Psychological treatments in cardiac rehabilitation: review of rationales and outcomes

Objective: In this review, the place of psychological interventions in card iac rehabilitation and differences in underlying rationales are presented. Treatment approaches vary in that some practitioners favor biobehavioral ap proaches with strong relaxation/breathing components, whereas others offer unstructured support, psychoeducation to maximize compliance, or psychologi cal interventions directed at reducing emotional distress. Methods: The eff ectiveness of psychosocial rehabilitation for endpoints like mortality, rec urrence, emotional distress, and inter mediate hard endpoints is reviewed b y integrating conclusions from narrative and meta-analytic reviews as well as recent major clinical trials. Results: The aggregated findings support t he use of psychosocial interventions and they also help to explain critical differences in outcome in that studies which fail to reduce distress also fail to Lead to reduced mortality or reduced event recurrence. Conclusion: Gender differences in outcome and recent trends in cardiology are discussed because both have distinct consequences for the effective delivery of psyc hological services to cardiac patients. (C) 2000 Elsevier Science Inc. All rights reserved.