move in the right direction in medicine often requires two
moves in the right direction for psychologists,” says Sears, who
offered tips for patients coping with ICD-related stress in a
2013 Circulation article. He also invented ICD Coach, a mobile
phone application that gives patients strategies for improving
their quality of life.
The American Heart Association has caught on, too: Last
year, it issued a scientific statement in Circulation calling
for educational and psychological interventions to improve
outcomes for both ICD patients and their families. “It’s a big
deal when medical societies decide that psychological issues are
so significant they must address them,” says Sears, one of the
Focusing on the positive
While most cardiac psychology research focuses on risk factors,
an emerging line of research focuses on protective factors. “It’s
helpful to consider what people are doing right and how that
might contribute to cardiovascular health,” says psychologist
Julia K. Boehm, PhD, a postdoctoral research fellow in the
department of social and behavioral sciences at the Harvard
School of Public Health.
In a paper in Psychological Bulletin last year, Boehm and
Laura Kubzansky, PhD, an associate professor of social and
behavioral sciences at the Harvard School of Public Health,
analyzed more than 200 studies. They found that psychological
well-being — especially optimism — seems to protect both
healthy people from cardiovascular disease and heart disease
patients from further problems. In most cases, the findings
held true even after controlling for traditional risk factors, such
as obesity, smoking and high cholesterol. The findings also
seem to be independent of psychological risk factors, such as
depression, anxiety and hostility.
“There’s really something to be gained by not just avoiding
depression but having meaning and hope in life,” says Boehm,
who is now exploring how positive emotions affect biological
markers, such as lipids and serum antioxidant levels.
Others, such as Matthew Burg, aren’t convinced. “This is an
observational finding,” he says, explaining that only a clinical
trial to test an intervention can determine whether finding
meaning in life or making similar changes will reduce risk.
“The medical literature is rife with failed clinical trials that
‘should have’ worked, given the observational findings,” he
says, citing hormone replacement therapy as one “no brainer”
that turned out to actually increase rather than decrease risk.
Plus, he says, “this type of thinking can lead to a blaming of the
Boehm agrees about the need for further research.
“Further down the road, it might be interesting if we could
establish that enhancing a person’s well-being translates into
benefits in terms of cardiovascular health,” she says. “There’s
really no evidence of that to date, but that might be one of the
implications of where the research might take us.” n
Rebecca A. Clay is a writer in Washington, D.C.
• Behavioral Cardiology/Cardiac
Psychology Listerv. This listserv aims to be
an informal digest of cardiac psychology and
behavioral cardiology research and news.
To subscribe, visit http://lists.apa.org/cgi-bin/
• “Heart and Mind: Cardiac Psychology.”
This Clinician’s Corner Video-on-Demand
from APA offers a three-hour overview of
cardiac psychology by Robert Allan, PhD.
• “Heart and Mind: Contemporary Issues
in Cardiac Psychology.” This five-part video-on-demand program from APA highlights
the critical role of psychological science in
understanding, preventing and treating cardiac
events. Visit www.apa.org/ed/ce.
• “Heart and Mind: The Practice of Cardiac
Psychology,” 2nd ed. This 2011 APA book
edited by Robert Allan, PhD, and Jeffrey
Fisher, MD, includes sections on cardiology
and psychocardiac disorders, psychosocial risk
factors for coronary heart disease and clinical
cardiac psychology. See www.apa.org/pubs/
• “How Motivation Affects Cardiovascular
Response: Mechanisms and Applications.”
This 2011 APA book edited by Rex A. Wright,
PhD, and Guido H.E. Gendolla, PhD, reviews
current research on motivationally based
cardiovascular response. Visit www.apa.org/
• “Psychotherapy With Cardiac Patients:
Behavioral Cardiology in Practice.” This 2008
APA book by Ellen A. Dornelas, PhD, outlines
lifestyle and psychological risk factors,
describes techniques for helping patients
overcome depression and other risk factors
and addresses factors that affect treatment
effectiveness. See www.apa.org/pubs/