Heart Condition? The Psychologist Will See You Now

The link between heart disease and mental health conditions such as anxiety, depression, and post-traumatic stress disorder (PTSD) is becoming so clear that some cardiology practices are offering psychological support as part of the treatment.

Many people report that talking to a clinical psychologist eases fears that their heart disease will get worse or they will have a second heart attack. These fears can lead people to develop health-related anxiety, which may spill over into other domains of life and prevent them from living their lives to the fullest. Some say their visits with a clinical psychologist take them in other directions, perhaps marking the first time they’re able to address an unprocessed trauma, such as domestic violence, displacement, or an adverse childhood experience.

“A significant number of people who have a heart condition also take antidepressants,” says Kim Smolderen, PhD, MSc, a Yale Medicine psychologist and co-founder of the Yale Medicine Heart and Vascular Psychology and Wellbeing Clinic, a pilot program. A few studies have put that figure around 40%, although the percentage varies widely among different groups. “That gives you some sense of how common it is for people to struggle to regulate their mood while they’re managing their heart disease.”

Cardiology isn’t the only medical specialty that offers care from mental health specialists in response to a growing recognition that the body and mind are deeply interconnected. Yale Medicine patients have access to psychological support at Yale New Haven Hospital Spine Center, Yale Medicine Center for Weight Management, Yale Cancer Center, Yale Sleep Center, and other programs.

Smolderen, a clinician and researcher who has dedicated much of her career to understanding the connection between mental and cardiovascular health, launched the adult cardiology pilot program this past year so that she and her team can assess how it impacts quality of life and outcomes for people with heart conditions who participate, and use those experiences to potentially expand the program.

The relationship between mental health and heart health is uniquely intricate. For instance, a person who has a sudden event, such as a heart attack, may experience this as a traumatic event, and the thought of it happening again can be very frightening, Smolderen says. “All the alarm bells go off and you’re immediately in confrontation with mortality. It’s a wake-up call people aren’t expecting.” However, any cardiac diagnosis can make a person feel vulnerable, she says.

A heightened and chronic “fight-or-flight” response—a physiological reaction to a perceived threat—is common in people who have depression or anxiety, especially for people who have prior trauma or PTSD. “What we see often is when this fight-or-flight system takes the upper hand, as opposed to the ‘rest and digest’ part of the autonomic nervous system, and it may cause strain on our body systems over time,” Smolderen says.

Chronic stress indeed impacts the entire body, causing the heart to beat faster, respiration to change, and blood pressure to rise. “All the physiological systems that are involved are exactly the ones that also are being treated by a cardiologist. And that is unique about cardiology and cardiovascular disease,” Smolderen adds. “We also know from research that if people are able to work on their stress regulation, it benefits their cardiovascular health directly.”

In addition, in people who are experiencing chronic stress, making healthy lifestyle choices is so much harder, Smolderen says. When we feel chronically stressed, we may resort to smoking, overeating, and sedentary behavior. Our sleep may be disrupted and we have difficulty keeping up with medication regimens.

The American Heart Association (AHA) says more research is needed to fully understand the connection between mental health and heart health. But in a 2025 scientific statement it published in its journal, Circulation, it addressed the importance of treating such conditions as anxiety, depression, and PTSD to improve quality of life and long-term health. The AHA suggests regular mental health screening for people who have cardiovascular disease or are at risk for it.

Yale Medicine heart patients can visit a clinical psychologist provider in the same clinic where they consult their cardiologist. The service is currently available at Yale New Haven Hospital’s Saint Raphael Campus. “They're walking through the same door,” Smolderen says. “That helps to convey the integrated character of the relationship between mind and heart and reduces the stigma—people can think of the therapy as part of routine care and know that they are not an exception.”

Typically 8 to 10 sessions are offered initially, and then doctor and patient decide together whether to extend them or make a referral so the patient can continue with a psychotherapist in the community. Treatment may include cognitive behavioral therapy (CBT), mindfulness-based interventions, medical hypnosis, and eye movement desensitization and reprocessing (EMDR), a psychotherapy treatment designed to alleviate the distress associated with traumatic memories.

“My goal is to help people build resilience and coping skills to manage their stress and help regulate their nervous system,” Smolderen says. “There are people who tell me they don't know how to relax or they don't have tools they can use to develop better coping skills. It is eye-opening for them to see that they too can learn self-management tools that can serve them for life.”

People talk about a variety of issues, some unrelated to their condition, Smolderen says. “They often take the time to process what has happened and share their story,” she says. They discuss how the heart attack, or other event or diagnosis impacted their quality of daily life and self-confidence. “We work together to problem-solve daily situations so that they will be less anxiety-provoking,” she says, noting that combinations of mindfulness-based interventions, CBT, and EMDR help and people are surprised to see its results. “For some, this is really the first time they have a tool they can use to actively control their breathing and relax in the moment.”

Some people want to talk about flashbacks after a heart event and their anxiety that it could occur again. “They might find they are trying to control things by avoiding activities. They might stop leaving the house,” Smolderen says. They may become isolated, she adds.

If a heart problem brings up issues that seem unrelated, she helps address those too. For instance, studies have shown an association between early trauma exposure, complex trauma, and heart disease later in life, says Smolderen. People who work through old traumas often also find relief with regards to their depressive symptoms and anxiety around their diagnosis, and they have a better ability to make other changes in their lives, she says. “Many people have never had the opportunity to bring up and reprocess those experiences, and they have the readiness to do it now,” she says.

Others may not be ready yet, and that is okay too. “There are still many practical tools we can teach individuals to self-manage chronic stress in their daily lives,” Smolderen adds.

Anyone who has concerns around chronic stress, anxiety, depression, or trauma may want to inform their cardiologist, so that they can be referred to a clinic. If there is no such integrated psychology clinic available in your health system, a therapist in the community who is familiar with health psychology and mental health care for medical conditions may be an option.

“I see a wide spectrum of cardiovascular problems,” Smolderen says. People have sought psychological support after surviving a cardiac arrest or open-heart surgery, or after minimally invasive heart surgery. Others may experience PTSD following an event such as a shock to their heart by an implantable cardioverter defibrillator.

Concerns often come up during visits with cardiologists, she says. “Maybe people are anxious or feeling sad around the diagnosis. If a cardiologist feels this is becoming an obstacle to a patient, they mention that we have this service available.”

While more research is needed to fully understand the connection, an estimated 33% to 50% of heart attack survivors may experience some form of psychological distress after a heart attack, according to the AHA. Depression, anxiety, psychosocial stress, or PTSD can affect physical recovery and long-term health, the association says. People with persistent psychological distress lasting up to a year are almost 1.5 times more likely to have a future cardiac event.

The AHA points to interventions such as cognitive behavioral therapy, medication, and mind–body strategies such yoga and meditation to improve emotional well-being and reduce stress. Other research has shown that people who participate in a cardiac rehabilitation program after a heart attack have reduced symptoms of depression, anxiety, and stress—and those reductions are associated with improved cardiac outcomes for heart attack survivors, according to the AHA. There is even research to demonstrate that in women who survived their heart attack, participation in a group therapy program focusing on stress reduction skills prolonged their survival over time.

Treating mind and body as a whole, regardless of whether it can prolong your life, just makes sense, Smolderen says. “I think living a life with better quality of life and mental health is worthwhile on its own. Even if there is still some stigma around it, I think people really want to be seen as a whole person and not just someone who needs treatment for a cardiac condition,” she adds.