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Effekt von Humortraining auf Stress, Heiterkeit und Depression bei Patienten mit koronarer Herzkrankheit und therapierefraktärer Angina pectoris

Effect of humor training on stress, cheerfulness and depression in patients with coronary artery disease and refractory angina pectoris

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Zusammenfassung

Hintergrund

Die therapierefraktäre Angina pectoris ist in der Behandlung von Patienten mit koronarer Herzkrankheit (KHK) ein häufiges Phänomen, erzeugt einen hohen Leidensdruck und beansprucht das Gesundheitssystem in hohem Maße. Die Entwicklung neuer Therapiekonzepte ist aus diesem Grund von besonderer Bedeutung. In dieser Studie wurde untersucht, ob ein professionelles, strukturiertes Humortraining einen Effekt auf die Beschwerdesymptomatik von Patienten mit therapierefraktären Beschwerden hat.

Methoden

Im Rahmen dieser Studie wurden im Zeitraum von 2013 bis 2014 insgesamt 35 Patienten mit stabiler KHK eingeschlossen. Der Studieneinschluss erfolgte bei therapierefraktären Beschwerden (CCS[Canadian Cardiovascular Society]-Stadium II–IV) trotz maximaler antianginöser Therapie und Ausschöpfung jeglicher Revaskularisationsoptionen. 25,8 % der Patienten hatten einen Myokardinfarkt in der Vorgeschichte. Im Rahmen der Studie erfolgte ein professionelles Humortraining über 7 Wochen. Zur Beurteilung des Effekts des Humortrainings wurden vorher und nachher folgende Untersuchungen durchgeführt: Belastungs-EKG, Haarsegmentanalyse mit Kortisolbestimmung, Beck-Depressions-Inventar(BDI)-Fragebogen, Trierer Inventar zum chronischen Stress (TICS), State-Trait-Heiterkeits-Inventar (STHI-S/T).

Ergebnisse

Von 31 der ursprünglichen 35 rekrutierten Patienten wurde die Studie erfolgreich beendet. Der Altersdurchschnitt lag bei 65,5 Jahren mit 94,5 % weiblichen Probanden. Im STHI-S-Fragebogen zeigte sich im Vergleich der Daten vor und nach dem Humortraining eine signifikante Verbesserung der Erheiterbarkeit (prä: 23,3 ± 5,4, post: 27,5 ± 5; p = 0,03). Dieser Effekt war noch deutlicher bei einer Subgruppenanalyse zu sehen, in der nur die weiblichen Studienteilnehmer berücksichtigt wurden (prä: 23,6 ± 5,5, post: 27,7 ± 4,6; p = 0,003). Im BDI zeigte sich im Vergleich der Daten vor und nach dem Humortraining eine deutliche Verbesserung (prä: 14,6 ± 8,1, post: 11,0 ± 6,5; p = 0,064). Diese war bei Analyse der 29 Frauen statistisch signifikant (prä: 13,1 ± 6,4, post: 9,9 ± 4,6; p = 0,037). Die Haarsegmentanalyse ergab bei Probanden mit erhöhten Werten vor dem Humortraining (>25. Perzentile, n = 22) eine signifikante Reduktion der Haarkortisolkonzentration (prä: 6,54 [3,78–12,12] pg/mg, post: 3,65 [2,82–7,68] pg/mg; p = 0,029).

Schlussfolgerung

Patienten mit therapierefraktärer Angina pectoris bei KHK profitieren von einem professionellen Humortraining. Dies konnte durch einen signifikanten Abfall der Kortisolkonzentration in der Haarsegmentanalyse, eine Verbesserung in der Erheiterbarkeit im STHI-S sowie eine signifikante Verbesserung im BDI gezeigt werden.

Abstract

Background

Angina pectoris refractory to conventional medical treatment is a common phenomenon in patients with stable coronary artery disease (CAD). Many of these patients suffer from depression and generate substantial costs in the healthcare system. Therefore, the development of new therapeutic concepts is of particular importance. This study investigated whether professional, structured humor training has a positive effect on the symptoms of patients with treatment refractory angina pectoris.

Methods

Between 2013 and 2014 a total of 35 patients with stable CAD were included. Enrolment was possible if patients suffered from treatment refractory angina pectoris (Canadian Cardiovascular Society, CCS grades II–IV) despite optimal antianginal medication and exhaustion of options for myocardial revascularization. Previously, 25.8% of the patients had had a myocardial infarction. In this study, a professional humor coaching was conducted with a duration of 7 weeks. In order to evaluate the effects of the coaching, the following examinations were performed before and after the intervention: exercise stress test (treadmill), hair segment cortisol analysis, Beck Depression Inventory (BDI), the Trier Inventory for the Assessment of Chronic Stress (TICS) and the State-Trait-Cheerfulness Inventory (STCI).

Results

Out of the 35 initially recruited patients 31 completed the study. The mean age was 65.5 years and 94.5% were female. There was a significant improvement in cheerfulness (STCI, pre 23.3 ± 5.4, post 27.5 ± 5, p = 0,03). This effect was even stronger in a subgroup analysis in which only female patients were included (pre 23.6 ± 5.5, post 27.7 ± 4.6, p = 0.003). The results of the BDI showed a remarkable improvement in the pre-post analysis (pre 14.6 ± 8.1, post 11.0 ± 6.5, p = 0.064). Analyzing only the female patients, this difference became significant (pre 13.1 ± 6.4, post 9.9 ± 4.6 p = 0,037). The hair segment investigations showed that patients who had a higher cortisol level in the beginning (>25. percentile, n = 22) showed a significant reduction of the cortisol concentration (pre 6.54 pg/mg, 3.78–12.12 pg/mg, post 3.65 pg/mg, 2.82–7.68 pg/mg, p = 0.029).

Conclusion

Patients with refractory angina pectoris and stable CAD benefit from a professional humor coaching. This effect was shown in a) a significant decrease in cortisol concentrations in the hair segment analysis, b) an improvement in cheerfulness in the STCI and c) a significant difference in the BDI between pre-post values.

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Danksagung

Wir danken Frau Sabine Nägele, Studienassistentin, für die exzellente Unterstützung bei der Organisation dieser Studie.

Funding

Funding

Diese Studie wurde von dem Verein der Freunde und Förderer des Robert-Bosch-Krankenhauses e. V. unterstützt. Weitere Unterstützung erfolgte durch die Berthold-Leibinger-Stiftung, Ditzingen.

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Correspondence to P. Ong.

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Interessenkonflikt

M. Voss, B. Wild, E. von Hirschhausen, T. Fuchs und P. Ong geben an, dass kein Interessenkonflikt besteht.

Das Studienprotokoll wurde unter der Nummer F-2014-114 von der Ethikkommission Stuttgart genehmigt.

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Voss, M., Wild, B., von Hirschhausen, E. et al. Effekt von Humortraining auf Stress, Heiterkeit und Depression bei Patienten mit koronarer Herzkrankheit und therapierefraktärer Angina pectoris. Herz 45 (Suppl 1), 80–87 (2020). https://doi.org/10.1007/s00059-019-4813-8

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