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Mental Mental Health Counseling Boosts Recovery Rates of Depressed People With Heart Disease

By Gregory A. Dawson, PhD, Troy University, Carol Lewis, PhD, Troy University, and R. Brahm Fay, Troy University

Heart disease, or coronary artery disease, is still the number-one killer of both men and women in the United States. The treatment for heart disease, typically an invasive surgical procedure known as Coronary Artery Bypass Graft (CABG), results in an unusually high incidence of depression post-surgery—almost six times the annual depression incidence rate for the general population. 

Post-operative depression often results in poor treatment outcomes and early death for people with coronary artery disease. 

While bypass surgery is becoming routine, healing a broken heart is far from routine. And though cardiac rehabilitation, which has a strong counseling component, has been successful in treating patients following bypass surgery, mental health counselors are rarely used in cardiac rehabilitation settings despite the six-fold increase in depression post-surgery. 

A significant problem is that fewer than 30 percent of bypass surgery patients choose cardiac rehabilitation to aid their recovery. Far fewer complete all phases of the cardiac rehabilitation program.

Some of the reasons for this include low referral rates by cardiologists and cardio-thoracic surgeons, high co-pays for Medicare and third-party insured patients, and a patient perception that surgery has fixed the problem. 

Anti-depressant medication that is prescribed to patients post-CABG, such as selective serotonin-reuptake inhibitors, while treating the depression successfully, often does not improve treatment outcomes and early death. 

Some research suggests antidepressants even hinder post-surgery recovery for patients with coronary artery disease.

Cardiac Rehabilitation Boosts Treatment Outcomes
The efficacious nature of cardiac rehabilitation and its ability to reduce post-operation mortality is clear. Mental health counseling is a valuable component of cardiac rehabilitation because it can help address post-surgical mental health issues that complicate recovery, and it may also aid in preventing depression. 

Cardiac rehabilitation is successful because it helps patients with coronary artery disease change their lifestyles to enhance treatment outcomes. In addition, it helps them build a social support network with others who share their health problem. 

Social support is critical in preventing depression and fostering successful heart disease treatment outcomes. Mental health counselors who work with heart disease patients and their loved ones provide another level of social support not currently addressed in cardiac rehabilitation settings.

Treating Heart Disease Patients With a History of Depression
Following bypass surgery, coronary artery disease patients who have a pre-surgery history of depression are at greater risk for early mortality than the general population of coronary artery disease patients. In addition, a history of depression is a primary risk factor in the development of coronary artery disease. Furthermore, patients with a history of depression are significantly less likely to complete cardiac rehabilitation as a result of their depression. This population has not been addressed in the literature as it relates to prevention of coronary artery disease and of further cardiac complications once diagnosed and treated. 

It’s likely that people already suffering from moderate to severe depression would benefit from mental health counseling that addresses ways to prevent coronary artery disease. Ideally, a modified cardiac rehabilitation program provided by mental health counselors could be prescribed for clients who have a history of depression and are at risk for developing coronary artery disease. 

Counselors trained in the wellness model of mental health counseling generally include exercise and nutrition in a treatment plan. The wellness model is an obvious fit for patients with histories of depression who are diagnosed with coronary artery disease. 

People with coronary artery disease may also be helped by expressive therapies since they mimic components of cardiac rehabilitation. For example, using movement or dance therapy has exercise value that could replace exercise machines such as the treadmill. 

Many patients who would not be enthralled with using treadmills and other exercise equipment may be excited about participating in movement or dance therapy.

Expressive therapies could be utilized as adjunctive therapies particularly with coronary artery disease patients with histories of depression who are referred for cardiac rehabilitation. Certainly the literature is clear that aerobic exercise aids in the treatment of depression and recovery from bypass surgery and other invasive procedures. 

In addition, art therapy and music therapy, which have been employed successfully as adjunctive therapies for cancer, would have value in cardiac rehabilitation.

Healing Broken Hearts, Physically and Metaphorically
Clearly there is a strong correlation between a broken heart and a heart that does not work properly. In an effort to discover insights about what best motivates heart disease patients to recover, future research should focus on the efficacy of a modified cardiac rehabilitation program for clients with a history of moderate to severe depression.

For best outcomes, the modified treatment should include licensed mental health counselors to dramatically improve the lives of both the broken hearted, and those with broken hearts. 

Gregory Dawson, PhD, and Carol Lewis, PhD, serve as assistant professors in the Counseling and Psychology Department of Troy University, Southeast Region, Florida. R. Brahm Fay is a graduate student and research assistant in the Counseling and Psychology Department at Troy University, Orlando. All have research interests in integrating mental health counseling in healthcare settings. They may be reached at,, and