Cognitive-behavioral and patient education interventions in cardiac catheterization procedures: The Palo Alto medical psychology project

The invasive medical procedures of cardiac catheterization were conceptualized as a crisis. Two interventions; a cognitive-behavioral treatment and a patient education treatment; were compared with an attention placebo intervention control group and a current hospital conditions control group. Patient self-reported state anxiety was assessed at preintervention, postintervention, and retrospectively with regard to the actual catheterization procedure. Professional (physician and technician) blind ratings of the patient's adjustment during catheterization were also taken. In addition, a self-statement inventory pertaining to the process of catheterization was administered retrospectively. Results of both sets of adjustment ratings indicated that the intervention groups were significantly more adjusted than each of the controls and that the cognitive-behavioral treatment was the superior intervention. State-anxiety analyses suggested that although both the interventions and the attention placebo control reduced postintervention subjective anxiety, only the two interventions produced levels of recalled (during the catheterization) state anxiety that were significantly lower than controls. Negative self-statements were related to poorer adjustment ratings. The findings support the utility of cognitive-behavioral crisis interventions.