Mind-body: Psychotherapy helps your heart
February 2nd, 2011
11:54 AM ET

Mind-body: Psychotherapy helps your heart

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 http://www.nacbt.org.

soundoff (230 Responses)
  1. Michael Stone

    Very interesting article with great insight. I find that meditation has helped to bring my blood pressure and heart rate down. There is a retreat that I became part of that may be of interest to you. http://www.intruessence.com. It is called called 7 Days 7 Chakras.

    February 2, 2011 at 14:10 | Report abuse | Reply
  2. Dizzyd

    With all the stress and loneliness out there, I'm surprised there aren't more heart attacks.

    February 2, 2011 at 15:00 | Report abuse | Reply
  3. Charmaine

    One excellent method of reducing stress after a long day at the office is to watch scenic relaxation videos. Avoid stressful programming on TV that can cause additional anxiety. Personally I like watching the Serenity Moments relaxation videos which have beautiful scenery and music that relax the mind and calm the soul. You might enjoy them also at http://www.serenitymoments.com I use them as a meditation tool for stress / anxiety relief.

    February 2, 2011 at 18:49 | Report abuse | Reply
  4. Justina

    Present West is destined to psychological mess-up, because it trusts in the corrupt human mind instead of admitting one's own guilt in absolut sense. Suppression of facts and truth always makes the matter worse. Admitting oneself as a sinner and knowing and accepting the forgiveness of God alone is true liberation to human spirit. Anything else is a cover-up.

    February 2, 2011 at 20:42 | Report abuse | Reply
  5. Cara

    In my opinion, this article does an excellent job of conveying the importance of the mind-body connection. You can't have one without the other, so why ignore the importance of mental health in overall well-being? However, I do not believe that CBT is the best type of psychotherapy to recommend to people who have heart health problems. It just happens to be the type of psychotherapy that was used in this research, probably because it is a more short-term model.

    February 2, 2011 at 21:05 | Report abuse | Reply
  6. Bob

    Mind body connection who would have thunk it???

    February 2, 2011 at 22:04 | Report abuse | Reply
  7. Dr Bill Toth

    Cognitive Behavioral Therapy = change your stinkin thinkin. And it works. As parents we're either an example or a warning. We teach our children how to or how not to interpret events as stress, excitement or learning experiences.
    Shakespeare sais something like this; Nothing is either good nor bad except that we make it so". Live With Intention, DrBillToth.com/blog

    February 3, 2011 at 07:39 | Report abuse | Reply
  8. Bob Ellal

    Qigong helped me beat four bouts of "terminal" bone lymphoma in the early nineties. It's also helped me manage the pain–physical and emotional–wrought by the cancer in the years since. Qigong also is an excellent stress reducer; after consistent practice life's "slings and arrows" bounce off one like pebbles plinking off a breastplate. Clear 14 years and still practicing every day!

    February 3, 2011 at 09:12 | Report abuse | Reply
  9. Jorge

    If I ever get a heart attack, it will certainly be a pointer to change gears. I will thereafter have a New York response to anyone trying to twang my last nerve, this has worked for my 93 year-old godmother who is a grouchy, irascible b***h, it will work for me, after all, it's not every day that one comes across such a life-changing reminder of life's shortness.

    February 3, 2011 at 11:16 | Report abuse | Reply
  10. Daniella Martin

    @Jorge, don't wait until you have a heart attack!
    This is a great article. CBT has been found to be very effective, though many people are discouraged from getting the counseling they need due to factors like cost, convenience, etc. One answer to this might be online counseling, which has been shown to work as well or better than in-person sessions, and can be less expensive and more accessible. Sites like Breakthrough.com offer complete privacy, an online "therapist shopping mall," and the ability to get counseling from home. Could be an answer for the 40 million Americans who aren't getting the help they need.

    February 3, 2011 at 14:20 | Report abuse | Reply
  11. Anthony DeMarco

    I have observed that healing can be hastened by preparing not only the patient’s body but the mind, as well. When the mind is freed from anxiety and fear, the body becomes more receptive to treatment and recovers more easily from whatever procedure is required.

    February 9, 2011 at 04:41 | Report abuse | Reply
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