Gender Considerations in Psychosocial–Behavioral Interventions for Coronary Heart Disease

Abstract

Six randomized clinical trials (RCT) have been published in major peer review journals, using psychosocial–behavioral interventions with patients who previously experienced major adverse coronary events (MACE). All dealt with important psychological and psychosocial factors that contribute to coronary heart disease (CHD). These RCT obtained either positive or null outcomes for CHD morbidity or mortality. The three RCT reporting positive results (Recurrent Coronary Prevention Project (RCPP), Stockholm Women’s Intervention Trial for CHD (SWITCHD), Secondary Prevention Trial in Uppsala (SUPRIM) used group-based cognitive behavior therapy (CBT), relaxation exercises, coping skills training, and addressed modifiable risk factors and lifestyle planning. Patients began treatment at least 3 months after MACE, received at least 20 intervention sessions, and were followed for an average of 4.5–7.8 years. Therapists were trained in CBT and used manualized treatment. Almost all patients were run in same sex groups. In contrast, the three RCT that obtained null results (WALES, M-HART, ENRICHD) did not use group-based CBT or lifestyle planning for all patients, began behavioral treatment shortly after MACE, provided fewer intervention sessions, and followed patients for an average less than 2.5 years. Whereas patients in the first of the positive trials (RCPP) consisted primarily of men (90 %), the two most recent positive RCT were conducted only with women (SWITCHD) or women and men (SUPRIM) treated in separate sex groups. These RCT were therefore able to focus on problems salient to each sex. Techniques included role playing exercises sensitive to problems important to each sex. This led to group discussions about solving problems germane to these patients. Verbal comments obtained from women, in particular, were positive about such discussions, and both patients and therapists felt that the women could better express themselves in single-sex groups and deal more openly with problems in their lives.