Psychosocial intervention in coronary artery disease: a review

This review attempts to provide comprehensive consideration of three phases of psychosocial intervention in coronary artery disease (CAD): preventive, acute, and convalescent/rehabilitative. Toward this end, a wide variety of literature, ranging from clinical-anecdotal reports and prescriptive exhortations to controlled systematic studies, is considered. The prevention literature is limited to the Type A behavior pattern (TABP). Despite conceptual and methodological problems. TABP modification research seems promising, though its significance for ultimate CAD-reduction remains to be demonstrated. The acute phase literature consists almost entirely of clinical lore. Systematic research is recommended on several aspects of denial and on the efficacy of the many anecdotally recommended interventions. The rehabilitative phase literature also includes a rich clinical lore, and, in addition, several systematic studies indicating psychological and perhaps physiological benefits from both individual and group supportive psychotherapy. It is concluded that the current state of knowledge in this area is promising but controversial, and that advance beyond this point requires a shift from global, clinically derived impressions to specific, tested hypotheses.