Psychological interventions in reducing post-traumatic stress disorder in post-myocardial infarction patients as an understudied yet critical intersection of physical and mental health for patients at a period of high vulnerability and risk of developing comorbidities: a commentary

This invited commentary refers to ‘Effectiveness of psychological interventions in reducing post-traumatic stress among post-myocardial infarction patients: a systematic review and meta-analysis, by T.R. Chew et al., https://doi.org/10.1093/eurjcn/zvae179. Myocardial infarction (MI) is a life-threatening coronary event recognized by sudden cardiac death and the most severe clinical presentation of heart diseases. Nearly 1 in 10 of those over 60 years were with MI.1 Psychological outcomes, such as post-traumatic stress disorder (PTSD), anxiety, and depression, represent common comorbidities in patients with MI, and which increase the risk of recurrent cardiac events.2 These psychological conditions also frequently co-occur and significantly impact on the overall health and recovery. Psychological interventions can reduce anxiety and depression, yet their effectiveness in reducing PTSD within this post-MI population remains unexplored.2, 3 The systematic review highlighted the effectiveness of psychological interventions, particularly cognitive-behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR), in reducing PTSD, anxiety, and depression among post-MI patients.4 These therapies address trauma through exposure-based techniques, offering significant short-term improvements. Importantly, both CBT and EMDR share foundational elements, such as graded exposure, which is critical in addressing trauma. Yet, their theoretical frameworks, goals, and applications differ significantly. Generally, CBT offers the most evidence-based approach for addressing all PTSD symptoms,5 while EMDR may be more effective for patients experiencing somatic symptoms related to PTSD and carries contraindications including for those with seizures, due to bilateral stimulation.6 Matching therapy to a patient’s insight, needs, and motivation is crucial for optimizing outcomes. Also, therapy duration also plays a critical role in efficacy. Post-traumatic stress disorder-focused therapies typically last 10–18 weeks, yet some studies in the review used shorter interventions, as brief as six weeks. While short-term improvements may occur, the review highlights limited assessment of time-points and therefore, unclear longevity of effects over time. This suggests that clinicians should consider adaptations to interventions that target relapse prevention in PTSD, including longer interventions or booster sessions to sustain benefits, which remains a significant challenge in chronic cardiac conditions.