This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rozanski, A. Articles by Kubzansky, L. D. Search for Related Content PubMed PubMed Citation Articles by Rozanski, A. Articles by Kubzansky, L. D. Related Collections Depression

Psychologic Functioning and Physical Health: A Paradigm of Flexibility

From the Division of Cardiology, St. Luke's–Roosevelt Hospital Center, and the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (A.R.); and the Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts (L.K.).

View larger version (45K): [in a new window]   Figure 1. A paradigm of psychologic well-being based on 3 interrelated components. Central to this paradigm is "vitality," a positive energetic state that is characterized by enthusiasm and a sense of aliveness. The energy associated with vitality helps to foster the work needed to regulate positive and negative emotions and to cope with life problems. This relationship is bidirectional because effective emotional competence and coping skills, in turn, help to preserve vitality by diminishing the frequency of energy-depleting negative emotions and/or taxing life problems. Emotional and coping flexibility are seen as key indicators of one's ability to successfully manage negative emotions and solve problems effectively.

View larger version (35K): [in a new window]   Figure 2. Patterns of inflexibility that have been shown to be associated with the development of abnormal cardiovascular pathophysiology and/or adverse clinical outcomes ranging from negative cognitive states (such as rumination, pessimism, and worry) to lifestyles that are likely to be associated with chronic physiological overload such as chronic job stress or caregiver strain.

View larger version (35K): [in a new window]   Figure 3. Individuals with chronic emotional disorders such as depression or who experience chronic stress may be subject to chronic physiological stress responses characterized by chronic overstimulation of the hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system (SNS). The resultant dysregulation of these systems may lead to decreased cortisol variability, hypercortisolemia, high norepinephrine levels, autonomic dysfunction, elevated resting heart rates, and other peripheral affects that are not shown. The chronic stress response is also characterized by a prolonged recovery to physiological stimulation and to enhanced cardiovascular reactivity to novel stressors.