Key result
In a qualitative study of 46 distressed cardiac rehabilitation patients, participants reported uncontrollable worries but were reluctant to discuss them, dismissing standard psychological techniques.
Why the study?
Psychological distress is prevalent in cardiovascular disease and increases future event risk, but widely recommended cardiac rehabilitation has offered limited benefit.
Distressed cardiac rehabilitation patients experience constant worry but are reluctant to discuss it, suggesting a need for interventions like metacognitive therapy that do not require sharing worry content.
May prompt clinicians to address uncontrollable worry differently in cardiac rehabilitation; leaves open whether metacognitive therapy reduces distress.
Background Psychological distress is prevalent among patients with cardiovascular disease and is linked to increased risk of future cardiac events. Cardiac rehabilitation (CR) is widely recommended for treating psychological distress but has been of limited benefit. This study aims to understand how distressed cardiac patients describe their emotional needs and the response of CR. Methods and Results A qualitative descriptive study was conducted with 46 patients who screened positively for anxiety and/or depression. Semi-structured interviews were held, and data were analyzed using a constant comparative approach. Patients described low mood and diverse concerns, including threat of another cardiac event, restrictions on their lives, and problems unrelated to their health. Patients described worrying constantly about these concerns, worrying about their worry, and feeling that worry was uncontrollable and harmful. Patients wanted to "get back to normal" but lacked any sense of how to achieve this and were reluctant to discuss their worries with CR staff. They hoped to recover over time, meanwhile seeking reassurance that they were responding "normally." Patients were mostly dismissive of psychological techniques used in CR. Conclusions These findings expose a conundrum. Distressed CR patients have diverse worries but do not generally want to discuss them, so they invest hopes for feeling better in time passing and reassurance. An intervention acceptable to CR patients would allow them to address diverse worries but without having to share the content of worries, would have "face validity," and would address patients' worry about worry. Metacognitive therapy is an intervention that might be suitable. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02420431.
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McPhillips et al. (2019) studied Cardiovascular disease with psychological distress (n=46). In a qualitative study of 46 distressed cardiac rehabilitation patients, participants reported uncontrollable worries but were reluctant to discuss them, dismissing standard psychological techniques.
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