Yori Gidron

Molecular and cellular interface between behavior and acute coronary syndromes

This review article integrates empirical findings from various scientific disciplines into a proposed psychoneuroimmunological (PNI) model of the acute coronary syndrome (ACS). Our starting point is an existing, mild, atherosclerotic plaque and a dysfunctional endothelium. The ACS is triggered by three stages. (1) Plaque instability: Pro-inflammatory cytokines (IL-1, IL-6, TNF-alpha) and chemoattractants (MCP-1, IL-8) induce leukocyte chemoattraction to the endothelium, and together with other triggers such as the CD40L-CD40 co-stimulation system activate plaque monocytes (macrophages). The macrophages then produce matrix metalloproteinases that disintegrate extra-cellular plaque matrix, causing coronary plaque instability. Acute stress, hostility, depression and vital exhaustion (VE) have been associated with elevated pro-inflammatory cytokines and leukocyte levels and their recruitment. (2) Extra-plaque factors promoting rupture: Neuro-endocrinological factors (norepinephrine) and cytokines induce vasoconstriction and elevated blood pressure (BP), both provoking a vulnerable plaque to rupture. Hostility/anger and acute stress can lead to vasoconstriction and elevated BP via catecholamines. (3) Superimposed thrombosis at a ruptured site: Increases in coagulation factors and reductions in anticoagulation factors (e.g. protein C) induced by inflammatory factors enhance platelet aggregation, a key stage in thrombosis. Hostility, depression and VE have been positively correlated with platelet aggregation. Thrombosis can lead to severe coronary occlusion, clinically manifested as an ACS. Thus, PNI processes might, at least in part, contribute to the pathogenesis of the ACS. This chain of events may endure due to lack of neuroendocrine-to-immune negative feedback stemming from cortisol resistance. This model has implications for the use of psychological interventions in ACS patients.

Translating research findings to PTSD prevention: Results of a randomized–controlled pilot study

Based on therapeutic studies revealing positive prognostic factors and on research findings revealing how trauma is processed, we developed the memory structuring intervention (MSI) in attempt to prevent posttraumatic stress disorder (PTSD). The MSI attempts to shift processing of traumatic memory from uncontrollable somatosensory and affective processes to more controlled linguistic and cognitive processes by providing patients organization, labeling, and causality. In a single-blind randomized–controlled pilot study, 17 traffic accident victims at risk for PTSD (heart rate >94 BPM) were assigned to two MSI or two supportive-listening control sessions. Three months later, MSI patients reported significantly less frequent intrusive, arousal, and total PTSD symptoms than controls. A replication study with a larger sample is underway.

The effects of a mindfulness intervention on obsessive-compulsive symptoms in a non-clinical student population.

This controlled pilot study tested the effects of a mindfulness intervention on obsessive compulsive disorder (OCD) symptoms and tested the psychological processes possibly mediating such effects. Participants with OCD symptoms (12 women, 5 men) received either mindfulness training (N=8) or formed a waiting-list control group (N = 9). Meditation included 8 group meetings teaching meditative breathing, body-scan, and mindful daily living, applied to OCD. The intervention had a significant and large effect on mindfulness, OCD symptoms, letting go, and thought-action fusion. Controlling for changes in “letting go,” group effects on change in OCD symptoms disappeared, pointing at a mediating role for letting go. This may be the first controlled study demonstrating that a mindfulness intervention reduces OCD symptoms, possibly explained by increasing letting go capacity. If replicated in larger and clinical samples, mindfulness training may be an alternative therapy for OCD.

Bus Commuters' Coping Strategies and Anxiety from Terrorism: An Example of the Israeli Experience

This study examined the use of three coping strategies: (1) emotion-focused coping (calming-distraction); (2) problem-focused coping (checking-behavior); and (3) denial (reduced perceived vulnerability), and their relationship to anxiety from terrorism among 50 Israeli bus commuters. Their mean age was 31 years (60% females). Commuting frequency was negatively correlated, and problem-focused coping was positively correlated with anxiety from terrorism. Ratios of problem-focused coping/denial and of problem-focused/emotion-focused coping were each positively correlated with anxiety from terrorism. Coping ratios accounted for 15% of the variance in anxiety from terrorism, after considering commuting frequency. Combining minimal problem-focused preventative acts with distraction and reduced perceived vulnerability may be beneficial.

Development and Cross-Cultural and Clinical Validation of a Brief Comprehensive Scale for Assessing Hostility in Medical Settings

This study presents the development and validation of a brief comprehensive hostility scale. Two items of each subscale from the Buss–Perry (1992) Aggression Questionnaire, most strongly correlated with their subscale score, were selected, yielding the eight-item New-Buss. Internal reliability was .66 to .81, and full and brief scales correlated r = .92 to .94. In Study 1 (95 Israeli students), New-Buss scores were significantly higher in self-rated deviant or speeding drivers than nondeviant or nonspeeding drivers, respectively. In Study 2 (279 American students), New-Buss scores correlated significantly with Barefoots Ho, Anger-Out, Anger-In, and Agreeableness. In Study 3 (79 Israeli patients undergoing angiography), New-Buss scores were significantly correlated with coronary artery disease severity independent of SBP in men below age 60 alone but not in women. Our findings support the cross-cultural feasibility, reliability, and concurrent, construct, and criterion validity of the New-Buss.

Effects of active distraction on pain of children undergoing venipuncture: Who benefits from it?

Abstract Objective: This study examined the effects of active distraction on duration of medical procedure and pain of children undergoing venipuncture. Method: Ninety-four children (aged 6-16 years), admitted to a pediatric emergency department were randomly assigned to an experimental condition (active listening to a song) or to usual care. Pain was assessed by childrens reports with a visual analogue scale (VAS) ruler positioned between two facial expressions. In addition, we measured pressure pain threshold using a dolorimeter, procedure duration and white-blood cell count (WBC). Results: After controlling for confounding variables, the experimental and control groups did not differ significantly in levels of pain. However, several interaction effects emerged indicating that the experimental condition yielded less pain in females, in children with low pain thresholds, and in those with WBC < 12 000. Procedure duration did not differ among conditions. Conclusions: Active distraction was effective in r...

You may need the vagus nerve to understand pathophysiology and to treat diseases.

Can different pathophysiological mechanisms and risk factors leading to various diseases be linked with altered transmission of signals by one common pathway? The present article provides evidence for the hypothesis that adequate vagal nerve activity reduces the risk of major diseases, via common basic mechanisms and interim risk factors. These diseases include cardiovascular disease, cancer, Alzheimers disease and the metabolic syndrome. Three basic mechanisms contribute to such illnesses: local oxidative stress and DNA damage, inflammatory reactions and excessive sympathetic responses, all of which are inhibited by vagal nerve activity. Efferent vagal activity that can be non-invasively measured by HRV (heart rate variability), derived from an ECG, is inversely related to all three basic mechanisms, to various risk factors (e.g. diabetes and dyslipidaemia) and, more broadly, to the diseases as well. Finally, vagal activity is proposed to moderate the effects of risk factors on developing such illnesses. By proposing an integrative neurobiological model of major diseases, identifying people at risk for, and treating patients with, such diseases may be done more efficiently. People with low HRV may be identified and subsequently treated by vagus nerve activation to possibly prevent or treat such illnesses. This proposed disease paradigm may have important preventative and therapeutic implications, whose clinical effects need to be investigated.

Interactive effects of memory structuring and gender in preventing posttraumatic stress symptoms.

This study retested effects of a Memory Structuring Intervention (MSI) and the moderating role of gender in relation to posttraumatic stress disorder (PTSD) symptoms. Thirty-four traffic accident victims with high pulse rates were randomly assigned to MSI or supportive listening (control) phone conversations soon after accidents. Based on converging clinical and neuroscience research, the MSI taught chronological organization, labeling emotions/sensations, and describing causality. PTSD symptoms were assessed 3 months later. No overall group differences were found. However, a group by gender interaction revealed that, for women, the MSI was associated with less PTSD symptoms than the control treatment, while the opposite pattern was seen in men. Limitations and possible explanations for these findings are discussed.

Psychological factors correlate meaningfully with percent-monocytes among acute coronary syndrome patients

Recent research demonstrates the importance of inflammatory parameters in the etiology and prognosis of the acute coronary syndrome (ACS). This study explored relations between psychological factors and immunological parameters routinely measured among ACS patients. Forty-two ACS patients completed questionnaires assessing perceived-control, emotional support, hostility, and life-events 2-4 days after hospitalization. Data on total leukocytes and percentages (%) of monocytes, %neutrophils, and %lymphocytes upon admission to hospital were collected from computerized medical charts as well as various biomedical information and risk-factors (e.g., diagnosis, left-ventricle-LV functioning, smoking, and hypertension). Of all significant biomedical variables, LV-function and arrival-time correlated uniquely with total leukocytes. Controlling for LV-function and arrival-time, hostility and life-events positively correlated with %monocytes, and perceived-control and emotional-support inversely correlated with %monocytes. Emotional-support was positively correlated and life-events were negatively correlated with %neutrophils. Macrophages play a pivotal role in plaque instability, the trigger of an ACS. This initiating role, and our finding of a relationship between recruitment of monocytes and a poor psychosocial profile, predictive of ACS, are consistent with a PNI component in the pathophysiology of ACS.

Internal locus of control moderates the effects of road-hostility on recalled driving behavior

Abstract This study examined the main and interactive effects of road-hostility and driving internal locus of control on self-reported driving behavior. Ninety-five Israeli students (mean age=25 years) anonymously completed scales assessing road-hostility, driving internal locus of control (DI), and the Speed and Deviance subscales of the Driving Style Questionnaire (DSQ-score). Only road-hostility was significantly correlated with DSQ-scores ( r =.54). DI moderated the effects of road-hostility in relation to DSQ-scores: The association between road-hostility and DSQ-scores was larger among subjects with low than with high levels of DI. Finally, 64% of high-hostile low DI drivers were involved in an accident compared to only 29% of high-hostile high DI drivers. These results suggest that future studies need to examine the effects of increasing DI on the negative effects of road-hostility on driving behavior. The study’s theoretical interpretations, application to accident-prevention and limitations are discussed.