DOI: 10.6129/CJP.20160613
Chinese Journal of Psychology 2016, Vol.58, No.2, 143-168
Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Cognitive-Behavior Group Therapy Approach
Chia-Ying Weng（Department of Psychology, National Chung Cheng University）；Chin-Lon Lin（Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation）；Tin-Kwang Lin（Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation；School of Medicine, Tzu Chi University）；Chih-Wei Chen（Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation）；Yi-Da Li（Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation）；Chiu-Tien Hsu（Department of Clinical Psychology Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation）；Su-Su Wong（Department of Child Development and Family Studies, Tzu Chi University）；Shih-An Pai（Department of Psychology, National Chung Cheng University）
Abstract
Objective: This study attempted to examine the effectiveness of a cognitive-behavior group therapy (CBGT)
program in reducing hostility and producing changes in its associated cardiovascular activity during the anger-recall task among patients with coronary heart disease (CHD). Method: This study adopted a case-control trial. In addition to standard medical care, the 16 intervention-group patients (mean age: 58.56 ± 6.63 years; men: 75%) attended eight weekly 2-hour sessions with the following components: (1) psycho-education; (2) self-awareness; (3) biofeedbackassisted relaxation training; (4) cognitive therapy, including cognitive flexibility and positive thinking; (5) behavior therapy to foster compassion towards oneself and others; and (6) social support. In order to improve the therapy’s efficacy, individualized stress-assessment reports and portable biofeedback devices (stress eraser) were provided to all participants to enhance their self-awareness and motivation to change. In Chinese culture, self-compassion is a fundamental aspect of CBGT that can reduce hostility. The 14 patients in the wait-list control (WLC) group (mean age: 57.50 ± 9.91 years; men: 78.5%) received standard medical care without clinical psychological treatment. Hostility, depression as well as anxiety, respiration rate, and blood volume amplitude (BVA) during the anger-recall task were assessed before and after intervention for the CBGT group and at identical time points for the WLC group. Results: Suppressive hostility (F(1,28) = 5.72, p < .05), expressive hostility (F(1,28) = 4.58, p < .05), total hostility (F(1,28) = 10.07, p < .05), and anxiety (F(1,28) = 13.75, p < .05) at post-intervention were significantly lower than at pre-intervention in the CBGT group, compared to the WLC group. Moreover, vasodilation function (F(1,23) = 4.64, p < .05) -- indexed by BVA -- increased, and respiration rate decreased (F(1,28) = 5.24, p < .05) in the CBGT group but not the WLC group. Conclusion: Patients with CHD experienced improved vasodilation function, lower anxiety, and fewer suppressive and expressive hostility behaviors following the CBGT psychosocial rehabilitation program.
Keywords: cognitive-behavior therapy, cardiac rehabilitation, coronary heart disease, suppressive hostility, biofeedback
