Psychotherapeutic intervention in angina: II. Implications for research and practice

The second of a two-part series, this article draws on the clinical and research literature reviewed in the first article to formulate guidelines for research and clinical practice. In future research, the complex heterogeneity of coronary artery disease (CAD) must be recognized in more rigorous descriptive, comparative, and physiologic correlative studies of psychosocial etiology. Pseudoangina is largely unexamined by systematic study and therefore warrants research on several of its aspects. Similarly, systematic research on intervention in anginoid pain is virtually nonexistent and obviously warranted. Clinical guidelines include the emphasis of didactic, supportive approaches, detailed focus on several aspects of the pain, early and extended psychotherapeutic availability, recognition and treatment of underlying specific psychopathology, and somatic interventions aimed at presumed pathophysiologic mechanisms.