management has been used successfully to reduce some of the risk factors for CHD
disease, including raised blood pressure (Johnston et al. 1993), blood cholesterol (Gill
et al. 1985) and type A behaviour (Roskies et al. 1986). Further, some studies also
indicate that it can reduce angina, which is highly predictive of heart attack and/or
death. For example, Gallacher et al. (1997) randomly allocated 452 male angina patients
to receive either stress management or no intervention at all. The results showed that
at six months follow-up, those who had received stress management reported a reduced
frequency of chest pain when resting. In a similar trial, Bundy et al. (1998) examined
both the independent and the combined effect of stress management and exercise on
angina compared with a control group taken from a waiting list. The results indicated
that those who undertook both stress management and exercise reported fewer
angina attacks and reduced reliance on medication. Therefore, stress management
appears to reduce angina, which in turn could reduce the occurrence of myocardial
infarctions.
Conclusion
CHD is a common cause of death in the Western world. It illustrates the role of
psychology in illness in terms of the beliefs people have about CHD, the psychological
consequences of a diagnosis, identifying and changing risk factors (e.g. smoking,
diet, exercise, type A behaviour and stress) and the development and evaluation
of programmes designed to modify risk factors in individuals who already have the
disease.
TO CONCLUDE
Illnesses such as obesity and coronary heart disease illustrate the role of psychology
throughout the course of an illness. For example, psychological factors play a role in
illness onset (e.g. health beliefs, health behaviours, personality, coping mechanisms),
illness progression (e.g. psychological consequences, adaptation, health behaviours) and
longevity (e.g. health behaviours, coping mechanisms, quality of life). These psycho-
logical factors are also relevant to a multitude of other chronic and acute illnesses, such
as diabetes, asthma, chronic fatigue syndrome and multiple sclerosis. This suggests that
illness is best conceptualized, not as a biomedical problem, but as complex interplay of
physiological and psychological factors.
? QUESTIONS
1 To what extent can obesity be explained by physiological factors?
2 Obesity is an eating disorder. Discuss.
3 Treating obesity causes more problems than it solves. Discuss.
4 CHD is an inevitable product of lifestyle. Discuss.
5 To what extent can a reinfarction be prevented?
OBESITY AND CORONARY HEART DISEASE 379