Heart Surgery: Confidence Helps

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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How well patients survive heart surgery also depends on how optimistic they are about their recovery. And that can be influenced. A short psychological training session is enough.

Confidence and trust in the doctor and therapy have a major influence on how well a treatment works. Belief in the effect is so powerful that, for example, tablets without active ingredients can relieve severe pain and other ailments. Doctors call the placebo effect the part that the psyche has in the effect of a treatment.

Scientists at the University of Marburg have investigated to what extent such a placebo effect could improve recovery after heart bypass surgery. To this end, psychologists led by Prof. Winfried Rief carried out a short psychological training session with 39 cardiac patients in the week before the operation, in which the patients' confidence in their recovery was to be strengthened.

Dreaming about life after surgery

During two 50-minute sessions, the participants were asked to create a concrete picture of their life after the operation. This also included what activities they would be able to do again thanks to the operation. For example, that they would be able to work in the garden or practice their job again.

Forge concrete plans

Together with the therapist, they then developed specific plans on how these goals could be put into practice. This visualization of a fulfilling life after surgery increased patient confidence that the procedure would be successful and that they would recover well from it.

Possible complications were also discussed and realistically assessed. This could be used to control possible fears.

To stabilize the effect, each patient received two 20-minute calls from the therapist, before and one six weeks after the procedure.

A group of 41 heart patients served as controls, who received psychological support for the same amount of time, but who did not do any specific exercises to strengthen positive expectations. Another group of 41 bypass recipients received no psychological care.

Less complaints, more quality of life

In fact, the psychological interventions paid off: “Patients who received any form of psychological support before the operation did better than the others six months afterwards,” summarizes Rief.

Those who received psychological support later suffered from fewer complaints, felt more productive at work, were more physically active, less concerned about their heart and had an overall higher quality of life. The doctors determined this on the basis of questionnaires. The patients who had made concrete plans for the time after the operation and had thus increased their positive expectations for life after the operation benefited the most. "This underlines the importance of a targeted engagement with patient expectations," the researchers write.

Less stress hormones in the blood

The psychological intervention could also be physically determined. For example, the increase in stress hormones in the blood of participants who had received psychological support was less pronounced after the procedure. That, too, could have a direct impact on recovery.

Further studies will have to show whether the placebo effect also has a long-term positive effect on patient health.

Source: Winfried Rief et al .: Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial: BMC Medicine, 10 January 2017

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