An attachment-based intervention for patients with cardiovascular disease and their partners: A proof-of-concept study.

Abstract

Couple distress is associated with cardiovascular disease (CVD) risk factors, whereas support is associated with heart-healthy behaviors and better CVD outcomes. Objective: To assess the clinical benefit of the Healing Hearts Together (HHT) intervention, an attachment-based relationship enhancement program for couples in which 1 partner has CVD, on relationship quality, mental health, and quality of life (QoL). Method: Patients from a tertiary cardiac care center and their partners (N = 78; 39 couples) attended the 8-session HHT group. Participants completed validated, self-report questionnaires pre- and postintervention, including the Dyadic Adjustment Scale (DAS), Couple Satisfaction Index (CSI), Hospital Anxiety and Depression Scale (HADS), and the SF-36 (QoL). At intervention completion, participants completed a satisfaction survey. Between-groups comparisons (patient/partner) were examined with analysis of variance. Paired-sample t tests were used to assess changes over time with HHT participation for the complete sample and for patients and partners separately. Results: Many participants reported relationship and psychological distress at baseline. Clinically and statistically significant changes from pre to postintervention were observed for relationship distress (DAS: +7.8 points; p < .001; CSI changes [+3.6] were clinically significant) and depression (−1.8; p < .001), whereas statistically significant changes occurred for anxiety (−1.5; p < .001), and physical (+2.1; p = .047) and mental (+3.3; p < .001) QoL. Patients, but not partners, reported statistically significant changes in QoL-mental component summary. Clinically and statistically significant changes were observed for anxiety for partners, but not patients. Conclusions: The HHT intervention was beneficial for patients’ and partners’ relationship quality, mental health, and QoL. A larger randomized controlled trial evaluating the impact of this intervention on relationship quality, mental health and QoL is warranted.

Attachment insecurities, caregiver burden, and psychological distress among partners of patients with heart disease

“…The findings of the present study have important clinical implications. Current practice predominantly excludes the caregiver from formal programs, despite increasing attention to the health and wellbeing of cardiac caregivers alongside the patient in rehabilitation [ 73 , 74 ]. Interventions should target caregivers reporting burden and attachment insecurity to potentially lessen caregiver distress as they support their partners with heart disease.…”

“…The findings in this study suggest that couple-based intervention programs that use an attachment lens might benefit the health and well-being of both patient and partner. In fact, burgeoning research supports the need and effectiveness of this form of intervention in a cardiac population [ 73 – 75 ]. In fact, a qualitative study found that couples desired interventions for relationship enhancement and the opportunity to share their experience of cardiac-related events with peers [ 75 ].…”

“…In fact, a qualitative study found that couples desired interventions for relationship enhancement and the opportunity to share their experience of cardiac-related events with peers [ 75 ]. These areas were included in an attachment-based intervention that demonstrated positive clinical and statistical mental health and quality of life changes in patients with heart disease and their partners [ 73 ]. In summary, the findings reported herein have important theoretical and clinical implications.…”

Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management

“…Traditional couple therapy approaches can be reserved as a “top step” for initially non-responsive couples or those facing more complex initial difficulties. The preliminary approaches for couple interventions tailored specifically for CHD populations described previously [ 172 , 173 ] could be adapted for delivery in each of these stepped forms.…”

“…Evidence regarding couple interventions in CHD that are more closely based in relationship science is preliminary but encouraging [ 172 ]. For example, in a small trial, the Partners for Life program [ 173 ] was well received by patients and partners and was associated with increased physical activity levels and improvements in relationship quality.…”