Interventional effect of Chinese daoistic cognitive therapy on type-A behavior of patients with coronary heart disease

Jinfu ZHU

ABSTRACT

BACKGROUND: Coronary heart disease (CHD) is commonly seen psychosomatic disease of cardiovascular system. Its behavioral characteristics have been closely concerned by scholars at home and abroad. Chinese daoistic cognitive therapy works well in patients with anxiety, but its application in the field of psychosomatic disease needs further development.OBJECTIVE: To probe into the interventional effect of Chinese daoistic cognitive therapy on type-A behavior of patients with coronary heart disease (CHD).DESIGN: A randomized controlled grouping observation.SETTING: Department of Psychology, Xinxiang Medical College.PARTICIPANTS: Totally 206 patients who were retired and received treatment in the Staff Hospitals of Changsha University of Science and Technology and Hunan University between August 2002 and January 2004were recruited. They were randomly divided into psychotherapy group (n=104)and control group (n=104).METHODS: Patients of control group underwent simple drug treatment and those of psychotherapy group underwent drug treatment + daoistic cog nitive therapy. Drug and dosage:①nifedipine 10 mg/d.②betaxolol 25-50mg/d. ③nitrendipine 20-30mg/d. ④captopril 25-50 mg/d. Dapistic cognitive therapy was divided into four parts according to operation procedure: Loose and calm technique, the technique of soft movement, the meeting of analyzing the cause of CHD and the records of health care and what one has learned from study. Psychotherapy group received 3-month treatment with Chinese daoistic therapy and 6-month follow-up and control group only received medical treatment. Both groups were test on a type-A behavior questionnaire (TABQ) and a mental detachment scale. TABQ included three-subscales: L scale is for measuring lie; TH scale for measuring time hurry and CH is for competition hostility. Subjects, whose value of L was equal to or beyond 7, were excluded. Subjects were considered as patients with type-A behavior if their TH+CH value was equal to or beyond 28. The Mental Detachment Scale was used to measure patients's outlook of value concerning degree of mental detachment on social life, family life and personal life and so on. The higher the scores, the higher the patients'mental detachment; the lower the scores, the lower degree the patients'mental detachment. MAIN OUTCOME MEASURES: Comparison of scoring of TABQ and mental detachment scale and incidence of type-A behavior before and after therapy in patie nts between two groups.RESULTS: Twelve patients of psychotherapy group and 15 patients of control group lost due to going out or other matters, 1 patient of control group died and finally, 92 patients of psychotherapy group and 87 patients of control group entered the stage of result analysis. ①The scores of TABQ after 3 or 6-month treatment were significantly lower in the psychotherapy group than in the control group, with significant difference [(20.8±5.8),(24.2±5.3) scores,t=4.072,P=0.000];[(21.2±5.7), (24.2±4.8) ,t=3.809, P=0.000]. The scores of TABQ were significantly decreased after 3-month intervention in comparison with before intervention, and there was no furincidence of type-A behavior after 3 or 6-month therapy was significantly lower in the psychotherapy group than in the control group, with significant difference (24/26, 35/40, x2=1.526, P=0.017); (26/28, 35/40, x2=1.463,therapy was significantly higher in the psychotherapy group than in the control group, with significant difference [(28.7±4.4), (27.2±3.6) scores,t=8.506, P=0.000]; [(32.6±3.1), (27.0±3.4) scores, t=11.371, P=0.000].The scores of Mental Detachment Scale were significantly increased after 3-month intervention in comparison with before intervention,and there was no further change of scores of TABQ after 6-month follow-up (P ＞ 0.05).② The incidence of type-A behavior after 3 or 6-month therapy was significantly lower in the psychotherapy group than in the control group, with significant difference (24/26, 35/40, x2=1.526, P=0.017); (26/28, 35/40, x2=1.463,P=0.021 ).③ The scores of Mental Detachment Scale after 3 or 6-month therapy was significantly higher in the psychotherapy group than in the control group, with significant difference [(28.7±4.4), (27.2±3.6) scores,t=8.506, P=0.000]; [(32.6±3.1), (27.0±3.4) scores, t=11.371, P=0.000].The scores of Mental Detachment Scale were significantly increased after 3-month intervention in comparison with before intervention (P＜ 0.01) and scores of Mental Detachment Scale after 6-month follow up was further increased (P ＜ 0.05).CONCLUSION: Daoistic cognitive therapy can decrease type-A behavior,increase clinical therapeutic effect and improve prognosis of patients with CHD.