Behavioral Cardiology: Toward the Development of Integrated Treatment Models

Abstract

Despite decades of research linking heart disease with psychosocial factors, behavioral health services have not yet become part of the standard for cardiac care. Given that more than one out of five patients with heart disease will experience psychiatric distress which requires evaluation and treatment (Dornelas & Burg, 2007), the paucity of information about how to integrate behavioral health into cardiovascular medicine is worrisome. The most common psychiatric disorders in cardiac patients are depression, anxiety, and adjustment disorders, all of which respond well to standard psychological treatments in primary care populations. Books such as this represent efforts to organize and integrate behavioral and cardiac medicine. But practitioners should take an active role in applying the science of psychology to the practice of behavioral cardiology. There is incredible diversity in the ways that cardiac illness can combine with individual personality traits, psychological disorders, family dynamics, and other psychosocial factors, as well as an array of different approaches to psychological intervention. Most clinicians will be initially influenced by their own training and orientation but will, by necessity, begin to integrate other sources of knowledge and approaches to patient care into their service delivery. There are many benefits to such flexibility in therapeutic approach. For example, many clinicians routinely combine meditation with traditional behavioral treatments. The traditional argument against eclecticism is that without a clear guiding conceptual framework, clinicians may make inconsistent and arbitrary treatment decisions that fail to help or even harm the patient. It is at this point that the field of behavioral cardiology has reached a plateau. There are an increasing number of clinical intervention trials underway but relatively few published outcome reports at the time of this writing, and so behavioral cardiology clinicians have few guidelines for their work.