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Cognitive behaviour therapy |
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Investigators: Background Cardiac rehabilitation programs can achieve much. However, their primary focus is upon helping patients recover through participation in exercise and education groups. Patients learn about which lifestyle changes they should make, and why. However, awareness is one thing. Studies show that behaviour change does not necessarily follow. Unfortunately, too many cardiac patients return to their former unhealthy lifestyles some months after their hospital discharge. Cardiac rehabilitation programs, which typically last only about six weeks, do not teach patients how to change their health behaviours, although they can help to initiate the process of change. Cognitive behaviour therapy Cognitive behaviour therapy (CBT) goes to the very root of this struggle to change behaviour. It has vital relevance to both primary and secondary prevention of heart disease. It is an approach which helps to equip patients with the necessary skills to change and maintain healthier behaviours. CBTCBT also helps people modify their negative thoughts, enabling them to improve their emotional state and reduce the cognitive and emotional barriers, including depression, which inhibit behaviour change. teaches skills such as decision making, confidence building, coping with stress, maximising social support and relapse prevention. Aims and methods Australian Rotary Health is supporting a three-year trial to test the effectiveness of an eight-week CBT group program to encourage sustained behaviour changes and help manage and prevent depression in cardiac patients. In this study, patients were recruited from consecutive admissions to the Royal Melbourne Hospital and the Melbourne Private Hospital after a heart attack or to undergo coronary artery bypass graft surgery or percutaneous coronary intervention. Half the patients were randomly allocated to the CBTCBT program began about six weeks after patients' admission to hospital. Most patients also attended the earlier cardiac rehabilitation program. group program and the remainder received standard care only (control group). The The CBT program The eight-week intervention aimed to improve emotional wellbeing, cardiovascular disease-related health behaviours and reduce physiological risk factors. Groups of six to 10 patients reviewed a different topic every week with the guidance of a psychologist and a nurse who acted as group facilitators. Topics included strategies to recognise and overcome depression and anxiety, how to manage a healthy diet and increase physical activity, and developing social support networks. Particular emphasis was placed upon overcoming depression and preventing depression in the future. Intake for the trial has now ceased. Follow-up assessments are underway to measure psychological, behavioural and physiological outcomes of all patients four and 12 months after their completion of the program. Screening clinic About four weeks after discharge from hospital, all participating patients attended a screening clinic where blood pressure, heart rate, weight, girth measurement, cholesterol and glucose levels were measured. Habits, such as cigarette smoking, were also recorded. As well patients did a test which involved walking around a designated course for six minutes. A nurse recorded how many metres were travelled. This test is an effective method of comparing fitness levels at different time points without the use of treadmills or other equipment. In addition to the physical measurements, participants also completed questionnaires assessing their levels of depression, anxiety, social support and medication adherence. Patients in both treatment and control groups attended two additional screening clinics after a further four and 12 months, with the same measurements being recorded and questionnaires completed. Results were sent to participants and their doctors. Feedback from participants Soon after attending the 12-month screening clinic, patients in the treatment group participated in a telephone interview to explore their responses to the CBT program and its impact upon their mood and health behaviours. As one patient said, "The heart attack was a major scare. The program helped to identify what needed to be done. It gave me a sense that I could do it and make the changes in lifestyle". According to others, the program "certainly gave you the tools to understand why you were thinking the way you were" and "helped me to be a realist and not a pessimist, and not to be angry about the situation". Significance of the project If CBT is demonstrated to be superior to standard care in improving risk factors and reducing depression, it should ideally be incorporated into cardiac rehabilitation and secondary prevention programs. Funding: Australian Rotary Health |
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