Emotions and cognitions in coronary heart disease: Risk, resilience, and social context

摘要

Until recently, scientists have lacked the technology and data needed to support or refute the centuries-old belief that emotions influence coronary health. The past two decades have witnessed dramatic advances in knowledge concerning the pathophysiology underlying coronary heart disease (CHD) and the contribution of emotions and cognitions to disease processes. This progress, in combination with findings from a growing body of large, methodologically sound epidemiological studies, provides substantial evidence that negative emotions and cognitions, including hostility and related constructs, and sub-facets of negative affectivity (e.g., depression, anxiety) contribute to the initiation and progression of CHD. In contrast, research focused on the potential resilient contribution of positive emotions and cognitions has been notably absent from the literature. Furthermore, studies concerning emotions and health have often neglected important contextual factors and concomitant social processes. In the current review. we examine the evidence regarding the roles of emotions and cognitions in CHD risks and outcomes, and suggest that further attention to positive emotional constructs is warranted. We also suggest that the literature would benefit from a more integrative conceptualization of cognitive/emotional and social factors, to better understand how each variable contributes to coronary disease. We further encourage a focus on broad contextual factors, including socioeconomic status (SES) and ethnicity, which may elucidate the circumstances under which health effects of cognitions and emotions are most likely to emerge. We conclude by noting the implications of the current knowledge base for coronary interventions and the practice of cardiac psychology.