Psychotherapy in patients with coronary heart disease

Abstract

In patients with coronary heart disease, psychosomatic-somatopsychic interactions are frequent and clinically relevant. Starting in the 1960s, psychosocial interventions have been used to improve the patient's wellbeing and disease outcomes. Besides educational and non-specific supportive interventions or relaxation trainings, more specific psychotherapeutic interventions have been reported. Many of these interventions aim at reducing distress and promoting healthy behaviors, thereby slowing down the disease process. More recently, studies have also been made on the psychotherapy for psychiatric comorbidities. In the largest psychotherapy trial in coronary patients, the ENRICHD trial, 2,481 post-myocardial infarction patients with depression or low perceived social support were randomized to receive up to six months of cognitive behavioral psychotherapy or treatment as usual. The treatment resulted in a marked reduction in depressive symptoms. However, given the high remission rate in the control group, the net treatment effect was modest. The targeted reduction in mortality was not achieved. The current state of the literature does not yet allow to give general evidence-based treatment recommendations. It rather requires the development of differential indications, the refinement of existing treatment concepts and the exploration of alternative psychotherapeutic methods. Individual treatment decisions must be based on the specific case, on the well-documented subjective benefits of psychotherapy in coronary patients as well as on theoretical assumptions about stress management and relaxation trainings and on general knowledge about the effectiveness of psychotherapy obtained in other patient groups. When working with coronary patients, psychotherapists should be aware of the cardiac condition and its typical precursors and consequences. They should also closely collaborate with the patients' cardiologists and family physicians.