Psychological treatments in cardiac rehabilitation: review of rationales and outcomes.

OBJECTIVE: In this review, the place of psychological interventions in cardiac rehabilitation and differences in underlying rationales are presented. Treatment approaches vary in that some practitioners favor biobehavioral approaches with strong relaxation/breathing components, whereas others offer unstructured support, psychoeducation to maximize compliance, or psychological interventions directed at reducing emotional distress.
METHODS: The effectiveness of psychosocial rehabilitation for endpoints like mortality, recurrence, emotional distress, and intermediate hard endpoints is reviewed by integrating conclusions from narrative and meta-analytic reviews as well as recent major clinical trials.
RESULTS: The aggregated findings support the 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 psychological services to cardiac patients.