Journal of Behavioral Medicine

, Volume 23, Issue 5, pp 437–450 | Cite as

Chest Pain and the Treatment of Psychosocial/Emotional Distress in CAD Patients

  • Mark W. Ketterer
  • Faye Fitzgerald
  • Steve Keteyian
  • Beth Thayer
  • Margaret Jordon
  • Cathy McGowan
  • Greg Mahr
  • Antoun Manganas
  • A. David Goldberg
Article

Abstract

Treatment of psychosocial/emotional distress as a strategy for diminishing chest pain in such patients remains entirely unutilized in standard care. Sixty-three patients with known or suspected CAD were entered in an aggressive lifestyle modification program. Patients completed the Symptom Checklist 90—Revised (SCL90R) at the diagnostic interview session, at 3 and at 12 months. Statistically significant drops were observed on multiple scales of the SCL90R at both 3 and 12 months. An item from the SCL90R was used as a proxy for angina. Multiple measures of emotional distress at baseline were found to correlate with chest pain at baseline, but not a number of traditional cardiovascular risk factors. The chest pain item displayed improvement at both 3 and 12 months. Improvement on all scales of the SCL90R correlated with improvement in chest pain. It may be possible to control chest pain in some CAD patients with psychosocial interventions.

ischemic heart disease angina stroke 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. Allison, T. G., Williams, D. E., Miller, T. D., Patten, C. A., Bailey, K. R., Squires, R. W., and Gau, G. T. (1995). Medical and economic costs of psychologic distress in patients with coronary artery disease. Mayo Clin. Proc. 70: 734–742.Google Scholar
  2. Amorosa-Tupler, B., Tapp, J. T., and Cardia, R.V. (1989). Stress management through relaxation and imagery in the treatment of angina pectoris. J. Cardiopulm. Rehab. 9: 348–355.Google Scholar
  3. Andrews, T. C., Raby, K., Barry, J., Naimi, C. L., Allred, E., Ganz, P., and Selwyn, A. P. (1997). Effect of cholesterol reduction on myocardial ischemia in patients with coronary disease. Circulation 95: 324–328.Google Scholar
  4. Beitman, B. D., Mukerji, V., Russell, J. L., and Grafting, M. (1993). Panic disorder in cardiology patients: A review of the missouri panic/cardiology project. J. Psychosom. Med. 27(Suppl. I): 35–46.Google Scholar
  5. Bengston, A., Herlitz, J., Karlsson, T., and Hjalmarson, A. (1996). Distress correlates with the degree of chest pain: A description of patients awaiting revascularization. Heart 75: 257–260.Google Scholar
  6. Black, J. L., Allison, T. G., Williams, D. E., Rummans, T. A., and Gau G. T. (1998). Effect of intervention for psychological distress on rehospitalization rates in cardiac rehabilitation patients. Psychosomatics 39: 134–143.Google Scholar
  7. Blumenthal, J. A., Jiang, W., Babyak, M. A., Krantz, D. S., Frid, D. J., Coleman, R. E., Waugh, R., Hanson, M., Appelbaum, M., O'Connor, C., and Morris, J. J. (1997). Stress management and exercise training in cardiac patients with myocardial ischemia. Arch. Intern. Med. 157: 2213–2223.Google Scholar
  8. Blumenthal, J. A., Jiang, W., Waugh, R. A., Frid, D. J., Morris, J. J., Coleman, R. E., Hanson, M., Babyak, M., Thyrum, E. T., Krantz, D. S., and O'Connor, C. (1995). Mental stressinduced ischemia in the laboratory and ambulatory ischemia during daily life: Association and hemodynamic features. Circulation 92: 2102–2108.Google Scholar
  9. Boltwood, M.D., Taylor, C. B., Burke, M. B., Grogin, H., and Giacomini, J. (1993). Anger report predicts coronary artery vasomotor response to mental stress in atherosclerotic segments. Am. J. Cardiol. 72: 1361–1365.Google Scholar
  10. Bundy, C., Carroll, D., Wallace, L., and Nagle, R. (1994). Psychological treatment of chronic stable angina pectoris. Psychol. Health 10: 69–77.Google Scholar
  11. Burg, M. M., Jain, D., Soufer, R., Kerns, R. D., and Zaret, B. L. (1993). Role of behavioral and psychological factors in mental stress induced silent left ventricular dysfunction in coronary artery disease. J. Am. Coll. Cardiol. 22(2): 440–448.Google Scholar
  12. Cannon, R. O., Quyyumi, A. A., Mingemoyer, R., Stine, A. M., Gracely, R. H., Smith, W. B., Geraci, M. F., Black, B. C., Uhde, T. W., Wacliwiw, M. A., Maher, K., and Benjamin, S. B. (1994). Imipramine in patients with chest pain despite normal coronary angiograms. N. Engl. J. Med. 330: 1411–1417.Google Scholar
  13. Chiles, J. A., Lambert, M. J., and Hatch, A. L. (1999). The impact of psychological interventions on medical cost offset: A meta-analytic review. Clin. Psychol. Sci. Pract. 6: 204–220.Google Scholar
  14. Clarke, D. M., Smith, G. C., and Herrman, H. E. (1993). A comparative study of screening instruments for mental disorders in general hospital patients. Int. J. Psychiatry Med. 23(4): 323–337.Google Scholar
  15. Collins, R., Ornish, D., Scherwitz, L., Schoenfield, D., Scheer, J., Elliot, M., Merrit, T., Horowitz, S., Wickmeyer, W., and Stangle, S. (1996). Are comprehensive lifestyle changes feasible and clinically beneficial? Preliminary results from the multicenter lifestyle heart trial. Psychosom. Med. 58: 85.Google Scholar
  16. Davies, R. F., Goldberg, A. D., Forman, S., Pepine, C. J., Knatterud, G. L., Geller, N., Sopko, G., Pratt, C., Deanfield, J., Conti, C. R., and the ACIP Investigators (1997). Asymptomatic cardiac ischemia pilot (acip) study two year follow-up: Outcomes of patients randomized to initial strategies of medical therapy versus revascularization. Circulation 95: 2037–2043.Google Scholar
  17. Deanfield, J. E., Shea, M., Kensett, M., Horlock, P., Wilson, R. A., deLansheere, C. M., and Selwyn, A. P. (1984). Silent myocardial ischemia due to mental stress. Lancet 2(8410): 1001–1005.Google Scholar
  18. Derogatis, L. R. (1977). The Symptom Checklist 90-Revised, NCS Assessments, Minneapolis, MN.Google Scholar
  19. Dusseldorp, E., van Elderen, T., Maes, S., Meulman, J., and Kraaij, V. (1999). A meta-analysis of psychoeducational programs for coronary heart disease patients. Health Psychol. 18(5): 506–519.Google Scholar
  20. Finn, S. E. (1982). Base rates, utilities and DSMII: Shortcomings of fixed-rule systems of psychodiagnosis. J. Abnorm. Psychol. 91(4): 294–302.Google Scholar
  21. Frasure-Smith, N., and Lesperance, F. (1998). Depression and anxiety increase physician costs during the first post-MI year. Psychosom. Med. 60: 99.Google Scholar
  22. Friedman, M., Breall, W. S., Goodwin, M. L., Sparagon, B. J., Ghandour, G., and Fleischman, N. (1996). Effect of type a behavioral counseling on frequency of episodes of silent myocardial ischemia in coronary patients. Am. Heart J. 132: 933–937.Google Scholar
  23. Gallacher, J. E. J., Hopkinson, C. A., Bennett, P., Burr, M. L., and Elwood, P. C. (1997). Effect of stress management on angina. Psychol. Health 12: 523–532.Google Scholar
  24. Giubbini, R., Galli, M., Campini, R., Bosimini, E., Bencivelli, W., and Tavazzi, L. (1991). Effects of mental stress on myocardial perfusion in patients with ischemic heart disease. Circulation 83(Suppl. II): 100–107.Google Scholar
  25. Goldberg, A.D., Becker, L.C., Bonsall, R., Cohen, J.D., Ketterer, M.W., Kaufman, P.G., Krantz, D. S., Light, K. C., McMahon, R. P., Noreuil, T., Pepine, C. J., Raczynski, J., Stone, P. H., Strother, D., Taylor, H., and Sheps, D. S., for the PIMI Investigators (1996). Ischemic, hemodynamic and neurohormonal responses to mental and exercise stress: Experience from the psychophysiological investigations of myocardial ischemia study (PIMI). Circulation 94: 2402–2409.Google Scholar
  26. Hartman, C. H. (1979). Response of anginal pain to handwarming. Biofeed. Self-Regul. 4: 355–357.Google Scholar
  27. Herrman, C. (1997). International experiences with the hospital anxiety and depression scale—A review of validation data and clinical results. J. Psychosom. Res. 42(1): 17–41.Google Scholar
  28. Ironson, G., Taylor, C. B., and Boltwood, M. (1992). Effects of anger on left ventricular ejection fraction in coronary artery disease. Am. J. Cardiol. 70(3): 281–285.Google Scholar
  29. Johnson, D.W., and Lo, C. R. (1983). The effects of cardiovascular feedback and relaxation on angina pectoris. Behav. Psychother. 11: 257–264.Google Scholar
  30. Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshelman, S., Wittchen, H. U., and Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSMIIIR psychiatric disorders in the united states: Results from the national comorbidity survey. Arch. Gen. Psychiatry 51(1): 8–19.Google Scholar
  31. Ketterer, M.W. (1993). Secondary prevention of ischemic heart disease: The case for aggressive behavioral monitoring and intervention. Psychosomatics 34(6): 478–484.Google Scholar
  32. Ketterer, M.W., Kenyon, L., and Gheorgiade, M. (1994). Arandomly-assigned, controlled pilot study of triaging and psychiatric consultation in acute myocardial infarction. Psychosom. Med. 56: 173.Google Scholar
  33. Ketterer, M.W., Huffman, J., Lumley, M. A., Wassef, S., Gray, L., Kenyon, L., Kraft, P., Brymer, J., Rhoads, K., Lovallo, W. R., and Goldberg, A. D. (1997). Five year followup for adverse outcomes in males with at least minimally positive angiograms: The importance of “denial” in assessing psychosocial risk factors. J. Psychosom. Res. 44(2): 241–250.Google Scholar
  34. Ketterer, M. W., Freedland, K. E., Krantz, D. S., Kaufmann, P., Forman, S., Greene, A., Raczysnki, J., Knatterud, G., Light, K., Carney, R. M., Stone, P., Becker, L., and Sheps, D. S., for the PIMI Investigators (2000a). Psychological correlates of mental stress induced ischemia in the laboratory: The psychophysiological investigations of myocardial ischemia (PIMI) study. J. Health Psychol. 5(1): 75–85.Google Scholar
  35. Ketterer, M.W., Mahr, G., and Goldberg, A.D. (2000b). Psychological factors affecting a medical condition: Ischemic coronnary heart disease. J. Psychosom. Res. 48: 357–367.Google Scholar
  36. Klimes, I., Mayou, R. A., Rearce, M. J., Cole, L., and Fagg, J. R. (1990). Psychological treatment for atypical noncardiac chest pain: A controlled evaluation. Psychol. Med. 20: 605–611.Google Scholar
  37. Krantz, D. S., Hedges, S. M., Gabbay F. H., Klein, J., Gottdiener, J. S., and Rozanski, A. (1994). Triggers of angina and st-segment depression in ambulatory patients with coronary artery disease: Evidence for an uncoupling of angina and ischemia. Am. Heart J. 128(4): 703–712.Google Scholar
  38. Ladwig, K. H., Roll, G., Breithardt, G., and Borggrefe, M. (1999). Extracardiac contributions to chest pain perception in patients 6 months after acute myocardial infarction. Am. Heart J. 137: 528–534.Google Scholar
  39. Lewin, B. (1997). The psychological and behavioral management of angina. J. Psychosom. Res. 43(5): 453–462.Google Scholar
  40. Light, K. C., Herbst, M. C., Bragdon, E. E., Hinderliter, A. L., Koch, G. G., Davis, M. R., and Sheps, D. S. (1991). Depression and type a behavior pattern in patients with coronary artery disease: Relationships to painful versus silent myocardial ischemia and B-endorphin responses during exercise. Psychosom. Med. 53: 669–683.Google Scholar
  41. Milani, R.V., Lavie, C. J., and Cassidy, M.M. (1996). Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events. Am. Heart J. 132: 726–732.Google Scholar
  42. Mumford, E., Schlesinger, H. J., and Glass, G.V. (1982). The effect of psychological intervention on recovery from surgery and heart attacks: An analysis of the literature. Am. J. Public Health 72(2): 141–151.Google Scholar
  43. Ornish, D., Brown, S. E., and Scherwitz, L. W. (1990). Can lifestyle changes reverse coronary heart disease? Lancet 336: 129–133.Google Scholar
  44. Payne, T. J., Johnson, C. A., Penzien, D. B., Porzelius, J., Eldridge, G., Parisi, S., Backham, J., Pbert, L., Prather, R., and Rodriguez, G. (1994). Chest pain self-management training for patients with coronary artery disease. J. Psychosom. Res. 38(5): 409–418.Google Scholar
  45. Rapp, M. S., and Thomas, M. R. (1975). Alleviation of angina pectoris following systematic desensitization. Can. Psychiatry J. 20: 96.Google Scholar
  46. Rozanski, A., Bairey, C.N., Krantz, D. S., Friedman, J., Resser, K. J., Morell, M., Hilton-Chalfen, S., Hestrin, L., Bietendorf, J., and Berman, D. S. (1988). Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N. Engl. J. Med. 318: 1005–1012.Google Scholar
  47. Schoebel, F. C., Frazier, H., Jessurun, G. A. J., De Jongste, M. J. L., Kadipasaoglu, K. A., Jax, T.W., Heintzen, M. P., Cooley, D. A., and Strauer, B. E. (1997). Refractory angina pectoris in end-stage coronary artery disease: Evolving therapeutic concepts. Am. Heart J. 134: 587–602.Google Scholar
  48. Stetson, B. A., Rahn, J. M., Dubbert, P. M., Wilner, B. I., and Mecury, M. G. (1997). Prospective evaluation of the effects of stress on exercise adherence in community-residing women. Health Psychol. 16(6): 515–520.Google Scholar
  49. Sullivan, M. D., LaCroix, A. Z., Baum, C., Grothaus, L. C., and Katon, W. J. (1997). Functional status in coronary artery disease: A one-year prospective study of the role of anxiety and depression. Am. J. Med. 103: 348–356.Google Scholar
  50. Swinson, R. P., Soulios, C., Cox, B. J., and Kuch, K. (1992). Brief treatment of emergency room patients with panic attacks. Am. J. Psychiatry 149(7): 944–946.Google Scholar
  51. Thompson, D., Hylan, T. R., McMullen, W., Romeis, M. E., Buesching, D., and Oster, G. (1998). Predictors of medical offset effect among patients receiving antidepressant therapy. Am. J. Psychiatry 155: 824–827.Google Scholar
  52. Tu, J. V., Pashos, C. L., Naylor, C. D., Chen, E., Normand, S. L., Newhouse, J. P., and McNeil, B. J. (1997). Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the united states and canada. N. Engl. J. Med. 336: 1500–1505.Google Scholar
  53. Van Boven, A. J., Jukema, J. W., Zwinderman, A. H., Crijns, H. J. G. M., Lie, K. I., and Bruschke, A.V.G., on behalf of the REGRESS Study Group (1996). Reduction of transient myocardial ischemia with prevastatin in addition to the conventional treatment in patients with angina pectoris. Circulation 94: 1503–1505.Google Scholar
  54. Verthein, U., and Kohler, T. (1997). The correlation between everyday stress and angina pectoris: A longitudinal study. J. Psychosom. Res. 43(3): 241–245.Google Scholar
  55. Yusuf, S., Wittes, J., and Friedman, L. (1988). Overview of results of randomized clinical trials in heart disease, part II. JAMA 260: 2259–2263.Google Scholar
  56. Zigmund, A. S., and Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatr. Scand. 67: 361–370.Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Mark W. Ketterer
    • 1
    • 2
  • Faye Fitzgerald
    • 1
  • Steve Keteyian
    • 1
  • Beth Thayer
    • 1
  • Margaret Jordon
    • 1
  • Cathy McGowan
    • 1
  • Greg Mahr
    • 1
  • Antoun Manganas
    • 1
  • A. David Goldberg
    • 1
  1. 1.Department of Psychiatry and Heart and Vascular Institute, Henry Ford Health Sciences CenterCase Western Reserve UniversityDetroit
  2. 2.Henry Ford Hospital/CFP3Detroit

Personalised recommendations