Cardiac disease is the leading cause of death and functional impairment in North America. Treatment adherence in general is a major obstacle for the cardiac population. Anxiety is a potential barrier to treatment adherence, yet results of previous studies are equivocal, possibly due to anxiety being measured too generally. Heart-focused anxiety was measured in the current study to determine if it is a better predictor of treatment adherence than general anxiety, after controlling for other known predictors of adherence. Sixty-five participants between 29 and 96 years of age (M = 69.24, SD = 14.18; 56.9% female) were recruited from the Loma Linda University Medical Center. Participants were given a questionnaire to complete, either by mail or online, in which demographic characteristics, treatment adherence, general anxiety, heart-focused anxiety, and other known predictors of treatment adherence were measured. Two hierarchical multiple linear regression models were run to test whether the subscales of heart-focused anxiety predicted lifestyle and medication adherence, respectively, above and beyond the influence of demographic variables, other known predictors, and general anxiety. Three hierarchical binomial logistic regression models were run to test whether heart-focused anxiety predicted healthy LDL, HDL and blood pressure levels above and beyond the influence of demographic variables, other known predictors, and general anxiety. None of the CAQ subscales significantly predicted adherence, but effect sizes were large enough to warrant interpretation. In general, fear-related anxiety increased odds of non-adherence, while avoidance and attention produced mixed results. Knowledge and positive coping significantly predicted lifestyle recommendation adherence, gender (being male) and positive coping significantly predicted unhealthy LDL cholesterol levels, and being unmarried significantly predicted lower blood pressure. Results suggest that patients with more fear-related anxiety are more likely to be non-adherent to recommended treatments. In general, the CAQ subscales were stronger predictors of treatment adherence than general anxiety, indicating that they may be better determinants of treatment adherence than general anxiety alone. Results also indicated that those with more knowledge and who use positive coping are more likely to be adherent to lifestyle recommendations, men and those with less positive coping skills are more likely to have high LDL cholesterol, and unmarried individuals are less likely to have high blood pressure. Targeting these individuals to offer specific interventions may improve treatment adherence through increased education, patient-physician communication, and psychological interventions aimed at reducing fear and anxiety.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Morrell, Holly E. R.

Second Advisor

Arechiga, Adam L.

Third Advisor

Herbozo, Sylvia M.

Fourth Advisor

Houston-Feenstra, Linda

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Cardiovascular Diseases - Psychology; Patient Compliance; Treatment Outcome; Anxiety

Subject - Local

Heart-focused Anxiety; Cardiac Disease; Treatment Adherence; Hierarchical Multiple Linear Regression Models



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives