Those who went to the most therapy sessions had a further reduction in risk, the researchers note. "The higher the attendance rates, the lower the risk," Gulliksson said.
"The psychological treatment had a clear impact beyond the already known beneficial effects of conventional treatments to prevent recurrent events," Gulliksson said. "The effects were similar for men and women," he added.
Exactly how the stress management strategies protect the heart is a question for future research, he noted.
It's possible that the better outcomes relate to long-term participation (six to 12 months at least) in a group designed to alter behavior, the authors say. Perhaps by decreasing emotional and behavioral reactivity, people can alleviate some of the burden placed on the cardiovascular system, they add.
"The positive results suggest that cognitive behavioral therapy intervention based on stress management should be added to secondary prevention programs and offered to all coronary heart disease patients," Gulliksson said. The therapy is also inexpensive and without side effects, he added.
But at least one expert remained unconvinced that the health benefits noted in the study were related to the CBT therapy.
"We know from many trials that people in intervention trials tend to get better care," said Dr. Robert Myerburg, a professor of medicine and cardiology at the University of Miami Miller School of Medicine.
What isn't clear from the study is whether the therapy patients kept to their medication regimen more consistently than the non-therapy patients, he said. For example, the study authors don't show whether blood pressure and cholesterol were better controlled in the therapy group than in the non-therapy group, Myerburg said.
"The question is, is this a direct effect or a nonspecific effect of an intervention where
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