Common and specific process factors in cardiac rehabilitation: independent and interactive effects of the working alliance and self-efficacy.
OBJECTIVE
Therapeutic processes in cardiac rehabilitation programs are virtually unexamined. Models were tested by which changes in the working alliance between patient and staff (agreement on goals/tasks; emotional bond) may affect outcomes in conjunction with changes in patient self-efficacy to change their diets and increase exercise.


METHODS
Cardiac patients (n = 79) participated in a 12-week program, and completed assessments at early, mid, and late treatment.


METHODS
Changes in cardiac depression, physical health, perceived exertion during exercise, rate/pressure product at submaximal exercise tolerance, weight loss, return to work, total fat intake.


RESULTS
Early-treatment changes in agreement on goals/tasks were related to changes in psychosocial factors and perceived exertion during exercise independent of effects of changes in self-efficacy. Early-treatment changes in goals/tasks and self-efficacy interacted to predict changes in cardiorespiratory fitness, weight loss, and return to work such that patients high on both goals/tasks and self-efficacy showed the most gains.


CONCLUSIONS
Sound therapeutic relationships between patients and staff may play an important role in facilitating the achievement of a wide-range of salutary outcomes during cardiac rehabilitation.
Burns
John W
JW
Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA. john.burns@rosalindfranklin.edu
Evon
Donna
D
D015444:Exercise; D005247:Feeding Behavior; D006040:Goals; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D012044:Regression Analysis; D020377:Self Efficacy; D012944:Social Support