Cognitive Behavioral Therapy May Prevent a Second Heart Attack

Roughly a third of heart attack patients have had psychosocial factors before their cardiac event; these include anxiety, depression, anger, hostility, work or marital stressors, or socio-economic problems. After a heart attack, it's also common to find such factors in patients, but it has not been possible to demonstrate any benefit from treating them on the subject’s outcome. A Swedish study, reported in the Archives of Internal Medicine, has examined the effects of cognitive behavioral therapy (CBT) on the rates of repeat heart attacks and other coronary disease events.

The people studied were 362 men and women under 75, who were discharged from hospital in the previous 12 months after a coronary disease event (heart attack or MI, unstable angina, resuscitated cardiac arrest, sudden or unexplained death, ischemic stroke, and transient ischemic attacks).  They were allocated to receive either traditional care or traditional care and CBT; the latter consisted of 20 two-hour sessions over one year in which participants learnt different methods of managing and reducing stress. The average follow-up period was 7½ years. All patients attended at least one session, and the average attendance at each session was 85%.

During the follow-up period the CBT group had a 41% lower rate of fatal and non-fatal recurrent coronary disease events; there were 45% fewer recurrent heart attacks, and a 28% lower all-cause mortality than in the traditional care group (this last percentage was not statistically significant, i.e. it could have occurred by chance alone). Within the CBT group there was a strong dose-response effect between the number of sessions attended and the patient’s outcome; in other words, the higher the attendance rates, the lower the risk.

This study provides further evidence of the effectiveness of CBT in decreasing the ill-effects of psychosocial factors on general health.  Indications include mood disorders (e.g. depression, bipolar disorder), anxiety disorders, PTSD, personality disorders, eating disorders (e.g. anorexia, bulimia), insomnia, substance abuse, and some psychotic disorders; it’s also used with benefit in diseases with a so-called psychosomatic component – IBS, fibromyalgia, etc.