The following is an excerpt from the book In Control

by Redford Williams, MD, and Virginia Williams, PhD

Published by Rodale; February 2006;$24.95US/$33.95CAN; 1-59486-256-7

Copyright © 2006 Redford Williams, MD, and Virginia Williams, PhD

Studies Show It's Possible To Control How You React To Stress

Beginning in the early 1980s, several randomized clinical trials of behavioral strategies targeted certain psychological and social risk factors in people with heart disease or cancer. By chance assignment, some subjects were taught the strategies, while others were put in a control group and didn't learn the strategies. Randomized clinical trials are considered the gold standard when it comes to proving that new treatments -- whether new drugs or behavioral approaches -- are effective in treating or preventing disease. These early studies found some amazing results.

People with malignant melanoma (a type of skin cancer) who received training in coping sills to handle stress slashed their recurrence rate by 50 percent and their death rate by an astonishing 70 percent.

Heart attack patients who received training that reduced both hostility and depression cut their risk of recurring heart attacks or death in half.

Other heart patients who were trained to use coping skills to reduce stress cut their risk of having subsequent heart attacks or needing bypass surgery or angioplasty by more than 50 percent.

One of our corporate clients found that training decreased bad stuff, such as depression and hostility, and increased good stuff, such as social support and self-esteem, among employees. These results were obtained in what might be described as "open label trials" of our program (in other words, there was no randomized control group). Now there have been two carefully conducted randomized clinical trials of patients with heart disease that document these benefits more rigorously.

In the first, psychologist Karina Davidson, PhD, and her student Yori Gidron at Dalhousie University in Halifax, Nova Scotia, randomly assigned heart attack patients to groups that received either the usual care or training to reduce hostility, which was based on an earlier version of our 8-week program. At the end of eight training sessions, those in the hostility-reduction group showed significant decreases in both hostility and blood pressure compared with those who received the usual care. More important, when the researchers followed up with the patients after 2 months, they found that both hostility and blood pressure levels had decreased even further in those receiving hostility-reduction training, while levels had drifted up slightly in those receiving the usual care. After 6 months, those who had received hostility-reduction training had been hospitalized again for an average of only about 1/2 day, compared with 2.5 days for the usual-care group.

A more recent randomized clinical trial was conducted by psychologist George Bishop, PhD, at the National University of Singapore and the National Heart Centre there. In that study, people who had undergone coronary bypass surgery were randomly assigned to either the usual care or to our coping skills workshop. Because we trained Dr. Bishop and his colleagues to deliver the workshop, the training was provided to the patients in Singapore just as it is in the United States, with some adaptations for Far Eastern culture. (For example, instead of practicing assertion toward someone who has distressed you, you would have a friend or relative act as an intermediary, thereby ensuring that no one would lose face.)

As first presented at the Annual Scientific Sessions of the American Heart Association in Chicago in November 2002, Dr. Bishop's study both confirmed and extended the results obtained by Dr. Davidson and Gidron. When tested 3 months after the workshops were completed, the patients who received training were better off on several fronts than those who received the usual care. For example:

They experienced less psychosocial bad stuff: lower scores on depression (a 60 percent decrease), anger (18 percent), and perceived stress (18 percent).

They experienced less biological bad stuff: lower resting heart rate (a 9 percent decrease) and reduced reactivity of blood pressure (56 percent) and heart rate (65 percent) when angered.

They experienced more psychosocial good stuff: higher scores for satisfaction with social support (a 14 percent increase) and satisfaction with life (13 percent).

These results provide direct evidence that training in coping skills can really change not only people's ability to improve their emotional lives but also their physical prognoses and prospects for future health.