Letters

Psychological rehabilitation after myocardial infarction

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7085.978b (Published 29 March 1997) Cite this as: BMJ 1997;314:978

Training of therapists may have influenced usefulness of programme

  1. Charles Pither, Medical directora,
  2. Amanda CdeC Williams, Research directora
  1. INPUT Pain Management Unit, St Thomas's Hospital, London SE1 7EH
  2. b INPUT Pain Management Unit, St Thomas's Hospital, London SE1 7EH
  3. c University of Wales College of Medicine, Landough Hospital, Cardiff CF64 2XX

    Editor–It seems ironic that the issue of 14 December contained both an editorial on the effectiveness of cognitive behavioural treatment1 and a study of rehabilitation after myocardial infarction with negative results.2 Although two possible explanations are dealt with in Richard Mayou's editorial (that many of the control group had good outcomes anyway and that the treatment arm offered a uniform treatment for a heterogeneous range of complaints),3 there are other important issues that merit discussion.

    DA Jones and RR West set out a number of goals (provide information, increase awareness of stress, teach relaxation, improve stress management, promote positive adjustment to illness, and increase confidence) with the presumed hypothesis that attainment of these aims would reduce morbidity and mortality. Was the lack of effect due to failure to teach a programme that could be utilised by the treated patients, or are psychological techniques ineffective in reducing mortality? The lack of any change in anxiety (albeit measured by an odd choice of instrument) would suggest the former.

    Psychological therapies are very different from, say, giving a drug because the exact components and quality are not specified by the …

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