Cognitive Behavioral Therapy and Social Support for Post-Cardiac Depression

A new study suggests yet another use of cognitive behavioral therapy (CBT) in helping people change their behaviors, this time in the treatment of smokers who suffer depression after a heart attack and are using tobacco to cope. Smoking is a severe risk factor in cardiac arrest, but quitting can of course be very difficult. CBT plus good social support seems to significantly enhance one’s ability to abstain from tobacco.

Dr. Mickey Trockel of Stanford University Medical School report that CBT alone isn’t generally enough to assist smokers in quitting, but that CBT in the context of a good social support system does greatly improve the chances of people trying to quit smoking.

People with heart disease have higher rates of depression than do the general public, which can make kicking the habit more difficult. In the new study, the researchers examined whether CBT had any effect on smoking in 1,233 people who had a heart attack and were depressed. Overall, people who had CBT were no less likely to report smoking than those who didn’t receive therapy. However, those who reported good social support and received CBT quit smoking one-third more often than those who did not receive CBT.

“Our findings suggest CBT may have little effect in reducing smoking behavior among a larger population of smokers outside a smoking cessation program,” Trockel and colleagues conclude. “More focused smoking cessation intervention is needed.”

Clinicians using CBT should consider whether their clients have good social support, and should not be surprised if CBT is less effective when social support is not present. Groups that offer both social support and CBT are likely to be very helpful in quitting smoking.

© Copyright 2008 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • me


    November 8th, 2008 at 11:51 AM

    just reading this makes me want to have a smoke.

  • Selena


    November 8th, 2008 at 11:31 AM

    Kicking the smoking habit can be very tough and without social support its hard to get out of an old habit. I have a question though, is depression the after effect of smoking or do people start smoking because they are depressed about something ?

  • AMH


    November 8th, 2008 at 11:47 AM

    And I have a question as well- does therapy like this seem to help those who smoke but have not had cardiac issues? I have a friend who has tried everything known to man to stop smoking- classes, meds, hypnosis but nothing seems to work for her. I was wondering if smokers have had any success by simply trying talk therapy?

  • samantha


    November 10th, 2008 at 2:43 AM

    I think a lot of people start smoking as a way to relieve stress. Smoking is a way to get temporary relief from some type of problem. It would be great if CBT could help.

  • Paula


    November 10th, 2008 at 4:22 AM

    I can remember when my mother had her first of many heart attacks she was so depressed afterwards that she would say the only thing that could make her feel better was a cigarette. As a non smloker my entire life I did not understand this at all. How could she allow the very thing that was causing so many of her symptoms be the one thing that she wanted more than anything in the world? It took me a while to realize that for her she associated a smoke with relaxing, her down time, her way to feel better after a long hard day. How could I begrudge her that? That is how I feel about my nightly glass of red wine after all. But she was never able to fully kick the habit and I feel that this horrible habit is what led to her ultimate demise. I think she felt so out of sorts with her body after the rigors of the heart attacks and subsequent surgeries that cigarettes were the only thing that made her feel her old sense of normalcy. I wish that earlier in her life she would have undergone treatments that would have allowed her to stop smoking but she did not and that is one of the contributing factors of her early death. Yes she made the choice to smoke but on some level she had no choice about it anymore and it consumed her until the end.

  • Alexis


    November 11th, 2008 at 12:25 AM

    When smoking doesnt become a choice anymore, I think that scares the person initially and they stay off cigarettes. Once the mundanity of recouping sets in, depression knocks on the door and all caution is thrown to the wind. A lot of people tend to suffer severe set backs because of this.

  • Jane J

    Jane J

    November 11th, 2008 at 5:21 AM

    Has anyone looked at whether or not the toxins that have to be flowing thru your body when one suffers from heart disease could in some way be a physiological reason for why depression rates are so much higher in cardiac patients? I know that there are logically other contributing factors, such as decreased ability to remian mobile and active, and perhaps even the isolation that one feels when medically ill, but this might add another whole dimension to research for physicianns. It seems that there are times when things are interrelated and we never even think about those. This might be a great place to start.

  • neena


    November 11th, 2008 at 7:13 AM

    I can empathize with you on this Paula, I lived for a few years with my uncle who was a chain smoker and ultimately died due to lung cancer but didn’t stop smoking despite the doctors warning him that it would kill him someday. He was a writer and always said that he couldn’t think without a cigarette in his hand and I always thought that he said it to cover up his addiction to smoking. But maybe he did use it a dependency tool where he felt that it helped him write better and therefore could never kick the fatal habit.

  • Sandra


    November 12th, 2008 at 5:16 AM

    For my sister her way of coping with everything is to have a cigarette or 20 and that just scares me to death. Her doctors have warned her about her health dangers, we have all tried talking to her but nothing works. She is so dependent on them that she cannot even find the will to try to give them up. What a sad habit and eventual outcomes cigarettes can lead to, not only for the smoker but for those who are exposed to 2nd hand smoke as well. The more we try to get her to quit the more defensive and defiant she becomes. I am simply tired of trying.

  • Kaye


    November 13th, 2008 at 3:59 AM

    Why is it that so many people insist on staying on such a path toward self destruction even when they know it is not the healthy thing to do?

  • Irene


    November 15th, 2008 at 5:17 PM

    There are people, no matter their state of health, who find it absolutey unnecessary to stop smoking. They find it to be something that makes them feel good and helps them relax, not as somehting that is detrimental to their health. And it is so often patients like this who have a long family history of nicotine use and abuse so it is hard to imagine that the chain will stop right there with them. There is nothing that anyone else can say or do to make someone quit and kick the smoking habit unless the smoker himself is absolutely ready to do so. As a former smoker I know that very well from experience.

  • Maggie


    November 17th, 2008 at 4:08 AM

    Smokers are not willing to change their behavior until they are ready to do so and there is nothing that any of us can simply just say which will make them change their minds. This is one of the toughest addictions to treat that I have ever seen. Sometimes the resulting health detriments that it can cause will be enough to make them change their behavior, sometimes not. It is up to them to decide.

  • Selena


    November 17th, 2008 at 7:38 PM

    Smoking is tough to knock off!! It not only takes the addict with it but also the family. My dad was a chain smoker and all of us kids are asthmatics. My health condition has made me hate going out to pubs or any place that has smoking areas.

  • Rebecca


    November 18th, 2008 at 8:59 AM

    Maybe for smokers they have to hit the proverbial rock bottom just like other drug addicts do to make them want to stop. You woud think that a cardiac incident would be the perfect rock bottom for someone but I just don’t know that that is enough to make some change their lives.

  • Ryan


    November 20th, 2008 at 5:22 AM

    My grandfather went into a severe funk after heart surgery last year. Everything went perfectly fine but it is as if he completely lost the will to go on and none of us can understand that. Was it his near death experience that left him feeling like life is so fleeting that you really have no control over it anyway? I am not sure. He was able to give up the cigarettes thank goodness but now there are even more pressing concerns. He has been on anti depressants I think since he came home and this was almost a year ago. Looks like there should be some improvement but I think there is a part of him that is willing himself to NOT get better. It is really bringing down the whole family as we are all beyond knowing what to do for him. He never wants to leave the house, get out and enjoy the fresh air. He is in a constant state of just being down.

  • Kyle


    January 6th, 2009 at 6:08 AM

    How prevalent are these cases of post cardiac depression?

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