Interviews with the female coronary patients were made, shortly after their own intervention program was finalized. The patients were asked by Birgitta Sandstedt (journalist) how they had reacted and whether they had grown as human beings, as a consequence of the intervention program.

Some examples:

Mrs F: “I was always the person who took responsibility, who got engaged and wanted to help. I was a real Florence Nightingale type…”

Mrs D: “I was always afraid that I would not be sufficiently good in my performance, that I would not ‘duga’ (engl. be sufficient). But then I learnt that I can be resistant, that I do not break into pieces, if something goes wrong. I have learnt that if something bad occurs to me, I can handle it and I do not fall apart.”

Mrs W: “I always worked very hard, I was always tired after my intense work days. But I did not allow the strain of my work to be seen, neither by clients nor by co-workers. My inside was in uproar, but I was calm on the outside. Therefore, when we had a difficult customer of some kind, I was told: “You can take this, it doesn’t bother you!”

Miss Q: “One thing I have really learnt from this program is waiting on the line, standing on a queue. (It is part of good citizen behavior in Sweden to wait patiently on the line.) Now with the knowledge I have gained from this program, I go to the food store, I choose the cashier with longest line, and I enjoy being able to wait without impatience until it is my turn… and one more thing that I have learnt from this program about stress: It just isn’t worth dying for.”

What was the best thing about the program?

Quotations from an interview by Herrmann Orth journalist with May Blom, PhD, therapist, group leader and Kristina Orth-Gomér, principal investigator, Stockholm Female Coronary Risk Studies.

HO: Hello May and Kristina,

You have kindly agreed to a talk about women’s stress, how it can lead to and facilitate diseases of the heart and what can be done to cope with it and actually reduce the stress.

KOG: Yes, we now have a solid experience from the cognitive behavioral stress management program. It is an intervention program based on cognitive behavior modification. It was originally designed in San Francisco, USA, but it was designed for men—in order to help them reduce their coronary prone behavior. It was modified to be used by Swedish women coronary patients in Umeå and then finally implemented to help the Stockholm women coronary patients reduce their stress. It is basically the same program structure in these different implementations, but the contents and examples provided to illustrate the new behaviors and new skills, may vary from 1 week to another. We often use materials from the daily newspapers or we use case reports of former patients. Especially the case reports are popular, because the women patients recognize much from their own problems and their own lives.

HO: May, you seem very experienced in this issue. Have you been working as a therapist for a long time?

MB: After my original education as a nurse, I specialized in cardiology, a field, which I have worked for several years.

KOG: We all worked at the Seraphimer Hospital, which used to be one of the most innovative cardiology clinics in Sweden. It was the site of the first and only randomized clinical trial of intensive coronary care (Academic thesis, Karolinska Institutet, Stefan Hofvendal). In 1991 we started the Stockholm Female Coronary Risk Project, an observatory longitudinal, cohort study of women with CVD. May has been a co-ordinator of cardiological and psychosocial components. When the intervention study was first discussed and it proved difficult to find appropriately educated personnel, we decided to try a new model, to educate the group leaders in behavioral techniques and behavioral medicine, while selecting them according to their cardiological and research experience. The choice was easy. May Blom and Birgitta Lindvall were both known from the Searaphimer clinic. The special behavioral medicine education for the task as a group leader was secured for both of them.

HO: So it means that the therapeutic group leaders in this project are nurses, not psychologists. When comparing with other projects, is that not a weakness?

MB: Birgitta and May had no problems to interact with cardiologists, nor psychologists. The working climate is generally relaxed and there is little formality in Swedish healthcare. For the patients it was mainly a good thing. They were able to answer many questions about such things as cardiological medications, an important concern for the patients.

HO: So when and how was it decided to start the intervention study?