Importance of psychosocial status in secondary prevention and rehabilitation of coronary artery disease

Lifestyle and behavioral factors play a major part in the development of coronary heart disease (CHD). Rehabilitation and secondary prevention of CHD must likewise consider behavioral and lifestyle change as adjuncts to other therapies. Principal among the psychosocial factors are depression, anxiety and anger/hostility. Related to these negative emotions, a distressed personality style (type-D) in which both negative emotion and social inhibition are present represents a psychosocial risk factor. In addition, social experience, both in the resources available through social networks and the subjective experience of isolation, is related to both the onset and course of CHD. Psychosocial interventions have been found to be effective in rehabilitation and secondary prevention. Finally, a case is made that all professionals working in cardiac rehabilitation and secondary prevention should be knowledgeable in the psychological constructs of motivation and readiness for behavioral change. The widely employed transtheoretical model of change is presented as an example of the need for interventions to be developed that recognize patients' difference in the readiness for change.