Handbook of Research Methods in Cardiovascular Behavioral Medicine THE PLENUM SERIES IN BEHA VIORAL PSYCHOPHYSIOLOGY AND MEDICINE Series Editor: William J. Ray, Pennsylvania State University, University Park, Pennsylvania BIOLOGICAL BARRIERS IN BEHAVIORAL MEDICINE Edited by Wolfgang Linden HANDBOOK OF RESEARCH METHODS IN CARDIOVASCULAR BEHAVIORAL MEDICINE Edited by Neil Schneiderman, Stephen M. Weiss, and Peter G. Kaufmann PHYSIOLOGY AND BEHAVIOR THERAPY Conceptual Guidelines for the Clinician James G. Hollandsworth, Jr. Handbook of Research Methods in Cardiovascular Behavioral Medicine Edited by Neil Schneiderman Univer5ily of Miami Coral Gable5, Florida Stephen M. Weiss and Peter G. Kaufmann National Heart, Lung, and Blood In5titute Bethe5da, Maryland Springer Science+ Business Media, LLC Library of Congress Cataloging in Publication Data Handbook of research methods in cardiovascular behavioral medicine / edited by Neil Schneiderman, Stephen M. Weiss, and Peter Kaufmann. p. cm.—(Plenum series in behavioral psychophysiology and medicine) Includes bibliographies and index. ISBN 978-1-4899-0908-4 1. Cardiovascular system—Diseases—Psychosomatic aspects—Research—Methodology. 2. Medicine and psychology—Research—Methodology. 3. Medicine, Psychosomatic- Research—Methodology. 4. Patient monitoring. I. Schneiderman, Neil. II. Weiss, Stephen M. III. Kaufmann, Peter (Peter G).) IV. Series. [DNLM: 1. Behavioral Medicine. 2. Cardiovascular System—physiology. 3. Research— methods. WG 100 H2358] RC669.H28 1989 616.1'208—dcl9 DNLM/DLC 89-3705 for Library of Congress CIP ISBN 978-1-4899-0908-4 ISBN 978-1-4899-0906-0 (eBook) DOI 10.1007/978-1-4899-0906-0 © 1989 Springer Science+Business Media New York Originally Published by Plenum Press, New York in 1989 Softcover reprint of the hardcover 1st edition 1989 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors Erling A. Anderson, Departments of Anesthesia and Internal Medicine, Cardiovascular and Clinical Research Centers, University of Iowa College of Medicine, Iowa City, Iowa 52242 Norman B. Anderson, Department of Psychiatry, Duke University Medical School, and Geriatric Re search, Education, and Clinical Center, Veterans Administration Medical Center, Durham, Nort}1 Carolina 27710 Steven A. Atlas, Cardiovascular Center and Department of Medicine, Cornell University Medical Col lege, New York, New York 10021 Garth Bissette, Laboratory of Psychoneuroendocrinology, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710 Seymour G. Blank, Department of Medicine, Cardiovascular Center, The New York Hospital-Cornell Medical Center, New York, New York 10021 Charles S. Carver, Department of Psychology, University of Miami, Coral Gables, Florida 33124 Margaret A. Chesney, Department of Epidemiology, School of Medicine, University of California at San Francisco, San Francisco, California 94143 L. A. Clark, AT&T Bell Laboratories, Murray Hill, New Jersey 07974 Theodore M. Dembroski, Department of Psychology, University of Maryland Baltimore County, Catonsville, Maryland 21228 L. Denby, AT&T Bell Laboratories, Murray Hill, New Jersey 07974 Vincent DeQuattro, Department of Medicine, University of Southern California School of Medicine, Los Angeles, California 90007 Joel E. Dimsdale, Department of Psychiatry, University of California, San Diego Medical Center, San Diego, California 92103 E. D. Dunlap, Division of Endocrinology and Metabolism, Veterans Administration Medical Center, Louisville, Kentucky 40202 Bonita Falkner, Department of Pediatrics, Hahnemann University, Philadelphia, Pennsylvania 19102 Gregory A. Harshfield, Department of Pediatrics, University of Tennessee, Memphis, Tennessee 38103 Larry V. Hedges, Department of Education, University of Chicago, Chicago, Illinois 60637 Alan S. Hollister, Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee 37232 B. Kent Houston, Department of Psychology, University of Kansas, Lawrence, Kansas 66045 Chun Hwang, Hypertension Center, Department of Medicine, Charles R. Drew Postgraduate Medical School, Los Angeles, California 90059 v vi CONTRIBUTORS Gail H. [ronson, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California 94305 Theodore Jacob, Division of Family Studies, University of Arizona, Tucson, Arizona 85721 Stevo Julius, Division of Hypertension, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0356 Jay R. Kaplan, Department of Comparative Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27109 Alfred L. Kasprowicz, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260 Peter G. Kaufmann, Behavioral Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892 Paul Kligfield, Division of Cardiology, Department of Medicine, The New York Hospital-Cornell Medical Center, New York, New York 10021 George F. Koob, Division of Preclinical Neuroscience and Endocrinology, Research Institute of Scripps Clinic, La Jolla, California 92037 David S. Krantz, Department of Medical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814 Cynthia M. Kuhn, Department of Pharmacology, Duke University Medical Center, Durham, North Carolina 27710 Lewis H. Kuller, Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania 15261 John H. Laragh, Cardiovascular Center and Department of Medicine, Cornell University Medical College, New York, New York 10021 Kevin T. Larkin, Department of Psychology, West Virginia University, Morgantown, West Virginia 26506 Debora De-Ping Lee, Department of Medicine, University of Southern California School of Medicine, Los Angeles, California 90007 Kathle'n C. Light, Departments of Psychiatry and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599 William R. Lovallo, Behavioral Sciences Laboratories, Veterans Administration Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104 Stephen B. Manuck, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260 Allyn L. Mark, Departments of Anesthesia and Internal Medicine, Cardiovascular and Clinical Research Centers, University of Iowa College of Medicine, Iowa City, Iowa 52242 Karen A. Matthews, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213 Philip M. McCabe, Behavioral Medicine Research Center, Department of Psychology, University of Miami, Coral Gables, Florida 33124 Mikhail Menshikov, Myasnikov Institute of the All-Union Cardiological Research Center, Moscow, U.S.S.R. CONTRIBUTORS vii Scott M. Monroe, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania 15260 Larry R. Muenz, SRA Technologies, Inc., 4700 King Street, Alexandria, Virginia, 22302 Yelena Parfyonova, Myasnikov Institute of the All-Union Cardiological Research Center, Moscow, U.S.S.R. M. A. Pfeifer, Division of Endocrinology and Metabolism, Veterans Administration Medical Center, Louisville, Kentucky 40202 Thomas G. Pickering, Department of Medicine, Cardiovascular Center, The New York Hospital Cornell Medical Center, New York, New York 10021 Gwendolyn A. Pincomb, Behavioral Sciences Laboratories, Veterans Administration Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104 D. Pregibon, AT&T Bell Laboratories, Murray Hill, New Jersey 07974 Jeffrey Ratliff-Crain, Department of Medical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814 William J. Ray, Department of Psychology, Pennsylvania State University, University Park, Pennsylva nia 16802 David Robertson, Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee 37232 Robert F. Rushmer, Center for Bioengineering, University of Washington, Seattle, Washington 98105 Patrice G. Saab, Department of Psychology, University of Miami, Coral Gables, Florida 33124 Vikas Saini, Cardiovascular Laboratories, Harvard University School of Public Health, Boston, Mas- sachusetts 02115 Neil Schneiderman, Behavioral Medicine Research Center, Department of Psychology, University of Miami, Coral Gables, Florida 33124 Jean E. Sealey, Cardiovascular Center and Department of Medicine, Cornell University Medical Col lege, New York, New York 10021 Jerome E. Singer, Department of Medical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814 Jay S. Skyler, Departments of Medicine, Pediatrics, and Psychology, University of Miami, Miami, Florida 33101 Michael J Strube, Department of Psychology, Washington University, St. Louis, Missouri 63DO Daniel L. Tennenbaum, Department of Psychology, Kent State University, Kent, Ohio 44242 Lawrence F. Van Egeren, Department of Psychiatry, Michigan State University, East Lansing, Michigan 48824 Richard L. Verrier, Department of Cardiology, Tufts University Medical School, Boston, Massachusetts 02115, and Department of Pharmacology, Georgetown University Medical Center, Washington, D.C. 20007 Myron H. Weinberger, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46223 Redford B. Williams, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710 viii CONTRIBUTORS Michael F. Wilson, ACOS for Research, Veterans Administration Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104 Michael G. Ziegler, Department of Medicine, University of California, San Diego Medical Center, San Diego, California 92103 Preface Cardiovascular disease continues to be the number ioral medicine" was developed and shaped into the one source of morbidity and mortality in our coun following definition: try. Despite a 35% reduction since 1964, these diseases, particularly coronary heart disease Behavioral medicine is the interdisciplinary field con cerned with the development and integration of behav (CHD), claim nearly 1,000,000 lives each year in ioral and biomedical science knowledge and techniques the United States (Havlik & Feinleib, 1979). relevant to the understanding of health and illness and The Framingham study, among others, has iden the application of this knowledge and these techniques tified three major risk factors implicated in the de to prevention, diagnosis, treatment and rehabilitation. velopment of CHD: smoking, elevated serum cho (Schwartz & Weiss, 1978) lesterol, and high blood pressure (Castelli et at., This concept of "biobehavioral" collaboration 1986). Given that these factors account for less challenged scientists and clinicians of many disci than 50% of the variance associated with CHD plines to consider how they might more effectively (Jenkins, 1976), it has become obvious that addi develop diagnostic, treatment, and prevention tional risk factors must be identified if further pro strategies by merging their perspectives to address gress is to be made in disease prevention and simultaneously, among others, behavioral, psy control. chosocial, genetic, physiological, biochemical, During the past twenty years, health researchers and cellular factors, i.e., to attempt to address the have given increased attention to behavioral, psy problem at all levels at which it presented itself chosocial, and environmental variables as potential (Schwartz, 1981). contributors to the spectrum of risk factors. Initial Three related principles guided their formula studies focused on the association of various per tions: sonality types, behavior patterns, and life events (stressors) with the prevalence of CHD, hyperten sion, and sudden cardiac death. Although these 1. Behavioral/psychological factors might have studies produced somewhat equivocal results, an interactive as well as an independent contri there appeared to be sufficient positive findings to bution to disease processes. warrant continued investigation. Yet investigators 2. Demonstrating an association between behavior from the various disciplines engaged in indepen and disease state would not in itself be suffi dent research on these topics were somewhat cient; one would also have to ultimately identi stymied as to how best to proceed. fy mechanisms of action to understand the Approximately ten years ago, a small group of causal relationships between behavioral and distinguished health scientists gathered to share disease processes as well as to develop specific their collective frustrations with the seeming in strategies of intervention and prevention. ability of the biomedical and behavioral science 3. Advances in noninvasive, nORintrusive bio communities to come to terms more effectively instrumentation have permitted simultaneous, with the diversity of variables related to prevention continuous measurement of physiological and and control of chronic diseases. From these and biochemical responses to psychological/envi subsequent discussions, the concept of "behav- ronmental challenge. Such opportunities would ix