were parents of young adult sibling pairs who had previously participated in a slightly different version of the protocol. Although spouses exhibited some behavioral similarities, there were no significant similarities in cardiovascular response to stress. However, despite the fact that parents and their offspring were tested on different occasions using somewhat different procedures, some similarities in cardiovascular reactivity were observed. Significant parent-offspring similarities in heart-rate response to mental arithmetic and diastolic blood pressure response to isometric hand-grip were observed, as well as several behavioral similarities. Assortative mating and the nature of one's current home environment seem to be less important in the familial aggregation of cardiovascular reactivity to stress than early environmental and/or genetic factors.

Caffeine effects on several indices of cardiovascular activity at rest and during stress

The effects of caffeine on cardiovascular responses to a mental arithmetic task were assessed using a between-subjects, double-blind design. Thirty-six male undergraduates were randomly assigned to either a placebo group or a group which received 250mg of caffeine. Repeated measurements of systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), digital blood volume pulse (DBVP), and finger pulse transit time (FPTT) were obtained during a predrug baseline, a postdrug resting period, and a mental arithmetic task. Significant Period (i.e., stress) effects were observed on all measures, except DBVP which revealed a marginally significant Period effect. Significant main effects of Drug were observed on DBP and DBVP. There were no significant Drug x Period interactions. These results indicate that the increases in DBP and the decreases in DBVP produced by caffeine were additive with effects produced by stress.

Age differences in the consistency of cardiovascular response patterns in healthy women

To determine if response consistency is higher in older women, twenty young adult (mean = 20 years) and twenty-two elderly (mean = 82 years) women participated in a 20-min stress protocol including serial subtraction, anxiety and anger imagery tasks. All subjects were healthy and free of diagnosed cardiovascular disease. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to the tasks were assessed. To allow comparisons of the effects of stress on different cardiovascular parameters, all baseline-stress change scores were converted to z-scores. Forty-two 3(parameter)X3(stressor) matrices of z-scores, one for each subject, were created. Intraclass correlations computed using these matrices revealed greater consistency of response hierarchies (e.g., DBP greater than SBP greater than HR) among elderly subjects. Possible mechanisms for this effect are discussed.

A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain

Sixty-six chronic low back pain sufferers were randomly divided into three groups. Following individual assessments consisting of psychological questionnaires, pain monitoring, and measurement of paraspinal electromyogram (EMG), one group received paraspinal EMG biofeedback and another a placebo treatment. The third group received no intervention. Two further assessments were carried out on all groups immediately after treatment and at a 3-month follow-up. All groups showed significant reduction in pain, anxiety, depression, and paraspinal EMG following treatment and at follow-up, but there were no differences between groups. A regression analysis failed to identify subjects' characteristics that predicted positive outcome in the biofeedback group. However, high scores on the Evaluative scale of the McGill Pain Questionnaire and high hypnotizability were significant predictors of positive outcome for the placebo group. It is concluded that paraspinal EMG biofeedback is not a specific treatment for chronic low back pain in a nonhospitalized population.

Multitreatment of obsessive-compulsive checking in a geriatric patient

Behavioral treatment of an elderly woman with an obsessive-complusive disoder is discussed in an attempt to illustrate: (1) the value of verbal exposure to feared stimuli in the treatment of fears that are difficult to elicit reliably in vivo, and (2) the effectiveness of behavioral techniques with geriatric patients.

A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain

Sixty-six chronic low back pain sufferers were randomly divided into three groups. Following individual assessments consisting of psychological questionnaires, pain monitoring, and measurement of paraspinal electromyogram (EMG), one group received paraspinal EMG biofeedback and another a placebo treatment. The third group received no intervention. Two further assessments were carried out on all groups immediately after treatment and at a 3-month follow-up. All groups showed significant reduction in pain, anxiety, depression, and paraspinal EMG following treatment and at follow-up, but there were no differences between groups. A regression analysis failed to identify subjects' characteristics that predicted positive outcome in the biofeedback group. However, high scores on the Evaluative scale of the McGill Pain Questionnaire and high hypnotizability were significant predictors of positive outcome for the placebo group. It is concluded that paraspinal EMG biofeedback is not a specific treatment for chronic low back pain in a nonhospitalized population.