The MOTIV-HEART Study: A Prospective, Randomized, Single-Blind Pilot Study of Brief Strategic Therapy and Motivational Interviewing among Cardiac Rehabilitation Patients.

Giada Pietrabissa,Alessandro Rossi,Gianluca Castelnuovo,Gian Mauro Manzoni

doi:10.3389/fpsyg.2017.00083

Abstract

Background: Psychological distress, biomedical parameters, and unhealthy lifestyles contribute to a poorer prognosis for cardiac disease. Public health's challenge is to motivate patients to utilize self-care.Objective: This prospective, randomized, single-blind pilot study aimed at testing the incremental efficacy of Brief Strategic Therapy (BST) combined with Motivational Interviewing (MI) in improving selected biomedical and psychological outcomes over and beyond those of the stand-alone BST in a residential Cardiac Rehabilitation (CR) program.Method: Fourty-two inpatients (17 females), enrolled in a 1-month CR program, were randomly allocated into two conditions: (a) Three sessions of BST and (b) Three sessions of BST plus MI. Data were collected at baseline, discharge, and after 3 months through phone interviews.Results: At discharge, no significant between-group difference was found in any outcome variable. Changes from pre- to post-treatment within each condition showed significant improvements only in the BST group, where the level of external regulation diminished, and both the participants' self-regulation (Relative Autonomous Motivation Index, RAI) and willingness to change improved. At the 3-month follow-up, within-group analyses on responders (BST = 9; BST + MI = 11) showed a statistically significant improvement in the level of systolic blood pressure in both groups.Discussion: Findings showed no evidence of the incremental efficacy of combining BST and MI over and beyond BST alone on either selected biomedical or psychological outcomes among CR patients.Conclusions: Ends and limitations from the present pilot study should be considered and addressed in future investigations.

Highlights

Cardiovascular Disease (CVD) is a global health issue and leading cause of morbidity and mortality in developed countries (Beauchamp et al, 2010).Psychological factors, such as lack of social support, depression, anxiety, and type A behavior/hostility, largely contribute to the etiopathogenesis of heart disease (Rozanski et al, 1999; Favoccia et al, 2014)
The inspection of baseline data revealed that patients assigned to that condition had a higher median and higher interquartile ranges in the Treatment Self-Regulation Questionnaire (TSRQ)-external regulation dimension than the Brief Strategic Therapy (BST) + Motivational Interviewing (MI) condition
While the BST + MI condition contained a majority of men, the other condition was mainly composed of women, which could have biased the treatment effects on both biomedical (Kg and Systolic Blood Pressure (SBP)) and psychological outcomes (B-IPQ-treatment control dimension and willingness to change)

Summary

Introduction

Cardiovascular Disease (CVD) is a global health issue and leading cause of morbidity and mortality in developed countries (Beauchamp et al, 2010) Psychological factors, such as lack of social support, depression, anxiety, and type A behavior/hostility, largely contribute to the etiopathogenesis of heart disease (Rozanski et al, 1999; Favoccia et al, 2014). Psychosocial determinants may, cause direct acute or chronic pathophysiological changes (Hemingway and Marmot, 1999) They may affect adherence to treatment and long-term maintenance of health related behaviors (e.g., smoking, diet, alcohol consumption, or physical activity), which in turn increase the risk of developing CVD (Ceccarini et al, 2015; Pietrabissa et al, 2015b). Public health’s challenge is to motivate patients to utilize self-care

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Discussion

Conclusion