心脏自主神经控制与敌意治疗的随机对照试验。
Cardiac autonomic control and treatment of hostility: a randomized controlled trial.
机构信息
Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, USA.
出版信息
Psychosom Med. 2010 Jan;72(1):1-8. doi: 10.1097/PSY.0b013e3181c8a529. Epub 2009 Dec 22.
OBJECTIVE
To test whether reduction in hostility increases autonomic regulation of the heart.
METHODS
In this randomized controlled trial, participants were 158 healthy adults, aged 20 years to 45 years, who were 1 standard deviation (SD) above national norms on the Cook-Medley Hostility and the Spielberger Trait Anger Indices. Participants also were interviewed, using the Interpersonal Hostility Assessment Technique (IHAT). They were randomly assigned to a 12-week cognitive behavior therapy program for hostility reduction or a wait-list control condition. The main outcome measure was cardiac autonomic modulation, measured as RR interval variability (RRV) derived from 24-electrocardiographic recordings.
RESULTS
In a multivariate analysis of variance assessing psychological outcomes of hostility, anger, and IHAT scores, there was a significant treatment effect with an average reduction across the three outcomes that was approximately 0.7 SD (ES = 0.685, SE = 0.184, p < .001) greater for the intervention group than for the control group. In contrast, the change in heart rate was -0.14 beat/min (95% Confidence Interval [CI] = -2.43, 2.14) in treatment participants and -1.36 beat/min (95% CI = -3.28, 0.61) in wait-list participants. High-frequency RRV, an index of cardiac parasympathetic modulation, increased by 0.07 ln ms(2) (95% CI = -0.10, 0.24) for participants in the treatment condition and decreased by 0.04 ln ms(2) (95% CI = -0.18, 0.10) for participants in the wait-list condition. These differences were not significant. The findings for other indices of RRV were similar.
CONCLUSIONS
Reduction of hostility and anger was not accompanied by increases in cardiac autonomic modulation. These findings raise questions about the status of disordered autonomic nervous system regulation of the heart as a pathophysiological mechanism underlying the hostility-heart disease relationship and about whether hostility itself is a mechanism or merely a marker of elevated risk of heart disease.
目的
检验降低敌意是否能增加心脏自主调节能力。
方法
在这项随机对照试验中，参与者为 158 名年龄在 20 岁至 45 岁之间的健康成年人，他们在 Cook-Medley 敌意量表和 Spielberger 特质愤怒量表上的得分均高于全国平均值 1 个标准差。同时，使用人际间敌意评估技术（IHAT）对参与者进行访谈。他们被随机分配到为期 12 周的敌意降低认知行为治疗方案或候补名单对照条件。主要观察指标是通过 24 导心电图记录得出的 RR 间期变异性（RRV），作为心脏自主调节的衡量标准。
结果
在敌意、愤怒和 IHAT 得分的多变量方差分析中，有一个显著的治疗效果，干预组在这三个结果上的平均降低幅度约为 0.7 个标准差（ES=0.685，SE=0.184，p<.001），明显大于对照组。相比之下，治疗组参与者的心率变化为-0.14 次/分（95%置信区间[CI]为-2.43，2.14），候补名单组参与者的心率变化为-1.36 次/分（95%CI为-3.28，0.61）。高频 RRV，作为心脏副交感神经调节的指标，治疗组参与者增加了 0.07lnms(2)（95%CI为-0.10，0.24），候补名单组参与者减少了 0.04lnms(2)（95%CI为-0.18，0.10）。这些差异并不显著。RRV 的其他指标的结果也相似。
结论
敌意和愤怒的减少并没有伴随着心脏自主调节能力的增强。这些发现引发了一些问题，即紊乱的自主神经系统对心脏的调节是否是敌意与心脏病之间关系的病理生理机制，以及敌意本身是否是一个机制，还是仅仅是心脏病风险升高的一个标志物。
Zotero 插件