cope with stressful situations. Kaluza (2000) evaluated an intervention designed to
change the coping profiles of 82 healthy working men and women. The intervention
lasted for 12 weeks and focused on assertiveness, cognitive restructuring, time man-
agement, relaxation, physical activities and the scheduling of pleasant activities.
Changes were compared to a control group who received no intervention. The results
showed significant improvements in emotion focused coping and problem focused
coping which were related to the individual’s original coping profiles. In particular,
those who were originally more problem focused became more emotion focused and
those who were more avoidant copers became more problem focused. The authors
suggest that the intervention changed unbalanced coping profiles. In addition, these
changes were related to improvements in aspects of well-being.Psychology and rehabilitation of patients with CHD
Psychology also plays a role in the rehabilitation of individuals who have been diagnosed
with CHD either in terms of angina, atherosclerosis or who have suffered a heart attack.
Rehabilitation programmes use a range of techniques including health education,
relaxation training and counselling and have been developed to encourage CHD sufferers
to modify their risk factors, such as exercise, type A behaviour, general lifestyle factors
and stress.
Modifying exercise
Most rehabilitation programmes emphasize the restoration of physical functioning
through exercise with the assumption that physical recovery will in turn promote
psychological and social recovery. Meta-analyses of these exercise-based programmes
have suggested that they may have favourable effects on cardiovascular mortality (e.g.
Oldridge et al. 1988). However, such meta-analyses are problematic as there is a trend
towards publishing positive results, thereby influencing the overall picture. In addition,
whether these exercise-based programmes influence risk factors other than exercise,
such as smoking, diet and type A behaviour, is questionable.
Modifying type A behaviour
The recurrent coronary prevention project was developed by Friedman et al. (1986) in
an attempt to modify type A behaviour. This programme was based on the following
questions: Can type A behaviour be modified? If so, can such modification reduce the
chances of a re-occurrence of a heart attack? The study involved 1000 subjects and a
five-year intervention. Subjects had all suffered a heart attack and were allocated to
one of three groups: cardiology counselling, type A behaviour modification or no treat-
ment. Type A behaviour modification involved discussions of the beliefs and values of
type A, discussing methods of reducing work demands, relaxation and education about
changing the cognitive framework of the individuals. At five years, the results showed
that the type A modification group showed a reduced re-occurrence of heart attacks,
suggesting that not only can type A behaviour be modified but that when modified there
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