Psychotherapy for Adult Mental Health

People with heart defects and their families often face significant stress.  Sometimes, they may have a condition such as anxiety or depression.  They often benefit from help coping better with the challenges of chronic illness.

Therapy (or “psychotherapy”) is a powerful tool to help people:

• Understand themselves

• Manage thoughts and feelings

• Learn coping strategies

Therapy can be provided by a psychiatrist, psychiatric nurse, psychologist, social worker, or mental health counselor. It can be in a hospital, school, clinic, or private practice. Many therapists offer remote meetings through telehealth.

Most therapists cannot prescribe medicines. Psychiatrists and psychiatric nurses can provide therapy and also prescribe medicines. During therapy, providers and patients use talk and activities to explore feelings, thoughts, and behaviors.  They work on learning ways to feel more successful and reach goals.

Families can find a therapist by asking their doctor or insurance company.  They can also look online for therapists in their area. College students can often access a therapist through their school's health services. It is important to find a therapist who fits well with a person’s goals and needs. Sometimes people try several therapists before they find one who is a good fit.

There are different kinds of therapy. Some therapists use just one type of therapy. Other therapists use a combination of therapy types.  Some of the types of therapy that are most helpful to people with heart defects include:

Acceptance and Commitment Therapy (ACT) helps people to cope with difficult feelings and move on towards their goals.  It may hep people with heart defects to learn to live with a difficult history, and to move forward.

During ACT, people learn to:

• Accept their emotions

• Accept difficult experiences and memories

• Take action to work towards goals

 ACT can be effective in treating anxiety, depression, obsessive-compulsive disorder (OCD), psychosis, eating disorders, substance use disorders, and chronic pain.

ACT can be used with older children, teens, and adults. It is not a good choice for young children, or people who have trouble using language or understanding abstract ideas. It is also not a good choice for people who are in unsafe situations that they should not accept.

Cognitive-Behavioral Therapy (CBT) helps people understand the connections among their thoughts, feelings, and actions.  It can help people with heart defects to understand what they are thinking and feeling, and why, and how to manage their thoughts, feelings, and behaviors more adaptively.

During CBT, people learn to:

• Notice unhelpful ways of thinking

• Notice unhelpful ways of acting

• Learn healthier patterns of thinking and acting

CBT is effective for anxiety, depression, eating disorders, and trauma, and is used with many patients who have heart defects. It can be used with children or adults.  It is not a good choice for people who do not use language, or who have trouble understanding abstract ideas.

Exposure Therapy helps people to overcome a pattern of fear or avoidance.  They learn to tolerate something they are scared of little by little. It is effective in treating anxiety, post-traumatic stress disorder (PTSD), panic disorder, and specific phobia.

Exposure therapy can be used with children, teens, and adults. When people with CHDs have a history of medical trauma, exposure therapy can help them to overcome their fears.

 Group Therapy is offered to groups of people with similar challenges.  One or two therapists lead a group therapy session.

Group therapy can be helpful in treating depression, grief, anxiety, panic disorder, or substance use disorder. It can also help people learn social skills.

Young people with CHDs often find it helpful to connect with others who have the same diagnosis, and groups may give them a chance to feel seen and understood.

Group therapy can be used with children, teens, or adults. It is often not a good choice for people who have personality disorders, who are considering hurting themselves, or who have psychosis.

Mindfulness Therapy helps people be more aware of their thoughts and feelings.  They learn to notice their surroundings, and how they react in their surroundings.

People learn how to:

• pause before acting

• act with intention

• manage their thoughts and feelings

Mindfulness therapy can be a good treatment for anxiety, depression, emotion regulation, and substance use disorder. It can help people with heart defects to find peace and calm even in the face of uncertainty.

Mindfulness-Based Stress Reduction (MBSR) is an especially good choice to treat anxiety and stress.  Mindfulness-Based Cognitive Therapy (MBCT) is an especially good choice to treat depression.

Mindfulness-based therapy may be offered in a group or one-on-one. It can be used with older children, teens, or adults.

Mindfulness-based therapy may not be a good choice for people who do not use much language, or people who have trouble understanding abstract ideas.

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) helps young people who have experienced one or more very scary events. They learn to understand the connections among their thoughts, feeling, and actions. They learn to:

• Notice unhelpful ways of thinking

• Notice unhelpful ways of acting

• Learn healthier patterns of thinking and acting

Through TF-CBT, young people are able to feel less guilt and fear.  Usually, a safe adult is included in a child’s TF-CBT treatment.  Some therapists offer TF-CBT that is specifically focused on medical trauma, which can be an important treatment for some people with heart defects.

TF-CBT is not a good choice for people who do not use language, or for people who have trouble understanding abstract ideas.

Sometimes, when a person is struggling with mental illness, it is hard to believe that they can get better. However, recovery is very possible. Prompt and appropriate treatment can help people to improve faster, and to stay well for as long as possible.

This content was reviewed by a psychologist at Boston Children’s Hospital.

Developmental care is best when it is local. Families local to Boston can receive care from the Cardiac Neurodevelopmental Program (CNP) and/or the Boston Adult Congenital Heart (BACH) program. Families from other regions can use the link below to find their local care team.