Cognitive processes and recovery from heart attack: a review and theoretical analysis

A review of the literature on psychosocial aspects of recovery from heart attack is presented with emphasis on psychological responses experienced by the patient. Several theoretical models have previously been proposed to explain these data: a psychodynamic view stressing the importance of denial as a coping mechanism, and a second perspective emphasizing patients' beliefs about their health status. A third model is proposed based on cognitive appraisal processes (perceived control and predictability) shown experimentally to mediate reactions to stressors in a wide variety of situations. Viewing heart attack as a crisis situation, it is assumed that particular aspects of illness will generally have a less negative impact on physiological and behavioral health outcomes to the extent they are perceived to be predictable and/or controllable. Specific interventions to alter these perceptions are discussed, and mechanisms linking various recovery outcomes are proposed. The validity of this model is examined with reference to existing research and suggestions for future research are made.