Individual and couple intervention for depressive coronary heart patients. Therapy manual, quality assurance and first experiences within the framework of a randomized controlled trial

Depressive symptoms in patients presenting with coronary heart disease have an impact on quality of life, health behavior, and prognosis. The psychotherapeutic interventions which had been tested for their efficacy in previous randomized controlled trials, showed only minor effects. A stepwise approach consisting of individual and group psychotherapeutic interventions was tested for efficacy in a German multicenter study. The presented paper describes the therapeutic procedure for two individual sessions and one couple session by means of case examples. The main focus was to determine depressive symptoms along with underlying maladaptive personality traits such as negative affectivity and social inhibition (type D pattern). Depressive mood, disappointments and mortifications both in private and professional life and also during the previous treatment are verbalized. Dysfunctional relation patterns and maladaptive sickness behavior are taken up by the psychotherapist and alternative behavior patterns are developed. The objective of the couple session is strengthening the partnership resources and offering relief of fears and worries relative to the heart disease. The psychotherapeutic procedure is psychodynamically oriented but also contains cognitive-behavioral and interactional treatment approaches.