:2188(15 March 2021) DOI: 10.22122/arya.v17i0.2188

Comparison of the effect of cognitive-behavioral therapy and dialectical behavioral therapy on perceived stress and coping skills in patients after myocardial infarction

Azam Nourisaeed, Shohreh Ghorban-Shiroudi, Arsalan Salari

DOI: http://dx.doi.org/10.22122/arya.v17i0.2188


BACKGROUND: Among the cardiovascular diseases (CVDs), myocardial infraction (MI) is one of the main causes of mortality around the world. A diagnosis of MI may be followed by psychological problems, such as depression, anxiety, and stress. Therefore, psychological interventions can be beneficial in routine treatment. The purpose of this study was to compare the effect of cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) on perceived stress and coping skills in patients after MI.

METHODS: This study was a randomized clinical trial with a pretest-posttest design and control group. The statistical population consisted of 45 patients after MI who referred to Noor Heart Clinic in Rasht, Iran, between 2018 and 2019. They were randomly divided into 3 groups of
15 individuals (2 interventions including CBT and DBT, and 1 control group). In the intervention groups, participants underwent 8 weekly 90-minute sessions. Data were collected using a 3 part self-report questionnaire including a demographic information form, the Ways of Coping Questionnaire (WCQ), and the Perceived Stress Scale‎-14 (PSS-14). The statistical methods used for data analysis included chi-square test, one-way ANOVA, repeated-measures ANOVA, and post hoc Bonferroni test.

RESULTS: We found significant main effects of group (F(2,42)=6.11; P=0.005) and time (F(2,84)=28.48; P<0.001), and a significant group-by-time interaction (F(4,84)=8.97; P<0.001) on perceived stress scores. For problem-focused coping scores, findings indicated significant main effects of group (F(2,42)=7.33; P=0.002) and time (F(2,84)=30.71; P<0.001), and a significant group-by-time interaction (F(4,84)=12.86; P<0.001). For emotion-focused coping scores, the results also indicated significant main effects of group (F(2,42) = 17.41; P < 0.001) and time (F(2,84)=31.74; P<0.001), and a significant group-by-time interaction (F(4,84)=14.90; P<0.001).

CONCLUSION: The current study revealed that DBT was more effective in improving emotion-focused coping than CBT.



Myocardial Infarction; Stress; Cognitive-Behavioral Therapy; Dialectical Behavioral Therapy

Full Text:



Chakraborty A, Sadhukhan D, Pal S, Mitra M. Automated myocardial infarction identification based on interbeat variability analysis of the photoplethysmographic data. Biomed Signal Process Control 2020; 57: 101747.

Davari M, Maracy MR, Khorasani E. Socioeconomic status, cardiac risk factors, and cardiovascular disease: A novel approach to determination of this association. ARYA Atheroscler 2019; 15(6): 260-6.

Smallheer BA, Dietrich MS. Social support, self-efficacy, and helplessness following myocardial infarctions. Crit Care Nurs Q 2019; 42(3): 246-55.

Xu X, Bao H, Strait KM, Edmondson DE, Davidson KW, Beltrame JF, et al. Perceived stress after acute myocardial infarction: A comparison between young and middle-aged women versus men. Psychosom Med 2017; 79(1): 50-8.

Smolderen KG, Brush A, Dreyer RP. Psychosocial factors and recovery after acute myocardial infarction in younger women. Curr Cardiol Rep 2019; 21(6): 50.

Aslani Y, Niknejad R, Moghimian M, Maghaddasi J, Akbari M. An investigation of the psychological experiences of patients under mechanical ventilation following open heart surgery. ARYA Atheroscler 2017; 13(6): 274-81.

Khayyam-Nekouei Z, Neshatdoost H, Yousefy A, Sadeghi M, Manshaee G. Psychological factors and coronary heart disease. ARYA Atheroscler 2013; 9(1): 102-11.

Roohafza H, Sadeghi M, Shirani S, Bahonar A, Mackie M, Sarafzadegan N. Association of socioeconomic status and life-style factors with coping strategies in Isfahan Healthy Heart Program, Iran. Croat Med J 2009; 50(4): 380-6.

Sadr Bafghi SM, Ahmadi N, Yassini Ardekani SM, Jafari L, Bitaraf Ardekani B., Heydari R, et al. A survey of coping strategies with stress in patients with acute myocardial infarction and individuals without a history of fixed myocardial infarction. Cardiol Res 2018; 9(1): 35-9.

Mohamadi J, Ghazanfari F, Drikvand FM. Comparison of the effect of dialectical behavior therapy, mindfulness based cognitive therapy and positive psychotherapy on perceived stress and quality of life in patients with irritable bowel syndrome: A pilot randomized controlled trial. Psychiatr Q 2019; 90(3): 565-78.

Reavell J, Hopkinson M, Clarkesmith D, Lane DA. Effectiveness of cognitive behavioral therapy for depression and anxiety in patients with cardiovascular disease: A systematic review and meta-analysis. Psychosom Med 2018; 80(8): 742-53.

Sahranavard S, Esmaeili A, Salehiniya H, Behdani S. The effectiveness of group training of cognitive behavioral therapy-based stress management on anxiety, hardiness and self-efficacy in female medical students. J Educ Health Promot 2019; 8: 49.

Afrasiabi F, Molazem Z, Mani A, Abdi Ardekani A. The effect of cardiopulmonary resuscitation and cardiac chest pain management training on perceived control, depression, stress and anxiety in the spouses of the patients with myocardial infarction: A randomized controlled trial. Int

J Community Based Nurs Midwifery 2020; 8(2): 116-26.

Maroufizadeh S, Foroudifard F, Navid B, Ezabadi Z, Sobati B, Omani-Samani R. The Perceived Stress Scale (PSS-10) in women experiencing infertility: A reliability and validity study. Middle East Fertil Soc J 2018; 23(4): 456-9.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24(4): 385-96.

Leung DY, Lam TH, Chan SS. Three versions of perceived stress scale: Validation in a sample of Chinese cardiac patients who smoke. BMC Public Health 2010; 10: 513.

Ingram PB, Clarke E, Lichtenberg JW. Confirmatory factor analysis of the perceived stress scale-4 in a community sample. Stress Health 2016; 32(2): 173-6.

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(4): 508-14.

Folkman S, Lazarus RS. Coping as a mediator of emotion. J Pers Soc Psychol 1988; 54(3): 466-75.

Nedaei A, Paghoosh A, Sadeghi-Hosnijeh A. Relationship between coping strategies and quality of life: Mediating role of cognitive emotion regulation skills. J Clin Psychol 2016; 8(4): 35-48.

Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Publications; 2018.

Kirchberger I, Burkhardt K, Heier M, Thilo C, Meisinger C. Resilience is strongly associated with health-related quality of life but does not buffer work-related stress in employed persons 1 year after acute myocardial infarction. Qual Life Res 2020; 29(2): 391-401.

Zhou ES, Penedo FJ, Lewis JE, Rasheed M, Traeger L, Lechner S, et al. Perceived stress mediates the effects of social support on health-related quality of life among men treated for localized prostate cancer. J Psychosom Res 2010; 69(6): 587-90.

Norlund F, Wallin E, Olsson EMG, Wallert J, Burell G, von EL, et al. Internet-based cognitive behavioral therapy for symptoms of depression and anxiety among patients with a recent myocardial infarction: The u-care heart randomized controlled trial. J Med Internet Res 2018; 20(3): e88.

Vitetta L. Mind body medicine: A tangible link between the gut and the brain. Ann Transl Med 2020; 8(4): 64.

Lv J, Zhang X, Ou S, Gu S, Su Z, Tong S, et al. Influence of cognitive behavioral therapy on mood and quality of life after stent implantation in young and middle-aged patients with coronary heart disease. Int Heart J 2016; 57(2): 167-72.

Hosseini SH, Rafiei A, Gaemian A, Tirgari A, Zakavi A, Yazdani J, et al. Comparison of the effects of religious cognitive behavioral therapy (RCBT), cognitive behavioral therapy (CBT), and sertraline on depression and anxiety in patients after coronary artery bypass graft surgery: Study protocol for a randomized controlled trial. Iran J Psychiatry 2017; 12(3): 206-13. [In Persian].

Babaei L, Fakhri MK, Jadidi M, Salehi Omran MT. The impact of dialectical behavior therapy on emotion regulation and perceived social support in patients with coronary heart disease. Babol Univ Med Sci 2015; 17(11): 21-7. [In Persian].

Oladi F, Bayazi MH, Dargahi M, Dehghani Neishabouri M. Cognitive behavioral group therapy and coping styles in patients with acute coronary heart disease. Iran Rehabil J 2014; 12(3): 24-9. [In Persian].

Tavakoli F, Kazemi Zahrani H, Sadeghi M. The impact of dialectical behavior therapy on interpersonal conflict resolution in patients with coronary heart disease. Iran J Nurs Res 2018; 13(2): 93-101. [In Persian].


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.