implantable cardioverter defibrillators (ICDs). Medicare has
begun penalizing hospitals with too many readmissions for
heart failure and heart attacks within 30 days of discharge, a
development that has prompted some hospitals to hire cardiac
psychologists (see article on page 50). “And the empirical
database has expanded enormously,” says Allan.
While early cardiac psychology research focused on
determining psychological risk factors for cardiovascular
disease, these days psychologists are moving beyond that
kind of epidemiological study. They’re beginning to find
evidence that psychological interventions may prevent cardiac
depression and hostility can save lives.
While researchers have long focused on
the role of anger, depression and other
psychological factors in worsening
outcomes after heart attacks, some
researchers are now examining how the
trauma of the heart attack itself can
affect cardiovascular health.
events and even lengthen lives. They’re also exploring new
areas, including how psychological risk factors actually affect
the heart, how environmental factors such as emergency
room crowding affect patients’ outcomes and how positive
emotions such as optimism and happiness may protect the
A life saver?
“The research linking certain psychological traits and heart
problems has burgeoned over the last decade,” says Allan.
A PubMed search on stress and cardiovascular disease, for
example, turns up more than 60,000 citations, with more than
35,000 of them related to psychosocial factors, he points out.
Over the last 15 years or so, says Allan, researchers have
largely abandoned work on the Type A behavior pattern that
dominated the early days of cardiac psychology. Instead, they
are now focusing on the role that two key elements of Type A
behavior — anger and hostility — play in the development
of coronary heart disease. Researchers have already amassed
convincing evidence of depression’s role, says Allan.
By contrast, there have been very few randomized clinical
trials assessing whether treating such psychosocial factors as
reported that while a small subset of studies found
psychological interventions to have a modest positive effect on
mortality, there was no strong evidence that such interventions
reduced the need for surgical revascularization procedures or
the risks of non-fatal heart attacks and total deaths.
For Allan, those findings simply suggest that not enough of
the right kind of interventions have been studied yet.
For one thing, he says, it’s difficult to study psychological
interventions the same way you would pills or other physical
interventions. Plus, the psychological interventions that have
been studied have been too brief to counter what Allan calls
“massive doses of traditional risk factors” — the decades of
unhealthy lifestyle choices, depression, anger and other risk
factors that most heart patients have amassed before they land
in a cardiologist’s office or even in the emergency room.
But there have been signs of hope, such as the Stockholm
Women’s Intervention Trial for Coronary Heart Disease. That
2009 study found an almost three-fold protective effect for an
intensive psychological intervention that included 20 sessions
over a year.
A 2011 study in Archives of Internal Medicine further
supported therapy’s heart-helping benefits. In the Secondary