Integrating psychologic approaches into the behavioral management of cardiac patients

Despite increasing evidence that depression and other psychologic risk factors promote atherosclerosis and adverse cardiac events, practice guidelines for integrating psychologic considerations into the management of cardiac patients are currently lacking. This review explores how application of psychologic principles may help physicians to implement three basic approaches for improving the behavioral management of cardiac patients. The first is the identification and reduction of barriers to following behavioral recommendations, including the presence of negative mood states and other psychologic factors. Patients often self-manage negative moods through unhealthy behaviors such as smoking or eating. However, replacement of these behaviors with more health-promoting behaviors such as exercise and stress management techniques is often difficult and may require active assistance. Second, physicians should help provide patients with external support systems such as referral to support groups or telephone follow ups, when necessary. Such external supports, however, often require other approaches for long-term maintenance of new health behaviors. Third, a motivational literature suggests that physicians can promote patient self-management by formulating health goals in a manner that satisfies "basic psychologic needs" such as the needs for autonomy and competency. Satisfaction of these needs increases "vitality" (a positive state of energy and enthusiasm). Motivation can also be enhanced by creating an emotional attachment to health goals. A case example is provided to illustrate the application of these concepts in clinical practice, and future directions are discussed, including a potential healthcare model that could make the behavioral management of patients more feasible in cardiac practice.