Cognitive Behavioural Therapy (CBT) for depression following heart attack

It is not uncommon for people who have suffered a heart attack to go on to subsequently develop emotional mental health problems such as depression. Indeed, as many as one in three survivors will qualify for a diagnosis of major depressive disorder. This is quite understandable when we consider that major life events, stress and burnout are known to contribute to the development of depression: a heart attack certainly qualifies as such a factor. For as many as one in seven people, heart attacks prove fatal. Surviving one can foster an awareness of the fragile nature of life, and create existential turmoil which can be hard to navigate alone.the stress of a heart attack can lead to depression

Given that this population are considered high-risk for the development of depression, is important that systems and therapies be put in place and made available to help survivors to rehabilitate from this trauma not only physically, but emotionally. In short, recovery from a heart attack may be as much the remit of the psychologist as the cardiologist.

There is growing evidence that, similar to its successes with other groups, Cognitive Behavioural Therapy (CBT) may be one of the most effective psychological therapies for heart attack patients who are struggling with depression. In 2008, a group of researchers from medical schools across America decided to look closer into the component parts of CBT to try to figure out exactly why this is: what parts of CBT should they emphasise to ensure that their patients would be most likely to return to good mental health?

The homework component of CBT was found to be key here: people who adhered more to these ‘take home’ tasks tended to experience better outcomes in their mental health. Why might this be? For many, the concept of having to do homework as a part of therapy sounds strange, but it is an important reason why CBT can be so successful within the space of only a few weeks or months, where other forms of therapy such as psychoanalysis can last years with no major improvements in mood or well-being.

CBT aims to foster autonomy and empowerment: weekly tasks set by the therapist allow crucial opportunities for the client to put into practice the tools, skills and techniques they have perfected during therapy, also enabling the therapist to see which areas have been fully mastered and understood. There can often be a great difference between the application of CBT tools in the safe, controlled space of a therapy environment, and in the ‘real world’, which is often more complicated than we anticipate.

In this way, CBT encourages the client to become their own therapist, successfully extrapolating the insights and breakthroughs made in therapy sessions to inform and assist their everyday life. With this in mind, it comes as no surprise that CBT has been repeatedly found to be as effective as many types of antidepressant, with lower rates of relapse over time. Importantly, it seems that this component of CBT should be emphasised for people who are recovering from a heart attack for the best chance of recovery from depression.

The House Partnership, 23rd June 2011

References

1. Stress reduction correlates with structural changes in the amygdala> by Britta K Hölzel, James Carmody, Karleyton C Evans, Elizabeth A Hoge, Jeffery A Dusek, Lucas Morgan, Roger K Pitman, Sara W Lazar

2. The effects of brief mindfulness meditation training on experimentally induced pain> by Fadel Zeidan, Nakia S Gordon, Junaid Merchant, Paula Goolkasian

3. Meditation acutely improves psychomotor vigilance, and may decrease sleep need> by Prashant Kaul, Jason Passafiume, Craig R Sargent, Bruce F O