If you’ve already suffered a heart attack or have other forms of heart disease, stress reduction is a critically important part of any therapy.

Duke University researchers studied 51 outpatients (ages 36 to 84) with heart disease who were enrolled in cardiac rehabilitation programs due to heart blockages, recurring chest pain, heart attacks, or bypass surgery.

About half of the study subjects participated in three months of traditional cardiac rehabilitation, which included regular exercise, a heart-healthy diet, and drugs to manage cholesterol and high blood pressure.

The other half went to cardiac rehab and attended weekly, 90-minute stress-management groups that combined emotional support, cognitive behavior therapy, muscle relaxation, and other stress-reduction techniques.

After three years of follow-up, 33 percent of the patients who received only cardiac rehabilitation had another cardiovascular event or were hospitalized for chest pain or death from any cause.

By comparison, 18 percent of the patients who participated in stress-management training during their cardiac rehabilitation had less subsequent cardiovascular trouble — about half the rate of the other group.