Heart Disease
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Judith A. Skala, Kenneth E. Freedland, Robert M. Carney
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Heart Disease
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Hogrefe Publishing
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9781616763138
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1
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CHF 19.80
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Angewandte Psychologie
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English
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91
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Wasserzeichen/DRM
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PC/MAC/eReader/Tablet
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PDF
Despite the stunning progress in medical research that has been achieved over the past few decades, heart disease remains the leading cause of death and disability among adults in many industrialized countries. Behavioral and psychosocial factors play important roles in the development and progression of heart disease, as well as in how patients adapt to the challenges of living with this illness.
This volume in the series"Advances in Psychotherapy" provides readers with a succinct introduction to behavioral and psychosocial treatment of the two most prevalent cardiac conditions, coronary heart disease and congestive heart failure. It summarizes the latest research on the intricate relationships between these conditions and psychosocial factors such as stress, depression, and anger, as well as behavioral factors such as physical inactivity and non-adherence to cardiac medication regimens. It draws upon lessons learned from a wide range of studies, including the landmark ENRICHD and SADHART clinical trials. It then goes on to provide practical, evidence-based recommendations and clinical tools for assessing and treating these problems."Heart Disease" is an indispensable treatment manual for professionals who work with cardiac patients.
The Authors
Judit A. Skala, RN, PhD, is a Research Instructor in the Department of Psychiatry at Washington University School of Medicine in St. Louis, MO, and an Instructor in Health Behavior and Health Psychology in the Department of Psychology at Washington University. After 20 years of experience in cardiac and psychiatric nursing, Dr. Skala completed the doctoral program in Clinical Health Psychology at Washington University. She was a Research Coordinator of the landmark ENRICHD clinical trial and has been a cognitive behavior therapist for several other clinical trials of treatments for patients with heart disease.
Kenneth E. Freedland, PhD, is a Professor of Psychiatry and Clinical Health Psychology at Washington University School of Medicine in St. Louis. He is an Associate Editor of Psychosomatic Medicine and is on the editorial board of Health Psychology. His research focuses on the role and treatment of depression and related problems in heart disease. He is a member of the Academy of Behavioral Medicine Research, a Fellow of the Society of Behavioral Medicine, and a Founding Fellow of the Academy of Cognitive Therapy. Dr. Freedland was a CBT supervisor for ENRICHD and has supervised several other clinical trials of CBT for patients with heart disease or other medical illnesses.
Robert M. Carney, PhD, is a Professor of Psychiatry and the Director of the Behavioral Medicine Center at Washington University School of Medicine in St. Louis. Dr. Carney is best known for his pioneering research on the role of depression in coronary heart disease, and he was one of the principal investigators of the ENRICHD clinical trial. He has served on the editorial boards of Annals of Behavioral Medicine, Psychosomatic Medicine, and Journal of Consulting and Clinical Psychology. He has extensive experience as a cognitive behavior therapist and clinical supervisor, and has particular expertise in the treatment of comorbid depression in medically ill patients.
3 Diagnosis and Treatment Indications
(p. 29-30)
3.1 Introduction
Whether to begin an evaluation with a focus on medical or psychological problems depends largely on the presentation. A patient may be an"unhappy referral" who believes that his/her medical complaints are not being taken seriously, or he/she may identify himself or herself as primarily having problems with coping or depression.
3.2 Medical History and Diagnosis
In our experience, most medical patients prefer to begin with the more familiar territory of their medical history and diagnoses. Usually any problems with understanding and coping with their medical condition will become clear during this phase of the interview. It is often difficult to obtain a complete medical history, because soon after starting to talk about their medical problems, patients switch to talking about the impact of these problems on themselves and their loved ones. Some practitioners are comfortable allowing an interview to weave around a variety of topics while adding notes to different parts of an outline, while others prefer a more structured approach. With either method, it is important to identify patients’ major medical diagnoses, their understanding of them, how long these problems have been present, and their predictions about the future impact of their health problems. Clearly, it is also important to obtain a working knowledge of common diagnoses in order to make reasonable judgments about patients’ understanding and expectations. In some cases, basic misunderstandings lie at the root of anxiety and depression and consultation with the patient’s physician may be required. If so, it is important to discuss this with the patient, obtain permission, and come to an agreement regarding the limits of disclosure.
In addition to getting information about illnesses and conditions, it is important to obtain a list of all medications being taken, including over-thecounter drugs, biologicals, and supplements. They may have an impact on symptoms of depression and anxiety, and they may also provide information about additional medical conditions that the patient may have forgotten to mention. It is also important to ascertain whether the patient routinely takes his or her medications as prescribed. For example, a patient presenting with loss of interest, low mood, and fatigue may simply be forgetting or neglecting to take a thyroid supplement.
3.3 Psychological Evaluation
3.3.1 General Guidelines
When working with a distressed heart patient, it is generally most helpful to focus on present difficulties. This does not mean that historical problems are irrelevant, but that historical information is used in the service of treating current problems and improving functioning as quickly as possible. Once depression, anxiety, or other problems have resolved or lessened, patients may choose to address other, more longstanding issues.
Many patients assume that they have been referred for psychological or psychiatric services because they complained too much, because their physician thinks they are"crazy," or because their physician believes that their persistent problems are"all in their head." These assumptions are barriers to forming a therapeutic relationship. Addressing them explicitly and describing them as common, understandable beliefs, is generally successful. Another common therapy-interfering belief is that accepting psychological therapy would connote weakness, particularly if the patient has observed other heart patients who appear to be coping well. A collaborative approach with a problem-solving focus often helps to allay this concern, especially if it is made clear that it is the patient who will be doing the real"work" of getting better.
Preface
6
Acknowledgments
7
Table of Contents
8
1 Description
10
1.1 Terminology
10
1.2 Definitions
15
1.3 Epidemiology
18
1.4 Course and Prognosis
21
1.6 Comorbidities
27
2 Theories and Models of the Disorder
28
2.1 Depression
28
2.2 Anxiety
31
2.3 Anger, Hostility, and Type A Behavior
32
2.4 Stress
33
2.5 Low Perceived Social Support
34
2.6 Personality Characteristics
36
2.7 Relationships Among Psychosocial Risk Factors
36
3 Diagnosis and Treatment Indications
38
3.1 Introduction
38
3.2 Medical History and Diagnosis
38
3.3 Psychological Evaluation
39
4 Treatment
44
4.1 Methods of Treatment
44
4.2 Mechanisms of Action
72
4.3 Efficacy and Prognosis
73
4.4 Combination Therapy
73
4.5 Problems in Carrying Out Treatment
74
5 Case Vignettes
75
Case 1: A Woman in her Sixties with Heart Disease and Diabetes
75
Case 2: A Man in his Fifties with Congestive Heart Failure
76
Case 3: A Man in his Seventies who Had Had a Heart Attack, Open Heart Surgery, and a Stroke
78
6 Further Reading
80
7 References
81
8 Appendix: Tools and Resources
85
8.1 Overview
85
8.2 Dysfunctional Attitudes About Health
85
8.3 Techniques for Overcoming Depression
85
8.4 CBT Problem List
86
8.5 CBT Treatment Planning Table for Cardiac Patients
86
Dysfunctional Attitudes About Health ( Supplement to the Dysfunctional Attitudes Scale)
87
Techniques for Overcoming Depression
88
CBT Problem List
89
Cognitive Therapy for Cardiac Patients Treatment Planning Table
90
