Heart and Soul



The Psychology of the Heart is woven into our everyday language.

When have you had a heavy heart?

Has your heart been broken?

What makes you light-hearted?

When was the last time you had a good hearty laugh?

Increasingly, research tells us that heart, brain and mind are all intimately interconnected. Perhaps without much reflection, we count on our hearts to power our brains and bodies. Yet more than a third of us will have a heart problem at some point. Everything can change…we are not invincible after all!



Coming to terms with a heart condition...

can bring many new challenges: emotional ups and downs, adapting to new life roles, learning how to lead a heart-healthy lifestyle, taking medications. Sometimes it can feel like going through some pretty rough waters!


After a cardiac event such as a heart attack, angioplasty or heart surgery...

people may experience many reactions, including disbelief, self-doubt, fear, anger, or sadness. Or you might feel gratitude for your second chance, draw closer to your loved ones, perhaps even experience personal growth. People react very individually.


Dr. Peter Prior, Psychologist


I have years of clinical experience in helping heart patients to reach calmer waters. I bring an effective, understanding and well-informed approach to assessment and treatment of psychological challenges associated with heart conditions. These can include panic, tension and fear, emotional trauma, depression, needing to recover a sense of direction and purpose in life, challenges in personal, marital and family relationships, or obstacles in returning to work, family life or other activities.

I have seen patients with each of the heart conditions described in this website, and know from clinical experience and research that each can have important psychological dimensions. If you are a heart patient, or if you know one, please take a moment to look over the information below.

Specific Cardiovascular Conditions and Psychology

Heart attack and angina: coronary artery disease

Coronary artery disease  is sometimes referred to as a “plumbing” problem, coronary artery disease involves inflammation, progressive narrowing and often, blockage of blood vessels that supply the heart muscle itself with blood, oxygen and nutrients. This  chronic   or long-term condition, called  atherosclerosis, can led to heart attack.

Atherosclerosis may also occur in other areas such as the neck or legs. Coronary artery disease may cause stable angina, or acute coronary syndrome (unstable angina, myocardial infarction/MI), otherwise known as heart attack. Common medications types include ACE inhibitors (e.g. ramipril), statins (e.g. atorvastatin), beta-blockers (e.g. metoprolol) ASA, prescribed for secondary prevention; that is, to reduce risk of worsening or recurrence. Many heart patients undergo “revascularization” procedures, to open up blood flow to heart muscle. These include angioplasty with stent insertion. After angioplasty, people may take medications (e.g. ticagrelor, clopidogrel) to keep stents clear. Patients may undergo coronary artery bypass grafting (CABG) surgery, also intended to restore blood flow to heart muscle.

Healthy lifestyle is vital for long-term risk reduction, both before and after a coronary event. Risk factors increase the likelihood of developing coronary artery disease in the first place, and of worsening or recurrent heart trouble. Most adults in Canada have at least one risk factor. Some risk factors cannot be changed, like family history (genetics) and increasing age. Fortunately many risk factors can be controlled or even eliminated, including lack of physical activity and exercise, high blood pressure (hypertension), diabetes, smoking, excessive alcohol consumption, high cholesterol, or overweight. Psychological health affects both the risk of coronary artery disease, and recovery from cardiac events such as heart attacks.


Psychology and Coronary Artery Disease. There is now a large amount of research linking psychological factors and coronary artery disease.

A cardiac event can be stressful and frightening for many, perhaps most patients, as well as for spouses and family members. Naturally, heart attacks, angioplasties or heart surgeries may often followed by disbelief, fear, anger, sadness, loss of self-confidence or sleep disturbance. These are normal, up to a point.

Substantial numbers of heart patients develop clinically significant conditions such as depression, anxiety disorders, sleep disorders or sexual dysfunction. These cause added suffering, can complicate medical recovery, and may benefit from professional attention.

Unhealthy lifestyle habits include lack of exercise and physical activity (leading to low cardiorespiratory fitness), poor diet, smoking and excessive alcohol use. These increase the risk of worsening heart disease and recurrent cardiac events. So does neglect of medications. Fortunately, risk can be reduced by developing and maintaining healthy lifestyle and medication habits. A psychologist can help you find your own strength, willpower and sense of direction.

Increasingly, scientific evidence shows that our psychology affects the risk of developing coronary artery disease in the first place, and the likelihood of recurrent heart trouble. This evidence is particularly strong for stress and clinical depression. Other probable psychological risk factors include anxiety, bereavement, social isolation, hostility and anger.

What links psychology to the risk of coronary artery disease?

This topic is the focus of active scientific study. There are probably two main linkages. 1) The indirect behavioural route: stress and depression can promote unhealthy lifestyle habits such as smoking, overeating, lack of exercise, or neglect of medications. 2) The direct physiological route: anxiety, stress, depression and other psychological factors may affect heart rhythms or promote inflammation or blood clotting.

I have extensive experience helping patients with coronary artery disease to recover after heart attack, angioplasty or surgery, to manage psychological conditions such as depression and anxiety, to manage stress, quit smoking, and to develop and sustain motivation for lifestyle change.

Cardiac Arrhythmias

Cardiac arrhythmias  are “electrical” problems of the heart. These result from disturbances to the heart’s natural pace-making and electrical system. Examples include atrial fibrillation, long QT syndrome, ventricular tachycardia or ventricular fibrillation. Patients may take medications to control the heart rate or rhythm (e.g. beta-blockers, antiarrhythmics) or to prevent strokes (blood thinners like warfarin or novel anticoagulants, “NOACs”, like dabigatran, apixaban, rivaroxaban). Patients may also undergo cardioversion or ablation to control arrhythmias, or have implanted devices such as pacemakers or ICDs (implantable cardioverter-defibrillators).

Psychology and Cardiac Arrhythmias. Medical and surgical treatments for arrhythmias have become increasingly sophisticated and effective. Yet people with arrhythmia may face depression, anxiety, and emotional challenges in adjusting to their condition. They may be very anxious about their symptoms.

Not all arrhythmias are life-threatening, although some are, such as ventricular tachycardia or fibrillation. Not surprisingly then, arrhythmic episodes can be emotionally disturbing or traumatic. Arrhythmias can be associated with anxiety, panic or psychological trauma with symptoms such as flashbacks, nightmares or a sense of helplessness. Such symptoms may be connected to a threatening cardiac event actually experienced by the patient, or to some other past trauma in that person’s life. Repeated ICD shocks can be very disturbing, and may be followed by fear, panic, trauma, and feelings of losing control over one’s life.

From research evidence, and in my clinical experience, psychological treatment can be helpful in assisting people to adjust to their arrhythmia, and in providing relief for psychological complications related to depression, anxiety, panic and emotional trauma.

Congenital Heart Disease

Congenital heart disease   involves “structural” problems of the heart present at birth. Some congenital abnormalities may create cyanotic (“blue”) conditions in which a person sometimes cannot get enough oxygen, due to inadequate heart pumping efficiency and blood flow. Adult patients may have had corrective heart surgery in infancy or childhood for conditions such as Tetrology of Fallot. Later in life some individuals may develop other heart conditions, such as cardiac arrhythmias. These in turn may be managed with medications or ICDs.

Psychology and congenital heart disease. Compared to some cardiac conditions, there is less research evidence about the psychology of congenital heart disease. Heart patients with surgically corrected congenital abnormalities very often have good long-term psychological adjustment and quality of life as adults.

In my clinical experience, psychological complications of congenital heart disease sometimes occur when patients have faced early challenges or traumas in childhood, or when new medical complications arise in adulthood, such as arrhythmia.  Careful psychological assessment and treatment may be helpful for difficulties such as emotional trauma, panic, depression, or problems in family or intimate relationships.


Cardiomyopathy    involves abnormal growth of heart muscle. It can have different causes, including genetics, high blood pressure or viral infections. Sometimes the cause is unknown. Cardiomyopathy or repeated heart attacks may lead to reduced pumping efficiency of the heart, and to congestive heart failure, in which fluid is not adequately cleared from the lungs or other areas of the body. Patients with cardiomyopathy or congestive heart failure may be treated by their heart doctors with drugs (e.g. digitalis, diuretics, beta-blockers or others) or surgery, or may have implanted devices such as ICDs.

Psychology, cardiomyopathy and heart failure.     While we need more psychological research in this area, we do know that depression is very common among patients with heart failure. Heart failure patients may also have mild cognitive (i.e. information processing) impairments, such as problems with memory, or “executive functions” like goal-setting, planning and organization.

Depression and cognitive impairments may complicate medical management and lead to worse outcomes. It is very important that heart failure patients learn effective self-management of their illness. That is, they need to gain knowledge, skills and confidence about key points of care such as self-monitoring of symptoms, weight changes, and medication use, to be able to work effectively in partnership with their doctors and other healthcare professionals.

My own clinical experience includes working with cardiomyopathy and heart failure patients to assist them with anxiety, panic and depression.