Changes in mode of control and self-control for post myocardial infarction patients evidencing Type A behavior: the effects of a cognitive/behavioral intervention and/or cardiac counseling.

A control model of psychological health was utilized to assess the effects of a cognitive/behavioral intervention and/or cardiac counseling with post myocardial infarction patients evidencing Type A behavior. A previously developed four quadrant control inventory measuring perceived mode of control and perceived self-control was given to groups in two sections of the Recurrent Coronary Prevention Project. The experimental group (coronary counseling plus cognitive/behavioral intervention) was tested after one year (E1) and two years (E2) of treatment. The cardiac counseling group was assessed only after two years (C2). As hypothesized, the cognitive/behavioral treatment section at E2 had a significantly higher overall satisfaction level and congruence between real and ideal self on each of the four quadrants than at E1, and than the cardiac counseling only (C2). Further, on each of the four quadrants, E2 had a psychologically healthier mode of control profile than the cardiac counseling only (C2); and a healthier profile on both the positive assertive and positive yielding mode of control than at E1. Finally, E2's self-control score was significantly higher than C2's. Comments on future directions in measuring perceived control, and on the relationship of control and Type A behavior are offered.

Feasibility of altering type A behavior pattern after myocardial infarction. Recurrent Coronary Prevention Project Study: methods, baseline results and preliminary findings.

We studied 1035 consecutive postinfarction patients to determine the feasibility of altering type A behavior and the effect such alteration might have on subsequent rates of infarction and cardiovascular death. Approximately 300 subjects were enrolled in small groups and primarily received cardiologic counseling on the usually accepted coronary risk factors. Six hundred subjects received, in addition to cardiologic counseling, advice and instructions designed to diminish the intensity of their type A behavior. The remaining subjects, serving as controls, received no counseling, but were examined and interviewed annually, as were those who dropped out of counseling groups. More than 98% of the 1035 subjects exhibited moderate-to-severe type A behavior during a videotaped structured interview. After the first year of this 5-year study, the rates of infarction and cardiovascular death were lower (p less than 0.01 and p less than 0.05, respectively) among subjects who received both cardiologic and behavioral counseling than among the control subjects. The rate of nonfatal infarction was lower (p less than 0.05) among subjects who received behavioral counseling than among those who received only cardiologic counseling or those who dropped out of either counseling group. The circumstances that most often preceded recurrent infarction or cardiovascular death were emotional crisis, excess physical activity, ingestion of a single fatty meal or a combination of these phenomena.