Psychotherapy for Cardiac Patients?

This article explores the mutual, interactive influence between cardiovascular disease and mental health. The psychological issues present among patients of cardiac health issues are mainly that of anxiety and mood disorders. Often termed “psychocardiology”, this field integrates both medical aspects of cardiology and psychotherapy.

The interactions between the mind and body are pronounced and evident. When we feel anxious, our heart pumps faster and we feel breathless. The interaction between psycho and soma is also complex and multifaceted.

Cardiological and psychiatric disorders are closely interrelated and have a bi-directional relationship. This is what we understand as a psycho-somatic interaction.

Mind and Body Connection in Cardiology

Cardiovascular disease is among the leading cause of morbidity and mortality in the industrialized world.  While psychiatric disorders have a prevalence rate close to 20% of the population, depressive illness  is one of the leading cause of disability worldwide (Murray & Lopez, 1997). 

Put together,  depression and anxiety related to depressoin is identified as a significant risk factor for mortality in patients with coronary heart disease (Barth et. al. 2004).

cardiovascular disease and depression

The article cites a meta-analysis of research papers and have found that depression and anxiety contributes to the mortality of patients of coronary heart disease. Cardiac patients who suffer depression are 2x more likely to die than cardiac patients who do not suffer depression in the 2 years of initial assessment of the disease.

Halaris (2013) highlights links underlying recognized cardiovascular disease and mood disorders. Genetic and epigenetic factors affect how an individual reacts to mental and biological stress. Psychosocial and environmental stressors together with lifestyle choices also determines susceptibility to level of disease states.

Among patients with Congenital Heart Disease, for example, it is found that illness perception of the patient is a significant predictor of  patients’ quality of life, cardiac anxiety and depression one year after the heart intervention (O’Donovan et.al. 2016). It indicates that how the patient see his/her illness and the self in this situation affects his/her health development and quality of life.

Psychological effect of Diagnosis of Heart Defects on Patients

Being diagnosed with heart complications, whether it is congenital heart disorder or coronary heart disease leads to years of continuous physical, psychological and/or social burdens for the patient and family.

Patients with early-recognized congenital heart defect live with the condition throughout life. This is especially so in the case of babies / children diagnosed with congenital heart defect.  The psychological state of these patients is deep rooted becomes embedded in identity.

Encased in the anxiety of other types of patients whose heart disease emerge later in life is the shock/abruptness of the heart failure due to a previously unknown / undetected defect. This further stir associations regarding health in general (loss of former self-identity, increase of insecurities etc.).

Psychotherapy needs of Cardiac Patients in Cardiology

Medical professionals in countries like Austria realize the need for an integrated-method of treatment of cardiac patients. Medical treatment is more focused upon when the symptoms are acute, and with chronic ailments the psychological work take precedence. Many fields of mental sciences work together with the doctors for after-care of the patients.

Psychotherapists, as per the studies cited in this article have un-covered the major psychological issues patients face: Clinical anxiety coupled with depression. These have also been shown to have adverse affect on the health development of the patients.

Anxiety is an increase in the awareness of psychic or physical sensations to a degree that makes it impossible for the real or imagined danger to be avoided; there is a constant danger signal together with the incapacity for active coping (Waelder, 1960). Relaxation in the tensions of anxiety seeks the experience not of satisfaction but of security (Sullivan, 1953). 

Patients come to psychotherapy with existential anxiety because of their life-death situation.  Illness perception is linked to these feelings. Along with it comes the perception of oneself in relation to a defect. Patients talk about the feeling of being vulnerable, ‘damaged’, ‘weak’.  For adult patients (especially those who are independent in life), these experiences are often concealed from relevant others.  

In therapy, these themes are worked through in the confidentiality and security of the session. The psychotherapist for such patients has to possess the resources to contain the very strong emotions of the clients, approaching the sessions with empathy and patience. Patience is normally understated, but important. Many patients take time to trust the therapeutic process, and may discourage the therapists from helping them. Feelings of hopelessness /helplessness do become projective identification.

“.. the therapist should function as a container of the patients’ anxieties. The fundamental therapeutic task at this stage is the analyst’s containment and interpretation of the patient’s anxiety. To the extent that this process is carried out, if the patient deposits—or rather evacuates — his anxiety and the analyst is able to bear it, a type of relationship is established in which the patient feels the analyst is an object who’s function is to contain him … As this process repeats itself, the patient develops a growing confidence in the relationship and gradually introjects ‘it’. It can be said theoretically, that from the moment there has been sufficient introjection, the patient has (achieves) within him an object where he (from now on) can deposit his anxieties … “

(Etchegoyen, 2005, p. 620).

The therapists who is able to see through the difficulties of the therapeutic sessions eventually builds the sound alliance. He/she is then able to support the client through the worst of feelings (especially that of loss), thus alleviating existential loneliness and isolation that is part of the depression.

Psychotherapy for Parents and Siblings of Children with Congenital Heart Defect

Psychotherapy cannot ignore that alongside a patient is his/her social system. Parents and siblings of child patients bear a big burden. Work with the family on a long term basis helps alleviate chronic stress faced by parents and supports the family. We can take heart from the research mentioned by Re et.al. (2013).

 

 

 

Bibliography

Barth, J., Schumacher, M., & Herrmann-Lingen, C. (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic medicine66(6), 802-813.

Etchegoyen, R. H. (2005). The fundamentals of psychoanalytic technique. Karnac Books.

Halaris, A. (2013). Inflammation, heart disease, and depression. Current psychiatry reports15(10), 400.

Murray, C. J., & Lopez, A. D. (1997). Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The lancet349(9063), 1436-1442.

O’Donovan, C. E., Painter, L., Lowe, B., Robinson, H., & Broadbent, E. (2016). The impact of illness perceptions and disease severity on quality of life in congenital heart disease. Cardiology in the Young26(1), 100-109.

Re, J., Dean, S., & Menahem, S. (2013). Infant cardiac surgery: mothers tell their story: a therapeutic experience. World Journal for Pediatric and Congenital Heart Surgery4(3), 278-285.

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