Conclusions We found that psychological intervention  improved psychological symptoms and reduced cardiac mortality for people with CHD .
However , there remains considerable uncertainty regarding the magnitude of these effects and the specific techniques most likely to benefit people with different presentations of CHD
Background Although psychological interventions are recommended for the management of coronary heart disease ( CHD ) , there remains considerable uncertainty regarding their effectiveness .
Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial
Background — Cardiac rehabilitation ( CR ) is the st and ard of care for patients with coronary heart disease . Despite considerable epidemiological evidence that high stress is associated with worse health outcomes , stress management training ( SMT ) is not included routinely as a component of CR . Methods and Results — One hundred fifty-one out patients with coronary heart disease who were 36 to 84 years of age were r and omized to 12 weeks of comprehensive CR or comprehensive CR combined with SMT ( CR+SMT )  , with assessment s of stress and coronary heart disease biomarkers obtained before and after treatment . A matched sample of CR-eligible patients who did not receive CR  made up the no-CR comparison group . All participants were followed up for up to 5.3 years ( median , 3.2 years ) for clinical events . Patients r and omized to CR+SMT exhibited greater reductions in composite stress levels compared with those r and omized to CR alone ( P=0.022 ) , an effect that was driven primarily by improvements in anxiety , distress , and perceived stress . Both CR groups achieved significant , and comparable , improvements in coronary heart disease biomarkers . Participants in the CR+SMT group exhibited lower rates of clinical events compared with those in the CR-alone group ( 18 % versus 33 % ; hazard ratio=0.49 ; 95 % confidence interval , 0.25–0.95 ; P=0.035 ) , and both CR groups had lower event rates compared with the no-CR group ( 47 % ; hazard ratio=0.44 ; 95 % confidence interval , 0.27–0.71 ; P<0.001 ) . Conclusions — CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with st and ard CR . Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00981253
Conclusions We found that psychological intervention  improved psychological symptoms and reduced cardiac mortality for people with CHD .
However , there remains considerable uncertainty regarding the magnitude of these effects and the specific techniques most likely to benefit people with different presentations of CHD
Background Although psychological interventions are recommended for the management of coronary heart disease ( CHD ) , there remains considerable uncertainty regarding their effectiveness .