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The heart-mind connection

September 1, 2006
by MARY HILL, LCSW, CEAP, REGINA WEBER, LCSW, and SANDY WERNER
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Behavioral health providers have an important role to play in patients with, or at risk of, heart disease

Behavioral health and employee assistance professionals have an important role in preventing and managing heart disease, which is a leading cause of death and disability in the United States. As with other diseases, heart disease often is associated with other disorders. Of particular note is the association between heart disease and behavioral health conditions.

Cardiovascular and Mental Health

Depression develops in one in four individuals who have a heart attack. When depression and heart disease are present together, the risk of death is three-and-a-half times greater than in nondepressed patients.1

Many studies have provided evidence of a link between heart disease and depression, anxiety, hopelessness, pessimism, hostility, and anger.2–4 Depression and anxiety are suspected to directly affect heart rhythms, increase blood pressure, alter blood-clotting capabilities, and lead to elevated insulin and cholesterol levels.5 Studies also have shown that the risk of having a heart attack doubles for two hours after an angry episode.6

Assessment and Treatment Planning

Given the prevalence of heart disease and the increased risk that develops when comorbid mental health disorders are present, behavioral health practitioners and employee assistance professionals should continually educate themselves about the risk factors and protective measures that may be addressed in a therapeutic behavioral health setting.

The primary risk factors for the development of heart disease are well known: smoking, a sedentary lifestyle, hypertension, high blood cholesterol levels, obesity, diabetes, and a family history of heart disease. Yet an effective disease management program or clinical intervention must address the connection between emotion, behavior, coping strategies, and cardiovascular health in a holistic, integrated manner. Addressing risk factors in a comprehensive treatment plan with a client and collaborating with treating medical professionals are imperative.

Behavioral health clinicians are in a unique position to help their clients identify their risk factors, encourage them to follow up with their medical practitioners, and address any distress they may be experiencing. With their focus on helping employers address employee health and productivity, employee assistance professionals cannot ignore the fact that coronary heart disease is a leading cause of premature, permanent disability in the U.S. workforce.7 They are in a unique position to raise awareness within their client organizations, provide thorough assessments and referrals for employees and their family members, assist employees returning to work, and provide follow-up services.

Collaboration and Referral

Behavioral health practitioners working in the community mental health setting are well-positioned to improve community awareness about the connection between heart disease and behavioral health disorders, and to help individuals receive appropriate diagnosis and treatment. This also is true for employee assistance professionals, who can effect similar change by leveraging the workplace as a forum for organizational and individual change. Here are some suggestions:

  • Identify community resources where clients with heart disease risk factors can be referred for medical assessment (especially important for clients without insurance).

  • Train staff to recognize heart disease risk factors, and to refer patients to appropriate resources.

  • Develop relationships with area agencies/providers who treat those with (or who provide education about) heart disease. Work to raise awareness among these agencies of the connection between heart disease and behavioral health issues, and ensure that they know where to refer clients for behavioral health assessments.

  • Encourage providers who treat clients with heart disease to refer to behavioral health providers those who need support in making lifestyle changes to improve their heart health.

  • With employer clients, develop a communication strategy to reach an entire employee population with educational messages and reminders of available services and resources.

Supporting Clients

With a heightened sensitivity to heart disease's risk factors and protective measures, behavioral health and employee assistance professionals are positioned to recommend and deliver behavioral interventions to their clients who have (or are at increased risk for) heart disease. Specifically, they can:

  • assess willingness to seek treatment;

  • develop interventions to “meet the patient where he/she currently is”;

  • talk about the heart-mind connection;

  • screen for comorbid behavioral health conditions;

  • encourage self-screening for those who are reticent to seek psychological screenings;

  • coordinate care between physical and behavioral health providers;

  • encourage lifestyle modifications that reduce stress and anxiety; and

  • encourage clients to join support groups.

If a client recently has been diagnosed with heart disease, the clinician can:

  • suggest that he/she learn as much as possible about the disease and get a referral to a cardiac rehabilitation program;

  • coach him/her to set reachable recovery goals, expect setbacks, and celebrate successes;

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