Mindfulness-Based Stress Reduction Program in Coronary Heart Disease: A Randomized Control Trial

By Parswani, Manish; Sharma, Mahendra et al. | International Journal of Yoga, July-December 2013 | Go to article overview

Mindfulness-Based Stress Reduction Program in Coronary Heart Disease: A Randomized Control Trial


Parswani, Manish, Sharma, Mahendra, Iyengar, S., International Journal of Yoga


Byline: Manish. Parswani, Mahendra. Sharma, S. Iyengar

Background: Psychological risk factors such as anxiety and depression have been associated with coronary heart disease (CHD). Stress can have an impact on the risk factors for the disease, such as high blood pressure (BP), physical inactivity and being overweight. Aims: Examine the effect of the Mindfulness-Based Stress Reduction (MBSR) program on symptoms of anxiety and depression, perceived stress, BP and body mass index (BMI) in patients with CHD. Settings and Design: Intervention was carried out at an Outpatient clinic. Parallel group - MBSR group; and treatment-as-usual group (TAU) - randomized control design with pre- (baseline), post-intervention and follow-up assessments was adopted. Materials and Methods: Thirty male patients, age range (30-65 years) with CHD were randomly allocated to either group. The therapeutic program comprised of eight weekly sessions of structured MBSR intervention for the MBSR group and one health education session for the TAU group. Regular medical intervention and monthly consultations with the cardiologist were consistent for both groups. The main outcome measures were: Hospital Anxiety and Depression Scale, Perceived Stress Scale (perceived stress), BP and BMI. Statistical Analysis: Independent sample t-tests, chi square test and paired sample t-test were used. Results: All patients completed intervention in the MBSR group. Significant reduction was observed in symptoms of anxiety and depression, perceived stress, BP and BMI in patients of the MBSR group after the completion of intervention assessment. At 3-month follow-up, therapeutic gains were maintained in patients of the MBSR group. Conclusion: The MBSR program is effective in reducing symptoms of anxiety and depression, perceived stress, BP and BMI in patients with CHD.

Introduction

Coronary heart disease (CHD) is found to be the leading cause of mortality worldwide. It is a condition in which the walls of the coronary arteries (arteries that supply blood to the heart muscle) become narrowed by a gradual build-up of fatty material called atheroma (BHF, 2003). When atheroma affects the coronary arteries, it can cause angina, myocardial infarction (MI) or sudden death. There are certain risk factors that are assumed to have a direct relationship with the origin and course of CHD, such as age (45 or older for men; 55 or older for women), family history of CHD, cigarette smoking, high blood pressure (BP), high blood cholesterol, overweight/obesity, physical inactivity and diabetes. [sup][1] Research indicates that India will bear 60% of the world's heart disease burden by 2010. In addition, researchers have determined that compared with people in other developed countries, the average age of patients with heart disease is lower among the Indian people, and Indians are more likely to have types of heart disease that lead to worse outcomes. [sup][2] Research indicates that psychosocial factors such as stress, depression and anxiety significantly contribute to the onset, manifestation and prognosis of CHD. Stress can have unwanted physical and emotional effects, which can affect the heart by releasing certain hormones that increase BP and can encourage clotting in the arteries. The stressors include social isolation, acute chronic life events and work-related stress. [sup][3] Research studies provide strong and consistent evidence that depression is an independent risk factor for CHD and its prognosis. [sup][4] Meta-analytic studies have supported the role of anxiety in the onset of CHD. [sup][5]

Given that psychological factors contribute to the onset, course and recovery in CHD, different psychological interventions have been tried with varying outcome measures. Psychoeducation approaches have also been found to be effective in aiming to modify lifestyles and BP optimization. [sup][6] Cognitive behavioural interventions include techniques such as biofeedback, relaxation training and cognitive restructuring, aiming to reduce anxiety, depression and improve quality of life in patients with CHD. …

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