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Integrating Psychologic Approaches Into the Behavioral Management of Cardiac Patients

From the Division of Cardiology, St. Luke’s–Roosevelt Hospital Center, and the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.

View larger version (25K): [in a new window]   Figure 1. Behavioral change can be considered according to a hierarchy of behavioral challenge, ranging from those that are least difficult (i.e., the initiation of new practices in which there is no preexisting habit that needs to be broken) to the most difficult (i.e., breaking addictive habits which satisfy physiological drives). Cardiologists’ common involvement in the management of behaviors that are the most difficult for patients to maintain helps explain why nonadherence to behavioral intervention is so commonly experienced in cardiac practice.

View larger version (48K): [in a new window]   Figure 2. Thayer’s proposed biopsychologic model for evaluating moods based on self-reported measurements of energy and tension levels (27). Research indicates that whereas states of "calm energy," "calm tiredness," and even "tense energy" are all associated with a predominance of positive moods, periods of "tense–tiredness" are relatively unpleasant and associated with a relatively higher frequency of pessimism and other negative cognitions.

View larger version (20K): [in a new window]   Figure 3. The potential behavioral effects of chronic stress are depicted. Chronic stress is associated with both higher tension and decrease energy, which predisposes to states of "tense–tiredness" and negative moods. As a consequence, patients with chronic stress may be more susceptible to depression, adverse behaviors that may be used to diminish tense–tiredness or negative mood states (e.g., eating or smoking), and less energy for adhering to healthy behavioral suggestions.