Cardiac Rehabilitation Patients' Accounts of Their Emotional Distress and Psychological Needs: A Qualitative Study.
Background Psychological distress is prevalent among patients with cardiovascular disease and is linked to increased risk of future cardiac events. Cardiac rehabilitation (CR) is widely recommended for treating psychological distress but has been of limited benefit. This study aims to understand how distressed cardiac patients describe their emotional needs and the response of CR. Methods and Results A qualitative descriptive study was conducted with 46 patients who screened positively for anxiety and/or depression. Semi-structured interviews were held, and data were analyzed using a constant comparative approach. Patients described low mood and diverse concerns, including threat of another cardiac event, restrictions on their lives, and problems unrelated to their health. Patients described worrying constantly about these concerns, worrying about their worry, and feeling that worry was uncontrollable and harmful. Patients wanted to "get back to normal" but lacked any sense of how to achieve this and were reluctant to discuss their worries with CR staff. They hoped to recover over time, meanwhile seeking reassurance that they were responding "normally." Patients were mostly dismissive of psychological techniques used in CR. Conclusions These findings expose a conundrum. Distressed CR patients have diverse worries but do not generally want to discuss them, so they invest hopes for feeling better in time passing and reassurance. An intervention acceptable to CR patients would allow them to address diverse worries but without having to share the content of worries, would have "face validity," and would address patients' worry about worry. Metacognitive therapy is an intervention that might be suitable. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02420431.
['McPhillips|Rebecca|R|', 'Salmon|Peter|P|', 'Wells|Adrian|A|', 'Fisher|Peter|P|']
D000223:Adaptation, Psychological D000339:Affect D001007:Anxiety D000072038:Cardiac Rehabilitation D003863:Depression D004644:Emotions D004739:England D007722:Health Knowledge, Attitudes, Practice D006331:Heart Diseases D006801:Humans D007407:Interviews as Topic D008603:Mental Health D036301:Qualitative Research D016032:Randomized Controlled Trials as Topic D013315:Stress, Psychological D016896:Treatment Outcome
cardiovascular disease mental health quality and outcomes