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Depression, Heart Attacks and CBT Homework

Doctors have long known that depression is a common side effect of a heart attack (or an “acute myocardial infarction” if you want to get technical).

And why wouldn’t it be? A person who just has suffered from a heart attack has just had their life flash before their eyes. Literally, given the morbidity numbers for a heart attack are around 15% without immediate treatment (like statins). That means around 1 in 7 people or so could die from a heart attack. It’s a number that really can put some perspective in your life.

Research has pegged this rate of both major and minor depression after a heart attack at around 1 in 3 (see, for example, Lloyd & Cawley, 1978). That means depression is a big deal after a heart attack and a good attending physician will recognize this risk and ensure that if it occurs, it is treated.

The 2001 Enhancing Recovery in Coronary Heart Disease (ENRICHD) study sought to better understand what kinds of treatment interventions can help a person combat depression of a heart attack.

A followup to the original study, that will be published in an upcoming 2008 issue of Psychotherapy and Psychosomatics, pulled out some more of the data collected in the original study to see if certain components of cognitive-behavioral therapy (CBT) were more effective than other components in helping to improve a person’s depression and increase their social support.

What they found was,

The standard components of CBT for depression are useful in treating comorbid depression in post-MI patients. Working on communication skills may help to improve depression but not necessarily social support outcomes in this patient population, while adherence to cognitive-behavioral homework assignments is important for both outcomes. […]

A greater emphasis on CBT homework adherence could improve both depression and social support outcomes.

The key finding was the importance of people doing their CBT “homework” — specific take-home tasks and skills-building exercises therapists assign their clients to build upon what was discussed in therapy session. While it may seem obvious (“Do your homework and you learn something new to help combat depression, thereby helping you feel better”), a lot of times CBT homework isn’t emphasized very much in some psychotherapy sessions.

Such homework, as research like this shows, can really make a difference in the effectiveness of a treatment outcome.

And when you’re talking about life or death, that can difference can be very, very important.

Reference: Cowan MJ, Freedland KE, Burg MM, Saab PG, Youngblood ME, Cornell CE, Powell LH, Czajkowski SM. (2008). Predictors of Treatment Response for Depression and Inadequate Social Support – The ENRICHD Randomized Clinical Trial.
Psych other Psychosom, 77(1):27-37.

Depression, Heart Attacks and CBT Homework

John M. Grohol, Psy.D.

Dr. John Grohol is the founder of Psych Central. He is a psychologist, author, researcher, and expert in mental health online, and has been writing about online behavior, mental health and psychology issues since 1995. Dr. Grohol has a Master's degree and doctorate in clinical psychology from Nova Southeastern University. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member of the Society for Participatory Medicine. You can learn more about Dr. John Grohol here.

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APA Reference
Grohol, J. (2018). Depression, Heart Attacks and CBT Homework. Psych Central. Retrieved on December 5, 2020, from
Scientifically Reviewed
Last updated: 8 Jul 2018 (Originally: 20 Dec 2007)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
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