Hostility, Depression, and Heart Disease
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You must read each slide, and complete any questions on the slide, in sequence.
Chapter 10: Cardiovascular Disease and Diabetes
Critical Thinking Exercise: Hostility, Depression, and Heart Disease
Although everyone feels angry from time to time, when everyday anger turns destructive or occurs with increasing frequency, it can have a variety of unhealthy effects. In addition to reducing the overall quality of a person’s life, uncontrolled anger can damage relationships and make people feel as though they are at the mercy of an unpredictable force.
Hostility and anger may also directly affect the health of a person’s heart. In one study, Duke University researchers asked patients with ischemia to wear wireless heart monitors for 48 hours, and to keep a diary of their emotions—sadness, tension, frustration, happiness, and feelings of control—during that time period. The researchers found that the patients who had stressful feelings were twice as likely to have a bout of ischemic pain an hour later as the patients who didn’t have stressful feelings.
In another, long-term prospective study of medical students at Johns Hopkins University, researchers found that those who experienced depression during their time at Johns Hopkins were, on average, twice as likely to develop cardiovascular disease or suffer a heart attack 15 years later, as students who didn’t experience depression. Other studies that examined the effects of depression on the heart have found that depressed people who already have heart disease are up to eight times more likely to develop ventricular tachycardia—a dangerous heart arrhythmia—than heart disease patients who are not depressed.
The effect of positive emotions on the heart is also a subject of research. One ongoing study at the Institute of HeartMath has reported that feelings of love and gratitude in coronary patients may actually make the beating of their hearts more uniform and consistent. This change is similar to the “relaxation response”—a state that is physiologically the opposite of the “fight-or-flight” response, in which blood pressure is reduced and blood flow to the heart is increased.
The American Psychological Association’s Web site includes an outstanding series of essays called “Psychology in Daily Life,” which offer solid and direct advice on hostility and the heart, based on the latest research. It also discusses strategies for anger management, such as cognitive restructuring. As part of this exercise, check out the information at www.apa.org/pubinfo/anger.html and then prepare answers to the questions that follow.
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Like other emotions, anger is accompanied by physiological and biological changes, including elevated heart rate and blood pressure and increased secretion of adrenaline and noradrenaline. Although anger is a completely normal, usually healthy emotion that is necessary to our survival, it can lead to problems if it is not controlled, or when it is expressed in inappropriate ways or suppressed by turning it inward.
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Anger can be caused by both internal events (such as worrying about a personal problem) and by external events (such as a coworker’s behavior). Memories of traumatic or enraging events can also trigger angry feelings. In his model of anger, Jerry Deffenbacher points to the importance of how individuals cognitively appraise trigger events. He proposes, further, that some people really are more “hotheaded” than others; they get angry more easily and more intensely than the average person. There are also those who don’t show their anger in loud, spectacular ways but who are chronically irritable and grumpy. Easily angered people sometimes withdraw socially, sulk, or get physically ill. Howard Kassinova suggests that most normal people experience anger a few times a week.
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People who are easily angered have a low tolerance for frustration, a pattern that may be partly genetic or physiological in origin. Some children, for instance, are born irritable and easily angered and may remain so throughout their lives. Another cause may be sociocultural. Because anger is generally viewed as an undesirable emotion, people tend to learn how to handle their anger or to channel it in constructive ways, but many people do not learn that. Research also shows that people who come from disruptive and chaotic families whose members are unskilled in communication are often more easily angered.
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When a person gets angry, heart rate increases, as does blood pressure and the levels of adrenaline, noradrenaline, and other stress hormones. Over time, these hyperactive physiological changes may place greater stress on the coronary arteries of anger-prone individuals. And, when anger is suppressed and turned inward, hypertension and/or depression may result.
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Cognitive restructuring involves changing the way one thinks. Anger-prone people tend to curse, swear, or speak in dramatic, exaggerated, and “highly colorful terms” when expressing their emotions. Through cognitive restructuring, anger-prone people learn to replace these overblown thoughts with more rational ones, to remind themselves that getting angry is unlikely to help the situation and may even make it worse, and to use logic to remind themselves that the world is not “out to get them.” Other strategies for keeping anger and hostility under control include using problem solving to analyze situations that may be anger triggers, improving communication by slowing down and listening more carefully to what others are saying, changing one’s immediate surroundings during stressful times, and even using humor to help defuse anger.