Learning how to cope with stress can help people with heart disease avoid having heart attacks in the future, according to research.
Experts believe cognitive behavioural therapy (CBT) could be the key to controlling many of the emotions that lead to heart problems.
CBT is thought to be effective in combating issues such as money worries, marital problems and work-related stress. Around a third of people having heart attacks have been linked to these "psychosocial" factors, regardless of other factors, including obesity and physical exercise.
It is hoped that by creating coping methods with these emotions at their source it will be possible to prevent future heart attacks.
A team of researchers from Uppsala University Hospital in Sweden carried out the latest study, which has been published in the journal Archives of Internal Medicine.
They looked at the effect of CBT on more than 190 men and women discharged from hospital after a coronary event (heart attack or stroke) in the previous year.
Another 170 patients acted as a control group to test the true effect of CBT.
The researchers wrote: "The programme has five key components with specific goals - education, self-monitoring, skills training, cognitive restructuring and spiritual development - and is focused on stress management, coping with stress and reducing experience of daily stress, time urgency and hostility."
People received therapy for two hours at a time over 20 sessions, delivered in small same-sex groups. The 170 patients acting as a control group received usual follow-up care.
Over the course of the next eight and a half years, 23 patients (12%) in the CBT group died, another 69 (36%) had a cardiovascular event that was not fatal and 21% had a non-fatal heart attack.
This compared to 25 deaths (15%), 77 non-fatal cardiovascular events (45%) and 51 non-fatal heart attacks (30%) in the other group.
Overall, people receiving CBT had a 41% lower rate of fatal and non-fatal events happening and 45% fewer recurrent heart attacks.
The more CBT sessions a person attended, the more likely they were to stay fit and well.