Heart attacks are life-changing events, but one type can be particularly distressing. 

Spontaneous coronary artery dissection primarily strikes women under 50. Often, they are physically fit nonsmokers with good cholesterol and normal blood pressure — in other words, the very people who least expect a cardiac emergency. The shock of such an event may help explain why as many as 30 percent of survivors develop symptoms of medically induced post-traumatic stress disorder.

“Medically induced PTSD is basically PTSD that results from a sudden, catastrophic, life-threatening medical condition,” said Christina Luberto, a clinical health psychologist in the Department of Psychiatry at Mass General Hospital/Harvard Medical School. “It actually accounts for about 7 percent of all PTSD cases.” 

Luberto is the founding director of the Mindful Living Center, a mental health service embedded with the Mass General Women’s Heart Health Program. The Mindful Living Center is one of the few programs in the country to integrate psychological services directly into cardiovascular care for women. 

Christina Luberto.

Stephanie Mitchell/Harvard Staff Photographer

“We treat survivors whose primary presenting problem is the fear of recurrence,” she said. “They’re terrified by the uncertainty and possibility that it is going to happen again.”

Despite its prevalence, medically induced PTSD wasn’t formally recognized until the 1990s, when the Diagnostic and Statistical Manual of Mental Disorders expanded the definition to include trauma from medical events. It later tightened the criteria to sudden conditions, excluding chronic conditions like cancer or HIV. Research has shown that patients with medically induced PTSD tend to have worse recoveries and a higher risk of death than those without.

Medically induced PTSD symptoms mirror the symptoms of PTSD from external traumas, Luberto said: intrusive memories, hyperarousal, negative changes in mood or belief, and avoidance. But there are key differences. 

“People often think of PTSD that results from external events like serving in combat. People may have flashbacks and intrusive memories. They’re thinking about what happened in the past. They might avoid things like celebrations with fireworks and loud noises, friends from that time, and they’re sort of able to do that,” she said. “With medically induced PTSD, the threat is not left in the past. You can’t escape the source of the ongoing threat, because the source of the threat is your own body.” 

That reality makes survivors hyper-aware of physical sensations. Sweat or an elevated heart rate can trigger panic. Because exercise can mimic the sensations patients experienced during their heart attack, they may avoid working out — paradoxically, the very thing that could aid recovery and prevent future events. Others may skip medication, avoid medical follow-ups, or, conversely, over-engage with the healthcare system, frequently calling or messaging their providers. 

“It’s a vicious cycle. What I hear is the future-oriented worry: ‘Is this going to happen again?’” 

Christina Luberto

“There’s what we call cognitive reactivity in response to physical symptoms. ‘Why am I sweating? Why is my heart beating? Maybe it’s the coffee, but maybe it’s not. Should I go to the hospital?’ And then all of this thinking creates more physical symptoms of anxiety,” Luberto said. “It’s a vicious cycle. What I hear is the future-oriented worry: ‘Is this going to happen again?’”

Her research shows how the distressing thoughts can escalate. “Survivors start to believe different things about their body, and on some level, about the world. They believe, you know, ‘My body betrayed me. This is going to happen again. I’m not safe.’”

The Mindful Living Center, which opened in October 2023, employs an adapted Mindfulness-Based Cognitive Therapy method based on Luberto’s prior NIH-funded research. In online group therapy sessions, patients confront the source of their distress: their bodies. 

“Mindfulness meditation brings you into the body, noticing the body without judgment, feeling sensations, noticing where the body can still feel safe or can still feel comfortable, and being able to regulate your attention to move it out of the body if the anxiety gets too much.” 

The results are encouraging. Since it opened, the Mindful Living Center has received 181 referrals and treated 86 patients. Ninety percent of patients in the Mindfulness-Based Cognitive Therapy sessions reported improved emotional health, and 75 percent reported improved cardiac health.

“Stress and anxiety can have significant negative consequences for patients, from how they experience medical care to their ability to empower themselves to take steps to reduce future events,” said Amy Sarma, Cathy E. Minehan Endowed Chair in Cardiology at MGH and an assistant professor of medicine at Harvard Medical School. “However, most cardiologists do not have access to the resources to help their patients as we do at Mass General Brigham. Our partnership with Dr. Luberto in this unique program enables us to significantly advance the care of our patients.”

Nandita Scott, Ellertson Family Endowed Chair in Cardiovascular Medicine and the director of the Women’s Heart Health Program, highlighted the “exceptional support” the mindfulness program has received from the cardiology leadership at Mass General Brigham. “It’s well-established that mental health and cardiovascular outcomes are closely linked, yet few divisions would have had the vision or resources to fund such an initiative,” she said.

Luberto, who is also an executive faculty member in the MGH Health Promotion Resiliency Intervention Research Center and the MGH Benson-Henry Institute for Mind-Body Medicine, hopes to increase the Mindful Living Center’s offerings to other research-backed methodologies for managing medically induced PTSD. In a recent study led by UCLA doctoral student Corinne Meinhausen, with Luberto serving as a co-author, researchers reviewed therapies ranging from traditional cognitive behavioral therapy to written exposure therapy, a short five-session program in which patients write detailed accounts of the traumatic event. The written exposure therapy’s lower dropout rates and strong earlier results make it an appealing option, especially for patients reluctant to commit to longer, more intensive therapies.

Luberto said doctors can be on the lookout for PTSD symptoms resulting from traumatic medical events. The American Heart Health Association recommends screening for depression; she suggests adding PTSD screening for spontaneous coronary artery dissection patients, along with a clear treatment pathway. There is little research on risk factors or prevention of medically induced PTSD, but compassionate care during hospitalization couldn’t hurt, she said. 

“There are trauma-informed care principles in mental healthcare in general that include giving patients choice. Being transparent. Considering cultural and identity factors. It’s an important research question to see if that can prevent risk, but even if it can’t, it’s just good care.”