The Behavioral Treatment of the Symptoms of Ischemic Heart Disease

  • Derek W. Johnston
Part of the NATO Conference Series book series (NATOCS, volume 19)


In this chapter I shall consider the behavioral treatment of two symptoms or correlates of ischemic heart disease, cardiac arrhythmias and angina pectoris. These symptoms can be disturbing, disabling or even life threatening, and effective behavioral treatments could aid, supplement, or in some instances replace existing medical and surgical treatments, and be expected to lead to significant improvements in the quality of life and life expectancy of many of the patients who suffer from ischemic heart disease. So far, attempts to treat these symptoms behaviorally have relied either on biofeedback or some form of relaxation training. While the rationale for the use of these techniques is obvious and appealing, they do not represent the full strength of the behavioral approach. Therefore, after reviewing the evidence for the efficacy of these techniques, I shall outline the developments that I consider to be most helpful in promoting a more comprehensive and imaginative behavioral approach to the treatment of the symptoms of ischemic heart disease.


Ischemic Heart Disease Angina Pectoris Rate Pressure Product Premature Ventricular Contraction Relaxation Training 
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Reference Note

  1. 1.
    Marie, G., Lo, C.R., Van Jones, J., & Johnston, D.W. The relationship between transit time and arterial blood pressure during dynamic and isometric exercise. Manuscript in preparation.Google Scholar
  2. 2.
    Lo, C.R., & Johnston, D.W. Cardiovascular feedback during dynamic exercise. Manuscript in preparation.Google Scholar
  3. 3.
    Lo, C.R., & Johnston, D.W. A comparison of the feedback of the product of interbeat interval and pulse transit time with relaxation training at rest and during dynamic exercise. Manuscript in preparation.Google Scholar
  4. 4.
    Marie, G., & Johnston, D.W. Pulse transit time during isometric exercise. Manuscript in preparation.Google Scholar
  5. 5.
    Johnston, D.W., & Lo, C.R. The effects of heart rate and blood pressure feedback on angina pectoris. Unpublished manuscript, 1979.Google Scholar


  1. Benson, H., Alexander, S., & Feldman, C.L. Decreased premature ventricular contractions through the use of the relaxation response in patients with ischemic heart disease. The Lancet, 1975, 2, 380 - 382.CrossRefGoogle Scholar
  2. Cheatle, M.D., & Weiss, T., Biofeedback in heart rate control and the treatment of cardiac arrhythmias. In Clinical Biofeedback; Efficacy and Mechanisms. L. White & B. Tursky, (eds.), Guilford Press, New York, (in press).Google Scholar
  3. Benson, H., Beary, J.F., & Carol, M.P. The relaxation response. Psychiatry, 1974, 37, 37 - 46.Google Scholar
  4. Clements, W.J., & Shattock, R.J. Voluntary heart rate control during static muscular effort. Psychophysiology, 1979, 16, 327 - 332.CrossRefGoogle Scholar
  5. Corbalan, R., Verrier, R. and Lown, B. Psychologic stress and ventricular arrhythmias during myocardial infarction in conscious dogs. American Journal of Cardiology, 1974, 39, 692 - 696.CrossRefGoogle Scholar
  6. Engel, B.T., & Bleecker, E.R. Application of operant conditioning techniques to the control of cardiac arrhythmias. In Cardiovascular psychophysiology. Current issues in response mechanisms, biofeedback and methodology. Chicago: Aldine, 1974.Google Scholar
  7. Gambrill, E.D. Behavior Modification. Handbook of Assessment, Intervention and Evaluation. San Francisco: Josey-Bass Publishers, 1977.Google Scholar
  8. Goldstein, D.S., Ross, R.S., & Brady, J.V. Biofeedback heart rate training during exercise. Biofeedback and Self-Regulation, 1977, 2, 107 - 125.CrossRefGoogle Scholar
  9. Goldstein, R.E., & Epstein, S.E. Medical management of patients with angina pectoris. Progress in Cardiovascular Diseases, 1972, 14, 360 - 397.CrossRefGoogle Scholar
  10. Herring, M., & Richlin, M. Effectiveness of self-relaxation training in reducing the severity of recurrent angina pectoris. Psychophysiology, 1977, 14, 101.Google Scholar
  11. Hnatiow, M., & Lang, P.J. Learned stabilization of cardiac rate. Psychophysiology, 1965, 1, 330 - 336.CrossRefGoogle Scholar
  12. Ishikawa, H., Tawara, I., Ohtsuka, R.W., Takeyama, M., & Kobayashi, T. Psychosomatic study of angina pectoris. Psychosomatics, 1971, 12, 390 - 397.Google Scholar
  13. Johnston, D.W. Exploiting the uniqueness of biofeedback. In J. Tiller & P. Martin (eds.). Behavioral Medicine. Sydney: Ciba-Geigy (in press).Google Scholar
  14. Johnston, D.W., & Lethem, J. The production of specific decrease in interbeat interval and the motor skill analogy. Psychophysiology, 1981, 18, 288 - 300.CrossRefGoogle Scholar
  15. Lang, P.J., Sroufe, L.A., & Hastings, J.E. Effects of feedback and instructional set on the control of cardiac rate variability. Journal of Experimental Psychology, 1967, 75, 425 - 431.CrossRefGoogle Scholar
  16. Littler, W.A., Honour, A.J., Sleight, P., & Scott, F.D. Direct arterial pressure and the electrocardiogram in unrestricted patients with angina pectoris. Circulation, 1973, 148, 125 - 134.Google Scholar
  17. McCruskery, J.H., Engel, B.T., Gotlieb, S.M., & Lakatta, E.G. Operant conditioning of heart rate in patients with angina pectoris. Psychosomatic Medicine, 1978, 40, 89 - 90.Google Scholar
  18. Matta, R.J.,Lawler, J.E., & Lown, B. Ventricular electrical instability in the conscious dog: effects of psychologic stress and beta adrenergic blockage. American Journal of Cardiology, 1976, 38, 594 - 598.CrossRefGoogle Scholar
  19. Perski, A., & Engel, B.T. The role of behavioral conditioning in the cardiovascular adjustment to exercise. Biofeedback and Self-Regulation, 1980, 5, 91 - 104.CrossRefGoogle Scholar
  20. Perski, A., Engel, B.T., & McCruskery, J.H. The modification of elicited cardiovascular responses by operant conditioning of heart rate. In J.T. Cacioppo & R.E. Petty (eds.). Focus on cardiovascular psychophysiology, (in press).Google Scholar
  21. Pickering, T., & Gorham, G. Learned heart rate control by a patient with ventricular parasystolic rhythm. The Lancet, 1975, 1, 252 - 253.CrossRefGoogle Scholar
  22. Pickering, T.D., & Miller, N.E. Learned voluntary control of heart rate and rhythm in two subjects with premature ventricular contractions. British Heart Journal, 1977, 39, 152 - 159.CrossRefGoogle Scholar
  23. Robinson, B.F. Relation of heart rate and systolic blood pressure to the onset of pain in angina pectoris. Circulation, 1967, 35, 1073 - 1083.Google Scholar
  24. Schiffer, F., Harley, L.H., Schulman, C.L., & Abelman, W.H. Evidence for emotionally induced coronary artery spasm in patients with angina pectoris. British Heart Journal, 1980, 44, 62 - 66.CrossRefGoogle Scholar
  25. Sleight, P. Stress factors in angina pectoris. Scottish Medical Journal, 1977, 22, 34 - 37.Google Scholar
  26. Sroufe, L.A. Learned stabilization of cardiac rate with respiration experimentally controlled. Journal of Experimental Psychology, 1969, 81, 391 - 393.CrossRefGoogle Scholar
  27. Steptoe, A. Psychological Factors in Cardiovascular Disease. London: Academic Press, 1981.Google Scholar
  28. Steptoe, A., Smulyan, H., & Gribben, B. Pulse wave velocity and blood pressure: calibration and application. Psychophysiology, 1976, 13, 488 - 493.CrossRefGoogle Scholar
  29. Taggart, P., Gibbons, D., & Somerville, W. Some effects of motor car driving on the normal and abnormal heart. British Medical Journal, 1969, 4, 130 - 134.CrossRefGoogle Scholar
  30. Taggart, P., Carrthers, M., Joseph, S., Kelly, H.B., Marcomichelakis, J., Noble, D., O’Neill, & Somerville, W. Electrocardiographic changes resembling myocardial ischemia in asymptomatic men with abnormal coronary arterio-grams. British Heart Journal, 1979, 41, 214 - 225.CrossRefGoogle Scholar
  31. Underbill, S.L., Wills, R.E., & Mansfield, L.W. Biofeedback control to decrease heart rate for relief of angina pectoris. Circulation, 1977, 55 & 56 Supplement 111, 102.Google Scholar
  32. Weiss, T., & Engel, B.T. Operant conditioning of heart rate in patients with premature ventricular contractions. Psychosomatic Medicine, 1971, 33, 301 - 321.Google Scholar
  33. Williamson, D.A., & Blanchard, E.B. Heart rate and blood pressure biofeedback: I. A review of the recent experimental literature. Biofeedback and Self-Regulation, 1979, 4, 1 - 34.CrossRefGoogle Scholar
  34. Zammara, J.W., Besseghini, I., & Wittenberg, S. The effects of the transcendental meditation program on the exercise performance of patients with angina pectoris. In D.W. Orme-Johnston & J.F. Farrow, (eds.) Scientific Research on the Transcendental Meditation Program. Maharishi European Research Press, 1977.Google Scholar

Copyright information

© Plenum Press, New York 1982

Authors and Affiliations

  • Derek W. Johnston
    • 1
  1. 1.Department of PsychiatryUniversity of OxfordOxfordEngland

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