Skip to main content
SpringerLink
Log in

Gender Considerations in Psychosocial–Behavioral Interventions for Coronary Heart Disease

  • Chapter
  • First Online:
Psychosocial Stress and Cardiovascular Disease in Women

Abstract

Six randomized clinical trials (RCT) have been published in major peer review journals, using psychosocial–behavioral interventions with patients who previously experienced major adverse coronary events (MACE). All dealt with important psychological and psychosocial factors that contribute to coronary heart disease (CHD). These RCT obtained either positive or null outcomes for CHD morbidity or mortality. The three RCT reporting positive results (Recurrent Coronary Prevention Project (RCPP), Stockholm Women’s Intervention Trial for CHD (SWITCHD), Secondary Prevention Trial in Uppsala (SUPRIM) used group-based cognitive behavior therapy (CBT), relaxation exercises, coping skills training, and addressed modifiable risk factors and lifestyle planning. Patients began treatment at least 3 months after MACE, received at least 20 intervention sessions, and were followed for an average of 4.5–7.8 years. Therapists were trained in CBT and used manualized treatment. Almost all patients were run in same sex groups. In contrast, the three RCT that obtained null results (WALES, M-HART, ENRICHD) did not use group-based CBT or lifestyle planning for all patients, began behavioral treatment shortly after MACE, provided fewer intervention sessions, and followed patients for an average less than 2.5 years. Whereas patients in the first of the positive trials (RCPP) consisted primarily of men (90 %), the two most recent positive RCT were conducted only with women (SWITCHD) or women and men (SUPRIM) treated in separate sex groups. These RCT were therefore able to focus on problems salient to each sex. Techniques included role playing exercises sensitive to problems important to each sex. This led to group discussions about solving problems germane to these patients. Verbal comments obtained from women, in particular, were positive about such discussions, and both patients and therapists felt that the women could better express themselves in single-sex groups and deal more openly with problems in their lives.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Berkman, L. F., Blumenthal, J., Burg, M., Carney, R. M., Catellier, D., Cowan, M. J., Schneiderman, N., & Enhancing Recovery in Coronary Heart Disease Patients Investigators [ENRICHD]. (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. Journal of the American Medical Association, 289, 2106–3116. PMID: 12813116.

    Google Scholar 

  • Bjarnason-Wehrens, B., Grande, G., Loewel, H., Völler, H., & Mittag, O. (2007). Gender-specific issues in cardiac rehabilitation: Do women with ischaemic heart disease need specially tailored programmes? European Journal of Cardiovascular Prevention and Rehabilitation, 14, 163–171. PMID:17446793.

    Article  PubMed  Google Scholar 

  • Clark, A. M., Hartling, L., Vandermeer, B., & McAlister, F. A. (2005). Secondary prevention program for patients with coronary artery disease: A meta-analysis of randomized control trials. Annals of Internal Medicine, 143, 659–672. PMID 16263889.

    Article  PubMed  Google Scholar 

  • Dusseldorp, E., van Elderen, T., Maes, S., Meulman, J., & Kraaij, V. (1999). A meta-analysis of psychoeducational programs for coronary heart disease patients. Health Psychology, 18, 506–519. PMID 10519467.

    Article  PubMed  Google Scholar 

  • Eaker, E. D., Sullivan, L. M., Kelly-Hayes, M., D’Agostino, R. B., Sr., & Benjamin, E. J. (2007). Marital status, marital strain, and risk of coronary heart disease or total mortality: The Framingham Offspring Study. Psychosomatic Medicine, 69, 509–513. PMID: 17634565.

    Article  PubMed  Google Scholar 

  • Frasure-Smith, N., Lespérance, F., Prince, R. H., Verrier, P., Garber, R. A., Juneau, M., & Bourassa, M. G. (1997). Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. Lancet, 350, 473–479. PMID: 9274583.

    Article  PubMed  Google Scholar 

  • Friedman, M., Thoresen, C. E., Gill, J. J., Ulmer, D., Powell, L. H., Price, V. A., … Dixon, T. (1986). Alteration of type a behavior and its effect on cardiac recurrences in post myocardial infarction patients: Summary results of the Recurrent Coronary Prevention Project. American Heart Journal, 112, 653–665. PMID:3766365.

    Google Scholar 

  • Fukumoto, Y., Libby, P., Rabkin, E., Hill, C. C., Enomoto, M., Hirouchi, Y., … Aikawa, M. (2001). Statins alter smooth muscle cell accumulation and collagen content in established atheroma of Watanabe heritable hyperlipidemic rabbits. Circulation, 103, 993–999. PMID: 11181475.

    Google Scholar 

  • Goldberg, D. P. (1972). The assessment of psychiatric illness by questionnaire. London, England: Oxford University Press.

    Google Scholar 

  • Gulliksson, M., Burrell, G., Vessby, B., Lundin, L., Toss, H., & Svärdsudd, K. (2011). Randomized controlled trial of cognitive behavioral therapy vs. standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease. Archives of Internal Medicine, 171, 134–140. PMID: 21263103.

    Article  PubMed  Google Scholar 

  • Horsten, M., Mittleman, M. A., Wamala, S. P., Schenk-Gustafsson, K., & Orth-Gomér, K. (2000). Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. European Heart Journal, 21, 1072–1080. PMID: 10843825.

    Article  PubMed  Google Scholar 

  • Jones, D. A., & West, R. R. (1996). Psychological rehabilitation after myocardial infarction: Multicentre randomized controlled trial. British Medical Journal, 313, 1517–1521. PMCID: PMC2353074.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kaplan, J. R., & Manuck, S. B. (2008). Status, stress, and heart disease. In F. Kessel, P. L. Rosenfield, & N. B. Anderson (Eds.), Interdisciplinary research case studies from health and social science (pp. 74–102). New York, NY: Oxford University Press.

    Google Scholar 

  • Kaplan, J. R., Manuck, S. B., Clarkson, T. B., Lusso, F. M., & Taub, D. M. (1982). Social status, environment and atherosclerosis in cynomolgus monkeys. Arteriosclerosis, 2, 359–368. PMID: 6889852.

    Article  PubMed  Google Scholar 

  • Knowler, W. C., Fowler, S. E., Hamman, R. F., Christophi, C. A., Hoffman, H. J., Brenneman, A. T., … Diabetes Prevention Program Research Group. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374, 1677–1686. PMCID: PMC3135022.

    Google Scholar 

  • Li, G., Zhang, P., Wang, J., Gregg, E. W., Yang, W., Gong, Q., … Bennett, P. H. (2008). The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: A 20-year follow-up study. Lancet, 371, 1783–1789. PMID: 18502303.

    Google Scholar 

  • Linden, W., Phillips, M. J., & Leclerc, J. (2007). Psychological treatment of cardiac patients: A meta-analysis. European Heart Journal, 24, 2972–2984. PMID 17984133.

    Article  Google Scholar 

  • Lindstrom, J., Peltonen, M., Eriksson, J. G., Ilanne-Parikka, P., Aunola, S., Keinanen-Kiukaanniemi, S., … Finnish Diabetes Prevention Study (DPS). (2013). Improved lifestyle and decreased diabetes risk over 13 years: Long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia, 56, 284–293. PMID: 23093136.

    Google Scholar 

  • Low, C. A., Thurston, R. C., & Matthews, K. A. (2010). Psychosocial factors in the development of heart disease in women: Current research and future directions. Psychosomatic Medicine, 72, 842–854. PMCID: PMC2978285.

    Article  PubMed Central  PubMed  Google Scholar 

  • Matthews, K. A., & Gump, B. B. (2002). Chronic work stress and marital dissolution increase risk of posttrial mortality in men from the Multiple Risk Factor Intervention Trial. Archives of Internal Medicine, 162, 309–315. PMID: 11822923.

    Article  PubMed  Google Scholar 

  • McCabe, P. M., Gonzales, J. A., Zaias, J., Szeto, A., Kumar, M., Herron, A. L., & Schneiderman, N. (2002). Social environment influences the progression of atherosclerosis in the Watanabe heritable hyperlipidemic rabbit. Circulation, 105, 354–359. PMID: 11804992.

    Article  PubMed  Google Scholar 

  • Mendes de Leon, C. F., Powell, L. H., & Kaplan, B. (1991). Change in coronary-prone behaviors in the recurrent coronary prevention project. Psychosomatic Medicine, 53, 407–419. PMID: 1924653.

    Article  PubMed  Google Scholar 

  • Moher, D., Schulz, K. F., & Altman, D. (2001). The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. Journal of the American Medical Association, 285, 1987–1991. PMID: 11308435.

    Article  PubMed  Google Scholar 

  • Orth-Gomér, K., Schneiderman, N., Wang, H., Walldin, C., Bloom, M., & Jernberg, T. (2009). Stress reduction prolongs life in women with coronary disease: The Stockholm Women’s Intervention Trial for Coronary Heart Disease (SWITCHD). Circulation. Cardiovascular Quality and Outcomes, 2, 25–32. PMID: 20031809.

    Article  PubMed  Google Scholar 

  • Orth-Gomer, K., Wamala, S. P., Horsten, M., Schenck-Gustafsson, K., Schneiderman, N., & Mittleman, M. A. (2000). Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study. Journal of the American Medical Association, 284, 3008–3014. PMID: 11122587.

    Article  PubMed  Google Scholar 

  • Rees, K., Bennett, P., West, R., Davey, S. G., & Ebrahim, S. (2004). Psychological interventions for coronary heart disease. Cochrane Database of Systematic Reviews, (2), CD002902. PMID: 15106183.

    Google Scholar 

  • Ridker, P. M., Cannon, C. P., Morrow, D., Rifai, N., Rose, L. M., McCabe, C. H., … Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT – TIMI 22) Investigators. (2005). C-reactive protein levels and outcomes after statin therapy. New England Journal of Medicine, 352, 20–28. PMID: 15635109.

    Google Scholar 

  • Rosengren, A., Hawken, S., Ounpuu, S., Silwa, K., Zubaid, M., Almahmeed, W. A., … INTERHEART investigators. (2004). Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART Study): Case-control study. Lancet, 364, 953–962. PMID: 15364186.

    Google Scholar 

  • Saab, P. G., Bang, H., Williams, R. B., Powell, L. H., Schneiderman, N., Thoresen, C., … ENRICHD Investigators. (2009). The impact of cognitive behavioral group training on event-free survival in patients with myocardial infarction: The ENRICHD experience. Journal of Psychosomatic Research, 67(1), 45–56. PMCID: PMC2774492.

    Google Scholar 

  • Schneiderman, N., Saab, P. G., Catellier, D. J., Powell, L. H., DeBusk, R. F., Williams, R. B., … Kaufmann, P. G. (2004). Psychosocial treatment within sex by ethnicity subgroups in the enhancing recovery in coronary heart disease (ENRICHD) clinical trial. Psychosomatic Medicine, 66, 475–483. PMID: 15272091.

    Google Scholar 

  • Theorell, T., Perski, A., Orth-Gomér, K., Hamsten, A., & de Faire, U. (1991). The effects of the strain of returning to work on the risk of cardiac death after a first myocardial infarction before the age of 45. International Journal of Cardiology, 30, 61–67. PMID:1991671.

    Article  PubMed  Google Scholar 

  • Vaccarino, V., Lin, Z. Q., Kasl, S. V., Mattera, J. A., Roumanis, S. A., Abramson, J. L., & Krumholz, H. M. (2003). Sex differences in health status after coronary artery bypass surgery. Circulation, 108, 2642–2647. PMID:14597590.

    Article  PubMed  Google Scholar 

  • Whalley, B., Rees, K., Davies, P., Bennett, P., Ebrahim, S., Liu, Z., …Taylor, R. S. (2011). Psychological interventions for coronary heart disease. Cochrane Database of Systematic Reviews, (8), CD002902. PMID: 21833943.

    Google Scholar 

  • World Health Organization. (2011). Cardiovascular diseases (CVDs). (Fact sheet no. 317). Retrieved from http://www.who.int/mediacentre/factsheets/fs317/en/#

    Google Scholar 

  • Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., … INTERHEART Study Investigators. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART Study): Case-control study. Lancet, 364, 937–952. PMID: 15364185.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology and Behavioral Medicine Research Center, University of Miami, Miami, FL, USA

    Neil Schneiderman Ph.D.

  2. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

    Kristina Orth-Gomér M.D., Ph.D.

  3. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    Gunilla Burell Ph.D.

Authors
  1. Neil Schneiderman Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Orth-Gomér M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gunilla Burell Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neil Schneiderman Ph.D. .

Editor information

Editors and Affiliations

  1. Karolinska Institute, Stockholm, Sweden

    Kristina Orth-Gomér

  2. Department of Psychology, University of Miami, Coral Gables, Florida, USA

    Neil Schneiderman

  3. Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, Georgia, USA

    Viola Vaccarino

  4. Department of Psychosomatic Medicine, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany

    Hans-Christian Deter

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Schneiderman, N., Orth-Gomér, K., Burell, G. (2015). Gender Considerations in Psychosocial–Behavioral Interventions for Coronary Heart Disease. In: Orth-Gomér, K., Schneiderman, N., Vaccarino, V., Deter, HC. (eds) Psychosocial Stress and Cardiovascular Disease in Women. Springer, Cham. https://doi.org/10.1007/978-3-319-09241-6_15

Download citation

Publish with us

Policies and ethics

Search

Navigation