Document Type : Original Article

Authors

1 Psychiatric Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan

2 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

CONTEXT: One of the most important issues in patients with coronary artery disease is their mental
health indices such as perceived stress and perception of disease.
AIMS: The aim of this study was to evaluate the effectiveness of mindfulness‑based intervention on
the perceived stress and disease perception of patients with acute coronary syndrome.
MATERIALS AND METHODS: This is a clinical trial, two‑group, and three‑stage study on 76 patients
with acute coronary syndrome who were randomly divided into intervention and control groups. Nine
weekly sessions of mindfulness‑based training program were administered to the intervention group.
The control group received routine services during this period. Data collection was done before,
immediately, and 1 month after the intervention, using the Perceived Stress Scale and the Illness
Perception Questionnaire. Data were analyzed using descriptive and inferential statistics.
RESULTS: There was no significant difference between the mean scores of perceived stress and
illness perception before intervention. After the intervention and 1 month after it, the mean score
of perceived stress in the intervention group was statistically significantly lower than the control
group (P < 0.001), and the perception of disease in the intervention group was statistically significantly
higher than that of the control group (P < 0.001).
CONCLUSIONS: It is worthwhile to suggest the mindfulness‑based training program to reduce the
perceived stress and correct the perception of disease for patients with acute coronary syndrome.
Keywords:

Keywords

1. Kahungu L. Contemporary themes in health care. Incidence and
Management of Coronary Heart Disease in the United Kingdom.
GRIN Verlag; 2018.
2. Lemos DJ, Omland T. Chronic coronary artery disease:
A companion to Braunwald’s heart disease E‑Book. Philadelphia:
Elsevier Health Sciences; 2017.
3. Momeni T, Musarezaie A, Moeini M, Esfahani NH. The effect of
spiritual care program on ischemic heart disease patients, anxiety, hospitalized in CCU: A clinical trial. J Res Behav Sci 2013;6:554‑64.
4. De Hert M, Detraux J, Vancampfort D. The intriguing relationship
between coronary heart disease and mental disorders. Dialogues
Clin Neurosci 2018;20:31‑40.
5. Akbari M, Mousavi MS, Shirani F, Massoumi G, Shafeie M,
Niknejad R, Khourasani P, Alavi M and Ghadami A. Sharing the
power through promoting heart health literacy: A participatory
action research in Iran. ARYA Atheroscler 2019;15:146‑51.
6. Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk
of incident coronary heart disease: A meta‑analysis. J Am Coll
Cardiol 2010;56:38‑46.
7. Pimple P, Lima BB, Hammadah M, Wilmot K, Ramadan R,
Levantsevych O, et al. Psychological distress and subsequent
cardiovascular events in individuals with coronary artery disease.
J Am Heart Assoc 2019;8:e011866.
8. Cohen S, Kamarck T, Mermelstein R. A global measure of
perceived stress. J Health Soc Behav 1983;24:385‑96.
9. Kamoei K, Meschi F. The relationship between perceived stress
and coping styles with psychological well‑being in cardiac
patients. Int J Med Res Health Sci 2016;5:707‑11.
10. Arnold SV, Smolderen KG, Buchanan DM, Li Y, Spertus JA.
Perceived stress in myocardial infarction: Long‑term mortality
and health status outcomes. J Am Coll Cardiol 2012;60:1756‑63.
11. Sadeghi M, Alavi M, Mohammadi M, Roohafza H, Mahmoodi A,
Visentin D, et al. Perceptions of illness as predictive factors for
perceived stress in patients participating in a cardiac rehabilitation
program. Nurs Health Sci 2019;21:508‑14.
12. van Erp SJ, Brakenhoff LK, Vollmann M, van der Heijde D,
Veenendaal RA, Fidder HH, et al. Illness perceptions and
outcomes in patients with inflammatory bowel disease: Is coping
a mediator? Int J Behav Med 2017;24:205‑14.
13. Winham DM, Jones KM. Knowledge of young African American
adults about heart disease: A cross‑sectional survey. BMC Public
Health 2011;11:248.
14. Morgan K, Villiers‑Tuthill A, Barker M, McGee H. The
contribution of illness perception to psychological distress in
heart failure patients. BMC Psychol 2014;2:50.
15. Sarrafzadegan N, Rabiei K, Alavi M, Abedi H, Zarfeshani S. How
can the results of a qualitative process evaluation be applied in
management, improvement and modification of a preventive
community trial? The IHHP Study. Arch Public Health 2011;69:9.
16. Tkhostov A, Nelyubina A. Illness perceptions in patients with
coronary heart disease and their doctors. Procedia Soc Behav Sci
2013;86:574‑7.
17. Sadeghimoghaddam S, Alavi M, Mehrabi T, Bankpoor‑Fard A.
The effect of two methods of relaxation and prayer therapy
on anxiety and hope in patients with coronary artery disease:
A Quasi‑experimental study. Iran J Nurs Midwifery Res
2019;24:102‑7.
18. Zeraatkar M, Boogar RI, Talepasand S, Amin A. The effectiveness
of healthy lifestyle promotion intervention on quality of life in
patients with congestive heart failure via cognitive‑behavioral
procedure. SSU J 201623 2016;23:1094‑107.
19. Crane R. Mindfulness‑Based Cognitive Therapy: Distinctive
Features. New York: Taylor and Francis; 2017.
20. Segal ZV, Teasdale J. Mindfulness‑Based Cognitive Therapy for
Depression. New York: Guilford Publications; 2018.
21. ZainalNZ, BoothS, HuppertFA. The efficacy of mindfulness‑based
stress reduction on mental health of breast cancer patients:
A meta‑analysis. Psychooncology 2013;22:1457‑65.
22. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness‑based
stress reduction in relation to quality of life, mood, symptoms
of stress, and immune parameters in breast and prostate cancer
outpatients. Psychosom Med 2003;65:571‑81.
23. Kimura T, Yokoyama A, Kohno N, Nakamura H, Eboshida A.
Perceived stress, severity of asthma, and quality of life in young
adults with asthma. Allergol Int 2009;58:71‑9.
24. Gao J, Fan J, Wu BW, Zhang Z, Chang C, Hung YS, et al.
Entrainment of chaotic activities in brain and heart during MBSR
mindfulness training. Neurosci Lett 2016;616:218‑23.
25. Spijkerman MP, Pots WT, Bohlmeijer ET. Effectiveness of online
mindfulness‑based interventions in improving mental health:
A review and meta‑analysis of randomised controlled trials. Clin
Psychol Rev 2016;45:102‑14.
26. Safaei M, Shokri O. Assessing Stress in Cancer Patients: Factorial
Validity of the Perceived Stress Scale in Iran; 2014.
27. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness
perception questionnaire. J Psychosom Res 2006;60:631‑7.
28. Snippe E, Dziak JJ, Lanza ST, Nyklíček I, Wichers M. The shape of
change in perceived stress, negative affect, and stress sensitivity
during mindfulness‑based stress reduction. Mindfulness
2017;8:728‑36.
29. Lengacher CA, Shelton MM, Reich RR, Barta MK,
Johnson‑Mallard V, Moscoso MS, et al. Mindfulness based
stress reduction (MBSR (BC)) in breast cancer: Evaluating fear
of recurrence (FOR) as a mediator of psychological and physical
symptoms in a randomized control trial (RCT). J Behav Med
2014;37:185‑95.
30. Radmehr P, Yousefvand L. he investigating rate of
mindfulness‑based cognitive therapy in reduces perceived stress
and increase life expectancy in women suffering coronary artery
disease. Iran J Health Educ Health Promot 2017;5:164‑72.
31. Akbari M, Nafisi N, Jamshidifar Z. Effectiveness of mindfulness
training in decreasing the perceived stress among the patients
suffering from breast cancer. J Thought Behav Clin Psychol
2013;7:7‑16.
32. Fowler C, Baas LS. Illness representations in patients with chronic
kidney disease on maintenance hemodialysis. Nephrol Nurs J
2006;33:173‑4, 179‑86.
33. Scharloo M, Baatenburg de Jong RJ, Langeveld TP,
van Velzen‑Verkaik E, Doorn‑op den Akker MM, Kaptein AA.
Quality of life and illness perceptions in patients with recently
diagnosed head and neck cancer. Head Neck 2005;27:857‑63.
34. Ljótsson B, Andréewitch S, Hedman E, Rück C, Andersson G,
Lindefors N. Exposure and mindfulness based therapy for
irritable bowel syndrome – An open pilot study. J Behav Ther
Exp Psychiatry 2010;41:185‑90.
35. Mohamadi J, Mir Drikvand F, Azizi A. Efficacy of mindfulness on
anxiety and depression in patients with irritable bowel syndrome.
J Mazandaran Univ Med Sci 2015;25:52‑61.