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For some of her patients, managing anger and depression are key components of therapy, says Stacy Raymond, Psy.D. Raymond is a cardiac psychologist in Ridgefield, Conn. (photo by Kathryn Hardy) |
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By Ami Albernaz
Alan Lieberman, Ph.D., a consultant to the cardiology department and cardiac rehabilitation unit at St. Elizabeth's Hospital in Brighton, Mass. has been working for the past eight years to restore cardiac patients to health. He helps his clients to better manage stress, to conquer addictions to smoking and overeating and to empower them to prevent future incidents. Lieberman is one of a growing number of cardiac psychologists who focus on the emotional and cognitive underpinnings of heart trouble.
With heart disease as the country's leading cause of death, it is not surprising that a branch of psychology is emerging to mitigate some of its underlying risk factors. Cardiac psychology first garnered attention in 1996 with a book aptly titled, "Heart and Mind: The Practice of Cardiac Psychology" (edited by Robert Allan, Ph.D. and Stephen Scheidt, M.D.). The compilation of research findings sparked interest among mental health practitioners, who work with cardiac patients in private practice, as consultants to cardiologists, or within intervention teams in rehabilitation programs.
Uniting mental health and physiology, cardiac psychology is holistic, taking into account the unique sets of circumstances that each patient faces. "The guiding principle is that the mind and body are interconnected," Lieberman says. "People bring their lives and problems with them." Cardiac failure is almost always frightening and disorienting; part of Lieberman's job is to help his patients manage their fears stemming from their states of health and the sudden disruption in their lives. "Ninety percent of heart patients have had no prior experience with a psychologist," he says. "They are by and large 'normal' people in a health crisis."
Lieberman consults with his patients' physicians and family members and ensures that patients are in a frame of mind to focus on their own health. He tells of one patient who was a caregiver for his wife, who had Alzheimer's disease. After his heart attack, the patient was worried that he would be unable to care for his wife. For the man's peace of mind, Lieberman called the nursing home for reassurance that his wife was being cared for. Lieberman's patient, his fears allayed, was then able to focus on his own health.
Lieberman's courses of therapy are structured according to each patient's needs. He teaches some patients relaxation techniques such as meditation or guided imagery, which have benefits beyond helping patients cope. "We know that calming patients before surgery helps patients bleed less and need less anesthesia," he says. For patients who find it helpful to talk to others about what they are going through, he might recommend group therapy. The goals are to address the psychological components of adopting healthier lifestyles - quitting smoking, cutting fat consumption, learning to relax.
Practicing in a somewhat different capacity is Stacy Raymond, Psy.D., of Ridgefield, Conn. Raymond became interested in cardiac psychology three years ago, seeing the need for a holistic approach to heart health through her work with her husband, a cardiologist. At the time, the specialty had even less recognition that it has now. Raymond prepared for working with cardiac patients by reading up on the field and even shadowing Robert Allan in New York. Today, some of Raymond's clients are also her husband's patients.
"Like most physicians, he can't talk to his patients for half an hour," she says. "But it's always been a concern for him to provide comprehensive care."
In approaching each new course of treatment, Raymond assesses lifestyle, risk factors, and the patient's level of awareness as to how emotions and stress levels impact the heart. "A lot of people operate at a high level of stress, and don't even realize it," she says. "People need to learn how it feels to be relaxed, and how to bring themselves to that state."
For some of her patients, managing anger and depression are key components of therapy. "A person is twice as likely to have a heart attack while in a fit of rage," Raymond says. She teaches her clients cognitive skills to help them reinterpret events and to recognize that they have control of their emotional states. "It's saying that 'I'm in control of my states of stress and relaxation,'" she says.
For clients dealing with depression, meanwhile, strengthening social support networks and helping them feel less isolated is critical. "If patients feel that their bodies are failing them and they remain depressed, they have three times the risk of dying that first year after a heart attack, compared to someone who's not depressed," she says.
Raymond helps her clients feel good about taking small steps in improving their health, rather than daunted by trying to implement sweeping changes all at once. It doesn't have to be all-or-nothing," she says. "If you make modest changes, you'll see results. You don't have to eat only tofu and bean sprouts, but you do have to make changes."
Mental health is also a key component of rehabilitation programs that marry physical and emotional resilience building. At the Mind-Body Institute (MBI), an affiliate of Boston's Beth Israel Deaconess Hospital, a 13-week cardiac program offers a combination of nutrition counseling, physical training and counseling. The guiding philosophy is that physical and mental health are inextricably linked and that substantial changes in one inevitably impact the other.
"Only 50 percent of heart disease can be explained from a physical standpoint - high cholesterol, obesity, and so on," says Aggie Casey, M.S., R.N., MBI director and clinical specialist. "There's also the hostility component, and those with significant anger and depression are at an increased risk of heart disease. We tend to see optimal heart health as a balancing of three legs. One leg is pharmaceutical, the other is surgical and the third leg is self-care: What can you do to empower patients to take better care of themselves?"
The psychotherapy component is a combination of individual and group counseling. Patients learn relaxation and cognitive skills - time management and constructive coping strategies - in a group setting. For patients with specific concerns, individual counseling is available. Patients leaving the program, Casey says, typically report improvements in quality of life.
The North Shore Medical Center in Salem, Mass. offers a similar cardiac rehabilitation program. Joanne Rowley, M.S., R.N., C.S., a psychiatric clinical nurse specialist, is part of an intervention team that provides an array of services, including exercise and nutrition counseling. Rowley meets individually with each patient starting out in the program. During a comprehensive assessment, patients assess what is most meaningful to them and from there, decide to make changes.
"A heart attack is a wake-up call," Rowley says. "Some patients might decide to take early retirement or realize that appreciating their family is important."
Following the initial consultation, Rowley meets with patients individually as needed. She also teaches relaxation skills in a group setting; some patients will later turn to Rowley for help in applying the skills to their own situations. Patients will also consult with Rowley in need of support in making difficult lifestyle changes, like quitting smoking. When needed, Rowley also refers some patients to other specialists: acupuncturists, marital counselors, outside support groups - whatever service would be most beneficial for a patient's emotional, and physical, well-being.
While it is more directly related to physical health, cardiac psychology maintains the central tenet that unites all branches of psychology: to empower people to make positive changes and to feel that they are in control of their lives and health. The goal, as Raymond says, is for patients to recognize "'I'm not completely in the hands of my cardiologist. I can make changes to improve my health.'"
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