International Journal of Behavioral Medicine

, Volume 22, Issue 5, pp 563–568

Valued Life Activities, Smoking Cessation, and Mood in Post-Acute Coronary Syndrome Patients

  • Andrew M. Busch
  • John Fani Srour
  • James A. Arrighi
  • Christopher W. Kahler
  • Belinda Borrelli



Continued engagement in valued life activities is a protective factor for depression and has been linked to readiness to quit smoking in medical populations but has never been examined among acute coronary syndrome (ACS) patients.


The purpose of this study is to investigate relationships among valued life activities, mood, and smoking post-ACS.


Participants were 54 post-ACS patients who were smoking before ACS hospitalization. Data on mood, smoking status, engagement in valued activities, restriction of valued activities, and satisfactory replacement of restricted activities was collected 1–12 months post-ACS.


Depressive symptoms were associated with both less valued activity engagement and greater valued activity restriction. Positive affect was associated with greater valued activity engagement and negative affect was associated with greater valued activity restriction. Satisfactory replacement of restricted activities was associated with greater positive affect, fewer depressive symptoms, and quitting smoking post-ACS. The majority of these relationships remained significant after controlling for relevant covariates, including physical functioning.


Valued activity restriction and engagement may contribute to depressed mood and failure to quit smoking in ACS patients. Psychotherapies that target greater engagement in valued life activities deserve further investigation in ACS patients.


Depression Coronary heart disease Smoking Activity restriction Acute coronary syndrome 


  1. 1.
    Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003;290(7):898–904. doi:10.1001/jama.290.7.898.CrossRefPubMedGoogle Scholar
  2. 2.
    Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006;21(1):30–8. doi:10.1111/j.1525-1497.2005.00269.x.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Thorndike AN, Regan S, McKool K, Pasternak RC, Swartz S, Torres-Finnerty N, et al. Depressive symptoms and smoking cessation after hospitalization for cardiovascular disease. Arch Intern Med. 2008;168(2):186–91. doi:10.1001/archinternmed.2007.60.CrossRefPubMedGoogle Scholar
  4. 4.
    Bjerkeset O, Nordahl HM, Mykletun A, Holmen J, Dahl AA. Anxiety and depression following myocardial infarction: gender differences in a 5-year prospective study. J Psychosom Res. 2005;58(2):153–61. doi:10.1016/j.jpsychores.2004.07.011.CrossRefPubMedGoogle Scholar
  5. 5.
    Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. Jama. 2003;290(1):86–97.CrossRefPubMedGoogle Scholar
  6. 6.
    van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, van Veldhuisen DJ, et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med. 2004;66(6):814–22. doi:10.1097/01.psy.0000146294.82810.9c.CrossRefPubMedGoogle Scholar
  7. 7.
    Busch AM, Borrelli B. Valued life activities and readiness to quit smoking among mobility-impaired smokers. Health Psychol. 2012;31(1):122–5. doi:10.1037/a0025218.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Mausbach BT, Chattillion EA, Moore RC, Roepke SK, Depp CA, Roesch S. Activity restriction and depression in medical patients and their caregivers: a meta-analysis. Clin Psychol Rev. 2011;31(6):900–8.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Conelea CA, Busch AM, Catanzaro MA, Budman CL. Tic-related activity restriction as a predictor of emotional functioning and quality of life. Compr Psychiatry. 2014;55(1):123–9. doi:10.1016/j.comppsych.2013.06.009.CrossRefPubMedGoogle Scholar
  10. 10.
    Benyamini Y, Lomranz J. The relationship of activity restriction and replacement with depressive symptoms among older adults. Psychol Aging. 2004;19(2):362–6. doi:10.1037/0882-7974.19.2.362.CrossRefPubMedGoogle Scholar
  11. 11.
    Parker RD, Adams J. Activity restrictions and recovery after open chest surgery: understanding the patient’s perspective. Proc (Baylor Univ Med Cent). 2008;21(4):421–5.Google Scholar
  12. 12.
    Fox PJ. The widow-maker heart attack at age 48. AuthorHouse: Bloomington; 2009.Google Scholar
  13. 13.
    Ferster CB. A functional analysis of depression. Am Psychol. 1973;28(10):857–70.CrossRefPubMedGoogle Scholar
  14. 14.
    Kanter JW, Manos RC, Bowe WM, Baruch DE, Busch AM, Rusch LC. What is behavioral activation? A review of the empirical literature. Clin Psychol Rev. 2010;30(6):608–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Lejuez CW, Hopko DR, Hopko SD. A brief behavioral activation treatment for depression. Treatment manual. Behav Modif. 2001;25(2):255–86.CrossRefPubMedGoogle Scholar
  16. 16.
    Dimidjian S, Barrera Jr M, Martell C, Munoz RF, Lewinsohn PM. The origins and current status of behavioral activation treatments for depression. Annu Rev Clin Psychol. 2011;7:1–38. doi:10.1146/annurev-clinpsy-032210-104535.CrossRefPubMedGoogle Scholar
  17. 17.
    Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77–84.PubMedGoogle Scholar
  18. 18.
    Zhang W, O’Brien N, Forrest JI, Salters KA, Patterson TL, Montaner JS, et al. Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS One. 2012;7(7):e40793. doi:10.1371/journal.pone.0040793.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063–70.CrossRefPubMedGoogle Scholar
  20. 20.
    Davidson KW, Burg MM, Kronish IM, Shimbo D, Dettenborn L, Mehran R, et al. Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome. Arch Gen Psychiatry. 2010;67(5):480–8.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989;64(10):651–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Fan X, Lee KS, Frazier, SK, Lennie TA, Moser DK (2014) Psychometric testing of the duke activity status index in patients with heart failure. Eur J Cardiovasc Nurs. [Epub ahead of print]Google Scholar
  23. 23.
    Hughes JR, Keely JP, Niaura RS, Ossip-Klein DJ, Richmond RL, Swan GE. Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tobacco Res Off J Soc Res Nicotine Tobacco. 2003;5(1):13–25.CrossRefGoogle Scholar
  24. 24.
    Doyle F, McGee HM, Conroy RM, Delaney M. What predicts depression in cardiac patients: sociodemographic factors, disease severity or theoretical vulnerabilities? Psychol Health. 2011;26(5):619–34. doi:10.1080/08870441003624398.CrossRefPubMedGoogle Scholar
  25. 25.
    Mausbach BT, Roepke SK, Depp CA, Moore R, Patterson TL, Grant I. Integration of the pleasant events and activity restriction models: development and validation of a “PEAR” model of negative outcomes in Alzheimer’s caregivers. Behav Ther. 2011;42(1):78–88. doi:10.1016/j.beth.2009.11.006.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Katz PP, Julian LJ, Omachi TA, Gregorich SE, Eisner MD, Yelin EH, et al. The impact of disability on depression among individuals with COPD. Chest. 2010;137(4):838–45. doi:10.1378/chest. 09-1939.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Pagoto SL, Schneider K, Olendzki B, Spates CR, Ma Y. Initial investigation of behavioral activation treatment for comorbid major depressive disorder and obesity. Psychother Theory Res Pract Train. 2008;45(3):410–5.CrossRefGoogle Scholar
  28. 28.
    Kanter JW, Busch AM, Rusch LC. Behavioral activation: distinctive features. London: Routledge Press; 2009.Google Scholar
  29. 29.
    Hayes SC, Strosahl K, Wilson KG (1999) Acceptance and commitment therapy. SpringerGoogle Scholar
  30. 30.
    Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007;27(3):318–26.CrossRefPubMedGoogle Scholar
  31. 31.
    Powers MB, Zum Vorde Sive Vording MB, Emmelkamp PM. Acceptance and commitment therapy: a meta-analytic review. Psychother Psychosom. 2009;78(2):73–80. doi:10.1159/000190790.CrossRefPubMedGoogle Scholar
  32. 32.
    Bricker J, Wyszynski C, Comstock B, Heffner JL. Pilot randomized controlled trial of web-based acceptance and commitment therapy for smoking cessation. Nicotine Tobacco Res Off J Soc Res Nicotine Tobacco. 2013;15(10):1756–64. doi:10.1093/ntr/ntt056.CrossRefGoogle Scholar
  33. 33.
    MacPherson L, Tull MT, Matusiewicz AK, Rodman S, Strong DR, Kahler CW, et al. Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. J Consult Clin Psychol. 2010;78(1):55–61.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2014

Authors and Affiliations

  • Andrew M. Busch
    • 1
    • 2
  • John Fani Srour
    • 2
    • 3
  • James A. Arrighi
    • 2
    • 3
  • Christopher W. Kahler
    • 4
  • Belinda Borrelli
    • 1
    • 2
  1. 1.The Miriam Hospital,Centers for Behavioral & Preventive MedicineProvidenceUSA
  2. 2.Warren Alpert Medical School of Brown UniversityProvidenceUSA
  3. 3.Rhode Island HospitalProvidenceUSA
  4. 4.Brown University School of Public HealthProvidenceUSA

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