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      Motivation in psychocardiological rehabilitation

      book-review

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          Abstract

          In this book a group of independed-minded academics has orchestrated a multi-authored text that represents an update of knowledge concerning how motivation influences Cardiovascular (CV) response. Discussing diverse motivational approaches that are representative of works carried out in several areas of psychology, health implications of the linkages between motivational variables and CV response have been investigated. The volume is divided into two major parts: Part I includes chapters that concern mechanisms of motivational influence on CV response, while in the Part II motivational paths to carry out with the aim of investigate CV response in different life circumstances have been considered. In more detail, 4 subsections organize Part I through 10 chapters, and 3 subsections constitute Part II by means of 9 chapters, each of those preceded by a summary of the key points. The opening chapters discuss the importance of modern neuroimaging techniques in allowing occasions to investigate how the interplay between CV status, cognitive-emotional functioning, and environmental demands are realized within the central and peripheral nervous systems. The relationship between emotional arousal and CV response has been noteworthy argued and enriched by results from recent research findings in various disciplines (Pietrabissa et al., 2012; Compare et al., 2013a). These studies demonstrate stress, motivational intensity, individual personality, self-regulation and mood states being in charge of health damaging CV adjustments, such as heart rate, blood pressure, and heart contraction force (Compare et al., 2011a, 2012, 2013b). Part II mainly contains evidences that CV activity is an indicator or even cause for CV diseases development, also including explanations about the role covered by gender, psychological processes, and social interactions in influencing health outcomes via relevant biological pathway. In addition, a set of considerations that may guide future research on this subject are discussed. Due to the various contributions from different authors of different countries, both style of writing and chapters arrangement widely varies. Some issues are effectively revisited on several occasions in the volume, constituting minor imperfections in an otherwise excellent, comprehensive, and up-to-date overview of mechanisms and applications related to CV disease. In fact, this book, edited by two psychologists and written by an International group of specialists in different fields of medicine, successfully covers the subject. Because of diseases generally display a multifactorial aetiology and symptoms require to be assumed as manifestations of a complex interplay of several factors, the bio-psycho-social approach of illness theorized by Engel (1977) remains in the background. Health and illness are not seen as opposite concepts or distinct entities but extremes of a continuum on which individuals constantly flux depending on the quality of their daily-life experiences, influenced by biological (e.g., genetics, age), psychological (e.g., attitude, stress) (Compare et al., 2011b, 2013c), and social (e.g., interpersonal relationships, socio-economic status) factors (Castelnuovo, 2010; Compare et al., 2013c). Due to this complexity, as well as stated the crucial role of both personal dispositions and intentions in modifying personal attitudes and behaviors, the relevance of setting realistic goal, implementing patient-centered treatments and developing motivational enhancement techniques, is highlighted. Overall, this book represents a well-collated collection of research outcomes, successfully demonstrating the importance of both psychological factors and motivation in the treatment of patients suffering from CV diseases (Manzoni et al., 2011a). In fact, as extensively discussed through the pages of this volume, the individual's level of initial motivation, reflecting the maximum energy spent by a person for goals attainment, represent one the main predictor of success in preventing and managing CV risk factors (Manzoni et al., 2011b) also by modern telecare systems (Villani et al., 2007). However, the text is so densely written than chapters seem to be resources for references rather than flowing text. Despite recent technological changes have made information readily available on the Internet, because of potentially appealing scholars and practitioners from a wide range of areas, together with its acceptable price, this book still constitute a significant source of outcomes and data.

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          The need for a new medical model: a challenge for biomedicine.

          The dominant model of disease today is biomedical, and it leaves no room within tis framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.
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            Social support, depression, and heart disease: a ten year literature review

            Background: Coronary heart disease is the major cause of morbidity and mortality in the world. Psychosocial factors such as depression and low social support are established risk factors for poor prognosis in patients with heart disease. However, little is known about the hypothetical relationship pattern between them. Purpose: The purposes of this narrative review are (1) to appraise the 2002–2012 empirical evidence about the multivariate relationship between depression, social support and health outcomes in patients with heart disease; (2) to evaluate the methodological quality of included studies. Method: PubMed and PsychINFO were searched for quantitative studies assessing the multiple effects of low social support and depression on prognosis outcomes in patients with heart disease. The following search terms were used: social relation*, cardiac disease, support quality, relationship, and relational support. Results: Five studies (three prospective cohort studies, one case-control study, and one randomization controlled trial) were selected and coded according to the types of support (social and marital). The majority of findings suggests that low social support/being unmarried and depression are independent risk factors for poor cardiac prognosis. However, all analyzed studies have some limitations. The majority of them did not focus on the quality of marital or social relationships, but assessed only the presence of marital status or social relationship. Moreover, some of them present methodological limitations. Conclusion: Depressive symptoms and the absence of social or marital support are significant risk factors for poor prognosis in cardiac patients and some evidence supports their independence in predicting adverse outcomes. Cardiac rehabilitation and prevention programs should thus include not only the assessment and treatment of depression but also a specific component on the family and social contexts of patients.
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              Short-term effects of a multi-disciplinary cardiac rehabilitation programme on psychological well-being, exercise capacity and weight in a sample of obese in-patients with coronary heart disease: a practice-level study.

              Given that many patients referred to cardiac rehabilitation (CR) are obese, diet therapy, exercise training, nutritional and psychological counselling for both obesity and psychological distress should be included as important components in all CR programmes. In this practice-level, observational study we evaluated the short-term within-group effects of a four-week multi-factorial inpatient CR programme specifically addressed to weight loss, fitness improvement and psychological health increase on 176 obese in-patients with coronary heart disease (CHD). Outcome measures were exercise capacity measured with estimated metabolic equivalents (METs), body mass index (BMI) and psychological well-being (PGWBI). Results show statistically significant improvements in all the PGWBI sub-scales and total score, except in general health (p = 0.393). No moderation effects were found for BMI class, age, diabetes and ejection fraction (EF). METs significantly increased by 30.3% (p < 0.001) and BMI decreased by 1.37 points (p < 0.001). Significant correlations were found between BMI and weight reductions with PGWBI anxiety and total score improvements. This multi-disciplinary CR programme including diet therapy, exercise training and psychological counselling provides indication for short-term within-group effectiveness on functional exercise capacity, BMI and PGWBI in a sample of obese in-patients with CHD. However, controlled studies are needed to corroborate the results we found.
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                Author and article information

                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                06 November 2013
                2013
                : 4
                : 827
                Affiliations
                [1] 1Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Ospedale San Giuseppe Verbania, Italy
                [2] 2Department of Psychology, Catholic University of Milan Milan, Italy
                Author notes

                This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology.

                Edited by: Angelo Compare, University of Bergamo, Italy

                Reviewed by: Cristina Zarbo, University of Bergamo, Italy

                Article
                10.3389/fpsyg.2013.00827
                3818470
                355084cc-f700-4b42-9b38-efca45fb4e3a
                Copyright © 2013 Pietrabissa, Manzoni and Castelnuovo.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 August 2013
                : 18 October 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 2, Words: 1258
                Product

                , editors.

                How Motivation Affects Cardiovascular Response: Mechanisms and Applications.

                2012. Washington, DC: American psychological Association. 424 p.ISBN: 10: 1433810263. ISBN-13: 9781433810268.

                Categories
                Psychology
                Book Review Article

                Clinical Psychology & Psychiatry
                motivation,cardiological rehabilitation,stroke rehabilitation,psychocardiology,cardiac psichology

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