You might be shocked by this title: Did they make a mistake? What does coronary heart disease have to do with psychological therapy? No mistake—coronary heart disease patients do need psychological therapy.
Consider this recent report: Renowned doctors from multiple Beijing hospitals have formed a specialized consultation center for psychosomatic disorders. This center will provide patients with personalized biomedical treatment and psychological behavioral therapy. Why establish such a center?Research indicates humanity has entered an era of heightened psychological stress. Conditions like coronary heart disease, diabetes, peptic ulcers, and neurodermatitis are now classified as psychosomatic disorders.
What exactly are psychosomatic disorders? Experts generally agree that mental stress can trigger a series of changes in autonomic nervous system and visceral functions. When this occurs in individuals with a predisposition to comorbidity (such as coronary heart disease patients), these changes can persist and develop into pathological alterations (e.g., coronary artery spasm) accompanied by symptoms (e.g., angina pectoris, arrhythmia). This constitutes a psychosomatic disorder.Clinically, it has been observed that individuals experiencing more than four major life setbacks have a fourfold higher probability of developing coronary heart disease (angina pectoris, arrhythmia, or acute myocardial infarction) compared to the general population. Furthermore, anger, mental tension, and emotional instability are closely linked to elevated systolic blood pressure, while the occurrence of myocardial infarction in relation to emotional fluctuations is a well-known fact.
I once encountered a 60-year-old coronary heart disease patient who frequently experienced precordial pain (angina pectoris). Despite receiving numerous medications for coronary heart disease, his condition showed no improvement (coronary angiography revealed only mild vascular stenosis).
Upon further inquiry, it emerged that this gentleman had always been exceptionally dedicated to his work. After retirement, he joined a bridge club and even became its leader. He channeled his former enthusiasm into the club's activities, exhausting himself daily. When faced with setbacks, he would become impatient and irritable. Recognizing this pattern, I administered behavioral and psychological therapy, which yielded excellent results.Behavioral and psychological therapy constitutes psychosomatic treatment.
Behavioral and psychological factors refer to the body's non-specific response—known as the general adaptation syndrome—to stimuli whether physical, chemical, biological, or psychosocial. Life stressors such as promotions, housing assignments, salary adjustments, divorce, bereavement, relocation, unemployment, or theft often trigger intense emotional fluctuations.The fast pace of life and work pressure can trigger angina pectoris, acute myocardial infarction, or arrhythmia episodes. Animal models demonstrate that emotional agitation (anger) can cause myocardial ischemia, manifested by a significant reduction in coronary blood flow, vasoconstriction, and ischemic changes on electrocardiograms.Observations indicate that nearly half of coronary heart disease patients, when under stress, exhibit abnormal cardiac activity and reduced cardiac output confirmed by isotope ventriculography. However, cardiac function rapidly returns to normal once the stressor is eliminated. Similarly, stressors are also significant triggers for myocardial infarction.
As early as 1910, scholars described the aggressive personality traits characteristic of coronary heart disease patients—the Type A behavior pattern—and conducted the first systematic research on the relationship between behavioral patterns and coronary heart disease. Their conclusion was that individuals with Type A behavior patterns tend to exhibit hostility, impatience, irritability,competitive, and often impatient for quick results. They experience a sense of urgency, striving to achieve an ideal goal in the shortest time possible. To this end, they immerse themselves in work, paying little attention to other aspects of life, and exhibit aggressiveness. So why are individuals with Type A behavior prone to coronary heart disease and its complications? What is its biological basis?Researchers in the 1960s and 1970s confirmed that under stress, individuals with Type A behavior exhibit elevated levels of plasma total cholesterol, triglycerides, norepinephrine, adrenocorticotropic hormone, and testosterone. These substances are all associated with the development and progression of coronary heart disease.Furthermore, researchers have discovered that psychological reactions can trigger hyperactivity in the sympathetic nervous system and increased secretion of catecholamines. These changes can serve as important mediating factors in the development of atherosclerosis, coronary heart disease, and angina attacks. Therefore, in addition to conventional therapeutic measures, behavioral (psychological) therapy should be incorporated into the treatment of coronary heart disease and its complications.Psychological therapy for coronary heart disease primarily encompasses two aspects: Helping patients develop a positive and effective fundamental attitude—adapting to environmental changes to reduce complications and mortality rates.
Through counseling (covering dietary habits, lifestyle, exercise routines, medication use, etc.), relaxation training, and suggestion therapy, the goal is to modify behavioral patterns in patients with coronary heart disease. This aims to reduce unexpected events among those exhibiting Type A behavior.
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