MONDAY, Jan. 24 (HealthDay News) -- A stress management program
based on cognitive behavioral therapy may reduce the risk of heart
attack, stroke and death in patients with heart disease, Swedish
About 30 percent of heart attacks may be linked to "psychosocial
factors," including chronic stressors such as poverty or emotional
problems, such as depression and hostility, the authors note in the
Jan. 24 issue of the
Archives of Internal Medicine.
"Psychological treatment appears to prevent recurrent [cardiac] events at least as effective as many of today's established pharmacological treatments," said lead researcher Dr. Mats Gulliksson, from the Family Medicine and Clinical Epidemiology Section at Uppsala University Hospital.
For the study, Gulliksson's group randomly assigned 362 men and
women with heart disease to usual care and cognitive behavioral
therapy or usual care with no therapy. Patients in therapy
underwent 20 two-hour sessions over a year.
Usual care included medications to lower blood pressure and
cholesterol or to prevent blood clots, Gulliksson said.
The premise of CBT is that by changing the way you think about
something, you can help yourself feel or behave better. The study
program included five key components with specific goals --
education, self-monitoring, skills training, cognitive
restructuring and spiritual development -- and focused on stress
management, specifically reducing the experience of daily stress,
time urgency and hostility.
Over almost eight years of follow-up, the CBT group had 23
deaths, 69 cardiovascular events, and 41 heart attacks. However,
among those who did not take part in therapy, 25 died, 77 had any
type of cardiovascular event and 51 suffered heart attacks, the
That works out to 41 percent fewer deaths and heart-related
events and 45 percent fewer heart attacks among those in the CBT
group, compared with patients who did not receive therapy, they
Those who went to the most therapy sessions had a further
reduction in risk, the researchers note. "The higher the attendance
rates, the lower the risk," Gulliksson said.
"The psychological treatment had a clear impact beyond the already known beneficial effects of conventional treatments to prevent recurrent events," Gulliksson said. "The effects were similar for men and women," he added.
Exactly how the stress management strategies protect the heart
is a question for future research, he noted.
It's possible that the better outcomes relate to long-term
participation (six to 12 months at least) in a group designed to
alter behavior, the authors say. Perhaps by decreasing emotional
and behavioral reactivity, people can alleviate some of the burden
placed on the cardiovascular system, they add.
"The positive results suggest that cognitive behavioral therapy intervention based on stress management should be added to secondary prevention programs and offered to all coronary heart disease patients," Gulliksson said. The therapy is also inexpensive and without side effects, he added.
But at least one expert remained unconvinced that the health
benefits noted in the study were related to the CBT therapy.
"We know from many trials that people in intervention trials tend to get better care," said Dr. Robert Myerburg, a professor of medicine and cardiology at the University of Miami Miller School of Medicine.
What isn't clear from the study is whether the therapy patients
kept to their medication regimen more consistently than the
non-therapy patients, he said. For example, the study authors don't
show whether blood pressure and cholesterol were better controlled
in the therapy group than in the non-therapy group, Myerburg
"The question is, is this a direct effect or a nonspecific effect of an intervention where we know that people tend to 'behave better' in terms of their outcomes and therapies?" he said.
Despite his skepticism, Myerburg doesn't see a downside if a
patient wants to try cognitive behavioral therapy.
"What I say to patients, as with all these unproven therapies, is as long as they are not doing harm I have no objection," he said.
For more information on cognitive behavioral therapy, visit the
National Association of Cognitive-Behavioral Therapists.