Modification of coronary-prone behaviors in coronary patients of low socio-economic status.
TL;DR: Results showed that only the psychological treatment group significantly reduced Pressured Drive and Speed-Impatience after treatment, and at 1- and 2-year follow-up, and are considered a reliable first step in the process of validating this program designed to improve coronary heart disease patients' quality of life.
Abstract: The purpose of this study is to determine the effectiveness of a group cognitive-behavioral treatment to modify coronary-prone behaviors in patients from a fairly low social and educational level. Participants were 98 male coronary patients randomly allocated to one experimental and two control groups. All groups received standard medical treatment. The experimental group received an additional psychological treatment and one of the two control groups received a health education treatment. Results showed that only the psychological treatment group significantly reduced Pressured Drive and Speed-Impatience after treatment, and at 1- and 2-year follow-ups. Depression was also significantly reduced only in this group at 2-year follow-up. The results are considered a reliable first step in the process of validating this program designed to improve coronary heart disease patients' quality of life.
Summary (3 min read)
Sample and Selection Procedure
- The climate of this region is mild and the life-style largely rural, the most important economic activities involving service to the tourism industry.
- After this session, the psychologist in charge of the program had an individual meeting with each participant to inform them to which group they had been assigned.
- In the first year of the project, both the PsT and HET groups were randomly drawn and allocated, but the resulting differences in education within the generally low educational level of the groups made it difficult to carry out the treatment programs and to achieve intragroup interaction.
- The dependent variables were assessed in group by the first author of this paper, assisted by a minimum of three collaborating psychologists.
- The Structured Interview was necessarily carried out individually.
- This questionnaire evaluates four factors (Anger/Arousal, Hostile Outlook, Anger-In, and Anger-Out) and a Total Anger Scale calculated by adding the individual's scores over the four factors.
- The authors used the Spanish adapted translation by Conde, Esteban, and Useros (1976) .
- The total number of sessions and general training procedure were the same in the PsT and the HET groups.
- Stress management, working on recognition of personal triggers and on how to cope with stressful situations.
- To ensure the integrity and quality of the treatment, a Therapist's Guide was compiled.
- A) clinical manifestations and treatment modalities, b) signs and alarm symptoms, c) risk factors, also known as 2. CHD.
- At the end of each session, the group leaders gave out homework that was checked at the beginning of the following session with the patients' active participation.
- The effects of the treatment were analyzed by a repeated measures general linear model.
- The results at 1 year were analyzed by a 3 ϫ 2 factorial design, with one betweengroup factor with three levels (PsT, HET, and SMT) and one within-group factor (the time of measure, with two times: before and after treatment).
- The treatment effects, including the 2 years of follow-up, were analyzed using a 2 ϫ 4 design with one between-group factor with two levels (PsT and HET) and one within-group factor with four levels (times of measure: before treatment, after concluding treatment, and at 1-and 2-year follow-up).
- All analyses were carried out using the SPSS 10.0 computer program.
- The recruitment process and the results of this can be seen in Diagram I. Average attendance across the 24 sessions of the program in the PsT group was 20.64 (86% of the sessions) and 19.68 (82%) in the HET group, with a range of attendance in each group of 12-24 individuals.
- Dropouts in the treatment groups were those who did not attend 50% of meetings.
- In the control group, the authors included as dropouts those who only filled in all the questionnaires once.
MODIFICATION OF CORONARY
- As can be observed, the 68 participants of the three groups were homogeneous in all variables except for age.
- The participants of the PsT group were younger than those of the control groups, which did not differ in this variable.
- The age difference among groups was not associated with statistically significant differences in the dependent variables studied.
- Comparisons of the 68 completers and the 30 dropouts did not show significant differences in any of the descriptors of the groups.
Type-A Behavior (FTAS)
- The analyses indicated that there were no significant differences among groups before or after treatment.
- The within-group contrasts, however, showed significant differences between the first and second time of measurement in the PsT group, as can be seen in Table 2 .
- The post-hoc contrasts indicated that the significant differences in this factor corresponded exclusively to the changes of the PsT group.
Type-A Behavior (Structured Interview)
- The contrasts by groups indicated that in the Total Scale, significant reduction between the pre-and posttreatment times of measurement appeared only in the PsT group, as can be seen in Table 2 .
- This significant reduction is due mainly to Factor 3, Speed/Impatience, in which only the PsT group showed significant differences between times of measurement.
- The significant effect in Factor 2, Anger-Out, vanished when analyzed by groups.
- Only the group that received PsT reduced its degree of physiological activation after the treatment.
- As can be seen in Table 5 , when analyzing by times of measure and groups, this significant effect appeared between the Time 1, before treatment, and all the other times of measurement only in the PsT group.
- In the HET group, this effect appeared between Times 1-3 and 1-4.
- The analyses of these significant effects by groups indicated that differences in Anger/Arousal appeared in the PsT group between Time 1 and all the other times of measurement, and in the HET group between Times 1-3 and 1-4.
- The distinctive characteristic of this study is that it involved male coronary patients of low socio-economic level, a group traditionally under-represented in intervention programs (Smith et al., 2002) .
- The dropout rate is less than that of similar studies, a result that indicates that the treatment program fulfilled the participants' needs and expectations.
- After treatment, the PsT group did not present statistically significant within-group changes, but its initial scores dropped after treatment and continued to decrease during the 2-year follow-up, until finally showing a statistically significant change between Times 1-4.
- The authors conclude that the treatment designed to modify coronary-prone behaviors was able to modify some behavioral components of the TABP-Pressured Drive and Speed-Impatience-but not the components with a more emotional content or those involving a deeper strata of the personality, such as anger and competitiveness.
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"Modification of coronary-prone beha..." refers result in this paper
...…rate during the year of treatment hardly reaches 31%, a lower percentage than the one provided in population-based studies (Chambless & Ollendick, 2001) and practically identical to that reported in studies about the effectiveness of treatments with specially controlled groups (Elkin et al., 1989)....
"Modification of coronary-prone beha..." refers result in this paper
...The dropout rate during the year of treatment hardly reaches 31%, a lower percentage than the one provided in population-based studies (Chambless & Ollendick, 2001) and practically identical to that reported in studies about the effectiveness of treatments with specially controlled groups (Elkin et…...
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Results showed that only the psychological treatment group significantly reduced Pressured Drive and Speed-Impatience after treatment, and at 1and 2-year follow-ups. Depression was also significantly reduced only in this group at 2-year follow-up.