Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2004:(2):CD002902.
doi: 10.1002/14651858.CD002902.pub2.

Psychological interventions for coronary heart disease

K Rees  1 , P Bennett, R West, Smith G Davey, S Ebrahim
Affiliations

Psychological interventions for coronary heart disease

K Rees et al. Cochrane Database Syst Rev. 2004.

Update in

Abstract

Background: Psychological interventions can form part of comprehensive cardiac rehabilitation programmes (CCR). These interventions may include stress management interventions, which aim to reduce stress, either as an end in itself or to reduce risk for further cardiac events in patients with heart disease.

Objectives: To determine the effectiveness of psychological interventions, in particular stress management interventions, on mortality and morbidity, psychological measures, quality of life, and modifiable cardiac risk factors, in patients with coronary heart disease (CHD).

Search strategy: We searched CCTR to December 2001 (Issue 4, 2001), MEDLINE 1999 to December 2001 and EMBASE 1998 to the end of 2001, PsychINFO and CINAHL to December 2001. In addition, searches of reference lists of papers were made and expert advice was sought.

Selection criteria: RCTs of non-pharmacological psychological interventions, administered by trained staff, either single modality interventions or a part of CCR with minimum follow up of 6 months. Adults of all ages with CHD (prior myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, angina pectoris or coronary artery disease defined by angiography). Stress management (SM) trials were identified and reported in combination with other psychological interventions and separately.

Data collection and analysis: Studies were selected, and data were abstracted, independently by two reviewers. Authors were contacted where possible to obtain missing information.

Main results: Thirty six trials with 12,841 patients were included. Of these, 18 (5242 patients) were SM trials. Quality of many trials was poor with the majority not reporting adequate concealment of allocation, and only 6 blinded outcome assessors. Combining the results of all trials showed no strong evidence of effect on total or cardiac mortality, or revascularisation. There was a reduction in the number of non-fatal reinfarctions in the intervention group (OR 0.78 (0.67, 0.90), but the two largest trials (with 4809 patients randomized) were null for this outcome, and there was statistical evidence of publication bias. Similar results were seen for the SM subgroup of trials. Provision of any psychological intervention or SM intervention caused small reductions in anxiety and depression. Few trials reported modifiable cardiac risk factors or quality of life.

Reviewers' conclusions: Overall psychological interventions showed no evidence of effect on total or cardiac mortality, but did show small reductions in anxiety and depression in patients with CHD. Similar results were seen for SM interventions when considered separately. However, the poor quality of trials, considerable heterogeneity observed between trials and evidence of significant publication bias make the pooled finding of a reduction in non-fatal myocardial infarction insecure.

PubMed Disclaimer

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

    1. Allison TG, Farkouh ME, Smars PA, Evans RW, Squires RW, Gabriel SE, et al. Management of coronary risk factors by trained nurses versus usual care in patients with unstabel angina pectoris (a chest pain evaluation in the emergency room (CHEER) substudy) Am J Cardiol. 2000;86:133–138. - PubMed
    1. Black JL, Allison TG, Williams DE, Rummans TA, Gau GT. Effect of intervention for psychological distress on rehospitalization rates in cardiac rehabilitation patients. Psychosomatics. 1998;39(2):134–43. - PubMed
    1. Brown MA, Munford AM, Munford PR. Behavior therapy of psychological distress in patients after myocardial infarction or coronary bypass. J Cardiopulm Rehabil. 1993;13(3):201–10.
    1. Burell G. Behaviour modification after coronary artery bypass graft surgery: effects on cardiac morbidity and mortality. J Rehabil Sci. 1995;8:39–40.
    1. Burell G. Group psychotherapy in Project New Life: Treatment of coronary-prone behaviors for patients who have had coronary artery bypass graft surgery. In: Allan R, Scheidt S, editors. Heart and Mind. American Psychological Association; Washington: 1996. pp. 291–310.

References to studies excluded from this review

    1. Amarosa TB, Tapp JT, Carida RV. Stress management through relaxation and imagery in the treatment of angina pectoris. J Cardiopulm Rehabil. 1989;9(9):348–55.
    1. Ashton CJ, Whitworth GC, Seldomridge JA, Shapiro PA, Weinberg AD, Michler RE, et al. Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial. Journal of Cardiovascular Surgery. 1997;38(1):69–75. - PubMed
    1. Ashton RJ, Whitworth GC, Seldomridge JA, Shapiro PA, Michler RE, Smith CR, et al. The effects of self-hypnosis on quality of life following coronary artery bypass surgery: preliminary results of a prospective, randomized trial. Journal of Alternative & Complementary Medicine. 1995;1(3):285–90. - PubMed
    1. Beresnevaite M. Exploring the benefits of group psychotherapy in reducing alexithymia in coronary heart disease patients. Psychotherapy and Psychosomatics. 2000;69:117–22. - PubMed
    1. Blankfield RP, Zyzanski SJ, Flocke SA, Alemagno S. Taped therapeutic suggestions and taped music as adjuncts in the care of coronary-artery-bypass patients. American Journal of Clinical Hypnosis. 1995;37(3):32–42. - PubMed

References to studies awaiting assessment

    1. Collins B, Donoghue S, Plant RD. An investigation into the use of relaxation techniques in the treatment of myocardial infarction. Clin Rehabil. 1992;6:73.
    1. Priebe S, Sinning U. Effects of brief couple therapy intervention in cardiac rehabilitation - a controlled trial [Effekte einer kurzen paatherapeutischen intervention in der koronarrehabilitation] Psychother Psychosom med Psychol. 2001;51:276–280. - PubMed

References to ongoing studies

    1. The CORE Investigators Design of a randomised controlled trial of comprehensive cardiac rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study) Curr Controlled Trials in Cardiovasc Med. 2000;1:177–183. - PMC - PubMed

Additional references

    1. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation. 1996;93:1976–80. - PubMed
    1. Beck AT, Ward CH, Mendelson M, Mock J, Erbauch J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:53. - PubMed
    1. Beck AT. In: Zeig JK, editor. Cognitive Therapy: Reflections; The evolution of psychotherapy: The third conference; New York: Brunner/Mazel. 1997.
    1. Bedford A, Foulds GA, Sheffield BF. A new personal disturbance scale (DSSI/sAD) Brit J Soc Clin Psychol. 1976;15:387–94. - PubMed
    1. Bennett P, Carroll D. Type A behaviours and heart disease: epidemiological and experimental foundations. Behavioural Neurology. 1990;3:261–77. - PubMed

Publication types