may be a reduction of reinfarction. However, the relationship between type A behaviour
and CHD is still controversial, with recent discussions suggesting that type A may at
times be protective against CHD.Modifying general lifestyle factors
In addition, rehabilitation programmes have been developed which focus on modifying
other risk factors such as smoking and diet. For example, van Elderen et al. (1994)
developed a health education and counselling programme for patients with cardio-
vascular disease after hospitalization, with weekly follow-ups by telephone. Thirty CHD
sufferers and their partners were offered the intervention and were compared with a
group of 30 control patients who received standard medical care only. The results
showed that after two months, the patients who had received health education and
counselling reported a greater increase in physical activity and a greater decrease in
unhealthy eating habits. In addition, within those subjects in the experimental condition
(receiving health education and counselling), those whose partners had also participated
in the programme showed greater improvements in their activity and diet and, in
addition, showed a decrease in their smoking behaviour. At 12 months, subjects who had
participated in the health education and counselling programme maintained their
improvement in their eating behaviour. The authors concluded that, although this study
involved only a small number of patients, the results provide some support for including
health education and counselling in rehabilitation programmes. More recently, how-
ever, van Elderen and Dusseldorp (2001) reported results from a similar study which
produced more contradictory results. They explored the relative impact of providing
health education, psychological input and standard medical care and physical training to
patients with CHD and their partners after discharge from hospital. Overall, all patients
improved their lifestyle during the first three months and showed extra improvement in
their eating habits over the next nine months. However, by one year follow-up many
patients had increased their smoking again and returned to their sedentary lifestyles.
In terms of the relative effects of the different forms of interventions the results were
more complex than the authors’ earlier work. Although health education and the psycho-
logical intervention had an improved impact on eating habits over standard medical care
and physical training, some changes in lifestyle were more pronounced in the patients
who had only received the latter. For example, receiving health education and psycho-
logical intervention seemed to make it more difficult to quit a sedentary lifestyle and
receiving health education seemed to make it more difficult to stop smoking. Therefore,
although some work supports the addition of health education and counselling to
rehabilitation programmes, at times this may have a cost.Modifying stress
Stress management involves teaching individuals about the theories of stress,
encouraging them to be aware of the factors that can trigger stress, and teaching them a
range of strategies to reduce stress, such as ‘self-talk’, relaxation techniques and general
life management approaches, such as time management and problem solving. Stress378 HEALTH PSYCHOLOGY