Conceptualization Measurement and Analysis of Negative Affective Risk Factors

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Timothy W.Smith

Since long before the inception of behavioral medicine as a scientific field, negative emotions have been described as contributing to the development and course of serious physical illness. A substantial and growing body of research now supports this hypothesis (Smith and MacKenzie, 2006; Steptoe, 2007a; Suls and Bunde, 2005). Among the specific negative affects studied, anger and related constructs (e.g., hostility) have the longest history of research, especially in cardiovascular disease (Chida and Steptoe, 2009; see Chapter 13). More recently, depression has emerged as a major research focus as a risk factor for the development and adverse course of physical illness (Nicholson et al, 2006; Steptoe, 2007b). Anxiety and related constructs (e.g., worry) are increasingly documented as having similar effects (Roy-Byrne et al, 2008; Suls and Bunde, 2005). Whether studied as symptoms of emotional distress, diagnosed mood or anxiety disorders, or related personality traits, it is increasingly clear that these affective characteristics pose significant health risks.

Yet, inconsistencies in this literature underscore the need for additional research (c.f., Nicholson et al, 2006), especially since some intervention trials based on these associations have not demonstrated expected health benefits (e.g., ENRICHD Investigators, 2003).

Department of Psychology, University of Utah, 380 South 1530 East (Room 502), Salt Lake City, UT 84112-0251, USA e-mail: [email protected]

Nonetheless, management of negative emotions and stress can potentially improve health outcomes (e.g., Linden et al, 2007). As a guide to future research, this chapter reviews implications of the fact that these negative affective characteristics are often closely related, despite distinct labels and clear conceptual differences. Until recently studies have typically examined only one such characteristic at a time. As a result, observed associations could reflect the individual risk factor studied, a closely related but unmeasured affective trait, or a broader individual difference in propensity to negative affect (Suls and Bunde, 2005).

Studies of the overlapping versus independent nature of associations between multiple negative affective characteristics and health outcomes are important not only in providing more precise answers to age-old questions about negative affect and physical health, but also for the design of interventions. In order to select or develop maximally useful treatments, it is important to determine if one of the individual negative affects is the predominant influence on health, if multiple specific affects are important, or if the observed associations reflect the role of a broader disposition to experience negative affect generally. The present chapter reviews the conceptual, measurement, and data analytic challenges in producing this more refined understanding.

A. Steptoe (ed.), Handbook of Behavioral Medicine, DOI 1G.1GG7/97S-G-3S7-G94SS-5_12, © Springer Science+Business Media, LLC 2G10

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