Abstract

Congestive Heart Failure (CHF) is a chronic disease which cannot be cured, and bears significant psychological consequences. Very little research has been done so far to examine the kind of psychological interventions needed to relieve the emotional distress of these patients. This study examined the effectiveness of group therapy for reducing distress and increasing psychosocial adjustment in patients with heart failure. The main hypothesis was that after attending group therapy, patients would show a lower level of psychological distress and a higher level of psycho–social adjustment than subjects in the control group, who were still awaiting group therapy. The study included 18 patients with moderate CHF (New York Heart Association Class II and III) or with LVEF (Left Ventricular Ejection Fraction) of less than 35%. Subjects were recruited from the database of the congestive heart failure clinic of the Meir Hospital in Kfar Saba, Israel. Subjects were assigned either to group therapy or to the control group (which was awaiting group therapy). The treatment group participated in seven one-hour-sessions. Each session was devoted to raising a specific topic relevant to coping with heart failure and its consequences. At the beginning and end of treatment, participants were asked to complete the BSI (Brief Symptom Inventory) questionnaire and the PAIS-SR (Psychological Adjustment to Illness Scale-Self Report) questionnaire, which measured the variables being used. To assess the contribution of the group therapy qualitatively, we used the NEII (Narrative Evaluation of Intervention Interview) questionnaire, which verified the effectiveness of group therapy. As stated, the hypothesis was that after group therapy, patients would experience a lower level of emotional distress and a higher level of psychosocial adjustment than they did before participation in the group; similarly, they would experience less emotional distress and better psychosocial adjustment than the control group did. In addition, the study was designed to explore the subjective experience of participants regarding the perceived effectiveness of treatment as well as perceived contributions generated by group therapy. Hypotheses were not confirmed, probably due to the limited number of subjects (N=18), as well as the lack of random assignment. Alongside this finding, other findings, which relied on qualitative assessment of the intervention group subjects, suggest that the level of perceived efficacy of group therapy is high. In addition, group therapy participants reported four main contributions derived from the treatment. Contributions, presented here in order of the relative importance attributed to them by respondents, were in the following areas: personal growth and change, social support, helping others and the acquisition of a sense of control and responsibility. These findings suggest that patients with heart failure assessed group therapy in terms of its focus on existential matters. This finding is significant, as most therapeutic groups designed for heart patients rely on behavioral approaches, with less emphasis on the existential dimension. Our recommendation in light of these findings is to establish this type of group therapy in hospitals.