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Psychological Factors in Cardiac Rehabilitation

Psychological Factors in Cardiac Rehabilitation. Frank McDonald Psychologist TGH. Overview. 1. What are the common psychological reactions to cardiac events? 2. What are the psychological influences on recovery from heart disease?

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Psychological Factors in Cardiac Rehabilitation

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  1. Psychological Factors in Cardiac Rehabilitation Frank McDonald Psychologist TGH

  2. Overview • 1. What are the common psychologicalreactions to cardiac events? • 2. What are the psychological influences on recovery from heart disease? • 3. Can psychological interventions make a difference to cardiac rehabilitation outcomes?

  3. Risk factors in the development and exacerbation of heart disease • Non-modifiable: Gender Age Family history • Modifiable: Cigarette smoking Raised blood fats High b.p. Physical inactivity • Other influences:Diabetes Contraceptive pill Alcohol use Stress and Depression Fate Lifestyle Dependent

  4. Psychological reactions after cardiac events • Major psychological reactions post MI : • 1. Denial (as defence against 2 &3) • 2. Anxiety • 3. Depression • Possible causes: threat to life, family obligations, loss of social role, missed opportunities,  self esteem,  sensitivity to aches and pains, past hx depression, physical weakness & boredom. • Possible stages: disbelief, denial, anger, depression, acceptance & resumption of control, & finally resolution & adaptation.

  5. Psychological influences on recovery • Negative influences: • Do certain personality factors affect rehospitalisation, mortality and morbidity? • Yes - • distress • hostility • ‘inhibited anger’ • helplessness/depression. • Distress = above 90th %ile on SCL-90-R • (Allison et al.1995) • = high prevalence of depression, • life stress, somatisation and use • of benzodiazepines • (Denollet,Sys and Brutsaert, 1995)

  6. Psychological influences on recoveryHostility component of Type A Behaviour Pattern(Booth-Kewley and Friedman, 1987) (Denollet,1993) Inhibited individuals non-expressive of anger(Denollet, 1993)Helplessness -  Competence  Depression (Krantz,1980)Depression -  Rehospitalisation (Levine et al., 1993) Mortality(Blumenthal and Emery, 1988)Psychological influences on recoveryHostility component of Type A Behaviour Pattern(Booth-Kewley and Friedman, 1987) (Denollet,1993) Inhibited individuals non-expressive of anger(Denollet, 1993)Helplessness -  Competence  Depression (Krantz,1980)Depression -  Rehospitalisation (Levine et al., 1993) Mortality(Blumenthal and Emery, 1988)Psychological influences on recovery • Hostility component of Type A behaviour pattern • (Booth-Kewley and Friedman, 1987) (Denollet,1993) • Inhibited individuals non-expressive of anger • (Denollet, 1993) • Helplessness -  Competence  •  Depression • (Krantz,1980) • Depression -  Rehospitalisation • (Levine et al., 1993) Mortality • (Blumenthal and Emery, 1988)

  7. Psychological influences on recovery • Mortality and maladjustment increases with: • depression • low morale • psychological distress • (Blumenthal & Emery, 1988) • Occupational factors such as : • excessive workload • low control • few possibilities for growth • are significantly associated with excess risk of CAD • (Krantz & Durel 1983)

  8. Psychological influences on recovery • While anxiety on its own may not be significantly related to CAD outcomes, considerable evidence links disturbing situations and life events with myocardial ischaemia, ventricular arrthymias and sudden death. • (Stoudemire 1995) • Low levels of socialsupport appear to interact with other factors such as life stress, job strain and TABP to increase risk for CAD events. e.g. • High life stress and high social isolation in the Beta Blocker Heart Attack Trial, death at 3 year follow up was 4 x more likely. These two factors were more prevalent among the least educated. • (Ruberman, 1984)

  9. Psychological influences on recovery • Positive influences:DispositionalOptimism • = Expectations that good outcomes occur when problems are confronted. • Correlates positively with problem-focused coping, faster hospital recovery and faster rate of return to normal life post discharge. • (Scheier et al.1989)Perceived control and beliefsthat certain behaviours are health protective. • (Stroebe and Stroebe, 1995)

  10. Can psychological interventions make a difference to cardiac rehab (CR) outcomes? • Possibly • Results of general lit reviews of CR with psych components re mortality &  morbidity are conflicting. (Studies vary in content and methodologies.) • Data on QOL and reduction of coronary risk behaviours vs. routine/conventional care generally more supportive. • (Blumenthal & Emery, 1988; Bennett & Carroll,1994) • Some meta-analytic studies of CR trials have produced findings in favour of •  mortality &  morbidity. • (Oldridge et al. 1988; Bobbio,1989; Linden et al. 1996)

  11. Psychological interventions • Screening • Structured interviews and psychometric assessment of psychological risk factors - • e.g. hostility, distress, depression and hopelessness. • Treatment • Stress management: emotion- focused and problem-focused strategies (e.g. home monitor b.p.) • Psychological Counselling • Cognitive and Behavioural • strategies for risk factors • Biofeedback

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