1 Integrating Psychological Approaches Into the Behavioral Management of Modifiable Risk Factors Alan Rozanski, M.D. January 30, 2013 • No disclosures 1. Define the rationale for integrating psychological approaches 2. Insights from Behavioral Cardiology 3. Illustrate practical principles and interventions 4. Discuss feasibility issues Goals
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1
Integrating Psychological Approaches
Into the Behavioral Management of
Modifiable Risk Factors
Alan Rozanski, M.D.January 30, 2013
• No disclosures
1. Define the rationale for integrating psychological approaches
2. Insights from Behavioral Cardiology
3. Illustrate practical principles and interventions
4. Discuss feasibility issues
Goals
2
• CVD mortality decreased by ~60%
• Decreased prevalence of myocardial infarction
• Decreased severity of infarction
• Decrease in stroke
• Decrease in frequency and severity of myocardial ischemia
Favorable trends
•Remains #1 killer•Reliance on Rx’s isincreasingly costly
•Adverse trends inprevention
CVD mortality by 60%PrevaIance of MISeverity of MIprevalance of stroke Ischemia
Favorable trends
Challenges
J Am Coll Cardiol 2012; 59: 2125-43
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PATIENT EMPOWERMENT
Collaborativegoal setting
More effective education
Collaborative Rx planning
Patient self-management
Patient-centered cardiovascular care
a
“A vital component of PCC is educating and motivating patients to become better
stewards of their health and more active participants in the management of their
diseases”.
1. Define the rationale for integrating psychological approaches
2. Insights from Behavioral Cardiology
3. Illustrate practical principles and interventions
4. Discuss feasibility issues
Goals
4
Psychosocial Risk Factors
1. Negative emotions2. Negative thought patterns3. Chronic stress4. Poor social support5. Poor sleep 6. Inadequate R&R
Ovarian dysfunction
EVOKED CENTRAL RESPONSES
ANS Dysfunction
Insulin resistance
Central obesity
Metabolic syndrome
Inflammation
Platelet activation
Endothelial dysfunction
bone density
CNS changes
Depression• ���� HPA
• ���� SNS
DEPRESSIONANXIETYSTRESS
LONELINESS
POOR DIETWEIGHT GAINSEDENTARY
SMOKING
DRIVE
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• Epidemiology
• Pathophysiological study
• Study of behavioral consequences
• Little translation into cardiac practice
The “big disconnect”
Potential for clinical translation
• Vast field of Medical Psychology • This field has identified and developed
applicable evidence-based interventions• Applied psychology is commonly used in
many non-medical fields
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1. Define the rationale for integrating psychological approaches
2. Insights from Behavioral Cardiology
3. Illustrate practical principles and interventions
4. Discuss feasibility issues
Goals
• John, a 55 yo very busy executive • Intermediate FRS• Moderately overweight• Highly sedentary • Increasing job stress• CAC scan: score = 180
Case example
• John, a 55 yo very busy executive • Intermediate FRS• Moderately overweight• Highly sedentary • Increasing job stress• CAC scan: score = 180
How do we get John to start and maintain anexercise program?