February 2nd, 2011
11:54 AM ET
Dr. Charles Raison, CNNHealth's Mental Health expert and an associate professor of psychiatry and behavioral sciences at Emory University, writes regularly on the mind-body connection for better health.
God forbid, but suppose you’ve just had a heart attack. You’re about to leave the hospital. You’re going to live, but you have new stitches inside your chest and all sorts of new worries in your life.To make these worries worse, you’ve gone online and read that psychosocial factors like stress contribute 30% of the risk for having another cardiac event, and contributed at least as much to the event you just had. Depression is even more of a problem, at least as bad as continuing to smoke 2 packs of cigarettes a day.
As you mull these thoughts, a cheery young researcher comes into your room and encourages you to enroll in a study designed to examine treatments that might decrease your chance of having another heart attack and that might thus help you life longer. The researcher gives you a choice: You can go on an antidepressant medicine for protection or you can attend 20 hours of group psychotherapy. Which would you choose?
If you chose medications you may have made the wrong choice based on an important new study from Sweden published last week in the Archives of Internal Medicine that reported that group cognitive behavioral therapy (CBT) appears to have the ability to protect people with heart disease from dying of their illness. On the other hand, almost a decade ago the largest study ever to examine whether antidepressants have the same long-term, lifesaving effects in people who have had a cardiac event came up negative.
Last week’s study compared a specially-designed type of group cognitive behavioral therapy with treatment as usual in 362 women and men 75 years or younger. All subjects had experienced a serious cardiac problem such as a heart attack (myocardial infarction in “doctor-speak”) or need for cardiac bypass surgery. Subjects were randomly assigned to the group CBT or treatment as usual and then repeatedly assessed for two years.
As described by the study authors, the group CBT intervention focused on the following five goals: education, self-monitoring, skills training, cognitive restructuring and spiritual development. Participants were taught how to bring this new knowledge to bear on reducing stress in their daily lives, including self-created stress resulting from feelings of hostility.
At the end of two years, when compared with the group that got treatment as usual, subjects randomized to CBT had a 45% reduction in heart attacks and were less likely to have died from a cardiac cause. The more therapy sessions a subject actually attended the better outcome he or she had.
Interesting stuff, but if you don’t live in Sweden what is the practical import of all this? First, studies like this really highlight the fact that many of us have outmoded ways of thinking that divide social/emotional factors from the physical functioning of the body. From this perspective, psychotherapy is good for dealing with your deadbeat husband, but has nothing to do with your heart, or your diabetes, or your cancer.
As one whose life work is to study these interactions, I can assure you that this type of thinking is just plain wrong. Social factors and the emotions they engender are at least as physically real, and as powerful, as any drug or surgery. So one of the most effective things we can do to improve our current health and protect our future physical well-being is to make a commitment to cleaning up and optimizing our emotional lives. As I often tell patients, “Other people can be either medicines or poisons. Focus on making them the former.”
A second important point is that if you are struggling with a serious medical illness and the manifold stressors that have come in its wake, you might really consider seeking out the types of social support and education that appear to have been offered by the CBT intervention in the study as a way of reducing stress. If it is hard for you to do these things just to feel better emotionally, take a moment the next time you are standing in front of the medicine cabinet. If there were a way to fit psychotherapy in there, it would be lined up right beside the blood pressure pills and statins in terms of its benefit on your heart and blood vessels. If you are aggressive in your medical care in general, why not think about adding some type of stress-management training to your medical regimen?
Finally, for those interested in more information on cognitive behavioral therapy (CBT) in general, a good starting place is
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