Continuous event recorders did not affect anxiety or quality of life in patients with palpitations

Using health psychology techniques to manage chronic physical symptoms

Chest pain and palpitations, non-malignant pain, breathlessness and fatigue often endure despite the receipt of appropriate nursing and medical care. This is distressing for patients, impacts on their quality of life and ability to function and is associated with high healthcare usage and costs. The cognitive behavioural approach offers nurses a model to understand how people's perceptions and beliefs and their emotional, behavioural and physiological reactions are linked. Common 'thinking errors' which can exacerbate symptom severity and impact are highlighted. Understanding of this model may help nurses to help patients cope better with their symptoms by helping them to come up with alternative more helpful beliefs and practices. Many Improving Access to Psychological Therapy services offer support to people with chronic physical symptoms and nurses are encouraged to sign post patients to them.

Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: a randomized controlled trial

OBJECTIVES

Many patients with noncardiac chest pain or benign palpitations have poor prognosis in terms of symptom persistence, limitations in everyday activities, and reduced health-related quality of life (HRQOL). The aim of the study was to compare a three-session manualized cognitive behavioral therapy (CBT) intervention with normal care for patients with noncardiac chest pain or benign palpitations in a randomized controlled trial.

METHODS

Patients with persistent complaints six months after a negative evaluation at a cardiological outpatient clinic were invited to participate. Of the 94 eligible patients, 40 agreed to participate and were randomly assigned to either an intervention or control group. Patients in the intervention group received three manualized sessions with CBT, including one physical activity exposure session. The control group received usual care from their general practitioner.

RESULTS

There were significantly larger improvements in the treatment group regarding fear of bodily sensations, avoidance of physical activity, depression and some domains of HRQOL at the end of treatment, and at three- and 12-month follow-up. A substantial proportion (about three-quarters) of the intervention effects on depression and avoidance of physical activity could be attributed to (was mediated by) the large reduction in catastrophic interpretations of bodily sensations.

CONCLUSION

A three-session program of manualized CBT, including exposure to physical activity, was effective treatment for patients with noncardiac chest pain and benign palpitations up to the 12-month follow-up.

Patients with noncardiac chest pain and benign palpitations referred for cardiac outpatient investigation: a 6-month follow-up

OBJECTIVES

The aims were to (a) study the characteristics and outcome in patients with noncardiac chest pain or benign palpitations referred for cardiac evaluation, (b) compare psychological characteristics in the two groups, (c) identify predictors of outcome (d) and explore characteristics of patients who wanted psychological treatment.

METHODS

The patients (N=154) were first evaluated by a psychiatrist and than by a cardiologist at the initial attendance and by self report after 6 months.

RESULTS

Thirty nine percent had at least one DSM-IV psychiatric disorder at attendance. At the 6-month follow-up, 43% still had clinically significant complaints and/or impaired function. Patients with palpitations were more likely to be female, younger and less likely to attribute cardiac symptoms to heart disease, but had otherwise similar psychological features to noncardiac chest pain patients. Depression score at attendance predicted significant complaints at follow-up. Interest in psychological treatment was associated with more fear of bodily sensations, more impaired function, and greater tendency to attribute symptoms to heart disease.

CONCLUSION

Psychiatric disorders were common. The 6-month outcome was poor and was associated with the depression score at attendance. Patients with fear of bodily symptoms and impaired function were most interested in psychological treatment.