Effect of humor training on stress, cheerfulness and depression in patients with coronary artery disease and refractory angina pectoris

Abstract

Angina pectoris refractory to conventional medical treatment is acommon phenomenon in patients with stable coronary artery disease (CAD). Many of these patients suffer from depression and generate substantial costs in the healthcare system. Therefore, the development of new therapeutic concepts is of particular importance. This study investigated whether professional, structured humor training has apositive effect on the symptoms of patients with treatment refractory angina pectoris. Between 2013 and 2014 a total of 35patients with stable CAD were included. Enrolment was possible if patients suffered from treatment refractory angina pectoris (Canadian Cardiovascular Society, CCS gradesII-IV) despite optimal antianginal medication and exhaustion of options for myocardial revascularization. Previously, 25.8% of the patients had had amyocardial infarction. In this study, aprofessional humor coaching was conducted with aduration of 7weeks. In order to evaluate the effects of the coaching, the following examinations were performed before and after the intervention: exercise stress test (treadmill), hair segment cortisol analysis, Beck Depression Inventory (BDI), the Trier Inventory for the Assessment of Chronic Stress (TICS) and the State-Trait-Cheerfulness Inventory (STCI). Out of the 35initially recruited patients 31 completed the study. The mean age was 65.5 years and 94.5% were female. There was asignificant improvement in cheerfulness (STCI, pre 23.3 ± 5.4, post 27.5 ± 5, p = 0,03). This effect was even stronger in asubgroup analysis in which only female patients were included (pre 23.6 ± 5.5, post 27.7 ± 4.6, p = 0.003). The results of the BDI showed aremarkable improvement in the pre-post analysis (pre 14.6 ± 8.1, post 11.0 ± 6.5, p = 0.064). Analyzing only the female patients, this difference became significant (pre 13.1 ± 6.4, post 9.9 ± 4.6 p = 0,037). The hair segment investigations showed that patients who had ahigher cortisol level in the beginning (>25.percentile, n = 22) showed asignificant reduction of the cortisol concentration (pre 6.54 pg/mg, 3.78-12.12 pg/mg, post 3.65 pg/mg, 2.82-7.68 pg/mg, p = 0.029). Patients with refractory angina pectoris and stable CAD benefit from aprofessional humor coaching. This effect was shown in a)asignificant decrease in cortisol concentrations in the hair segment analysis, b)an improvement in cheerfulness in the STCI and c)asignificant difference in the BDI between pre-post values.