Psychotherapy with Cardiac Patients: Behavioral Cardiology in Practice: Behavioral Cardiology in Practice


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Valuable guidance offered on behavioral cardiology
(April 2009 Issue)

�Psychotherapy with Cardiac Patients: Behavioral Cardiology in Practice"
By Ellen A. Dornelas
American Psychological Association
Washington, D.C., 2008

By Paul Efthim, Ph.D.

This is a terrific guidebook for clinicians working with cardiac patients.

Connecticut psychologist Ellen Dornelas, Ph.D, director of behavioral health programs at the Henry Low Heart Center at Hartford Hospital and an associate professor of clinical medicine at UConn School of Medicine, has devoted her career to practice, research and training in the relatively new field of behavioral cardiology. Her new book goes well beyond previous works by giving specific and detailed guidance about how to tailor psychological interventions with this variegated population.

For example, patients with coronary artery disease who may have experienced a sudden heart attack, angioplasty and/or coronary bypass surgery tend to present differently from patients with congestive heart failure, a chronic disease with complex features. The book describes these and many other heart conditions in detail, outlines the psychological research on each and offers valuable guidance drawn from the author's considerable experience on how to understand and engage people who are struggling with a range of emotional, medical, and social challenges as a result of their heart problem.

To take another example, arrhythmia patients may receive an implantable defibrillator, a life-saving device that delivers one or more electrical shocks to prevent sudden cardiac death. However, such patients on average get shocked - which feels like getting kicked in the chest - about twice a year. As a group, these individuals understandably are prone to anxiety. They are also more isolated, according to Dornelas, because it is unlikely that they know others who have received such a device. For these and other reasons, such patients especially stand to benefit from psychotherapy, but may not seek it out.

The author presents her material in three sections. The first part gives an overview of cardiovascular system, types of heart disease, medical treatments, risk factors and research on the links between heart and mind. Next, Dornelas covers depression, anxiety, hostility, social support and existential issues. The final set of chapters looks at factors that complicate treatment, including addictions, obesity and sex differences.

It is a relief to see a text that goes beyond the usual focus on CBT to integrate a variety of other approaches, such as Leigh McCullough's affect-focused therapy. Dozens of case examples bring the material to life. Medical, personality, sociocultural, gender and other individual difference variables are considered together in formulating treatment planning. Special topics receive indepth coverage, including the link between panic disorder and fears of cardiac malfunction which can lead to ER visits; the phenomenon of cardiac denial; and troubling patterns of sex bias in the treatment of female cardiac patients.

According to the author, some of the most important treatment goals for this population include sensitizing individuals about their own emotional states, capitalizing on cardiac events as catalysts for psychological growth, gaining a sense of internal control as a way to decrease anxiety, reducing social isolation and helping patients conceptualize their cardiac event, hospitalization or procedure as a potentially traumatizing event that needs to be acknowledged as such.

This nearly 300-page book is comprehensive, well-written and easy to use. It would benefit from even more details about treatment approaches, such as the highly effective "Hook" intervention or perhaps a model curriculum for a time-limited group therapy program attached to a cardiac rehabilitation center. On balance, it serves as a one-of-a-kind handbook that may prompt more psychologists and other health practitioners to get more involved in this young, growing subspecialty area.

Paul Efthim, Ph.D. is a licensed psychologist in full-time practice in Brookline, Mass. He holds faculty appointments at the Massachusetts School of Professional Psychology and the Boston Institute for Psychotherapy.