Purpose: This study aimed to compare the effectiveness of Short-Term Psychodynamic Psychotherapy (STPP) and Cognitive Behavioral Therapy (CBT) on the Behavioral Inhibition System (BIS), Behavioral Activation System (BAS), and mental toughness in patients with coronary artery disease (CAD).Methods and Materials: The research employed a quasi-experimental design with a pre-test/post-test structure and included two experimental groups and one control group. A total of 45 patients with CAD, aged 35–55 years, referred to Farshchian Hospital in Hamadan, Iran, were selected through convenience sampling and randomly assigned to the groups. The psychodynamic therapy group received twelve 2-hour sessions over 90 days, while the CBT group participated in twelve 90-minute sessions within the same timeframe. Data were collected using the Carver and White BIS/BAS Scale and the Clough Mental Toughness Questionnaire. Analysis of covariance (ANCOVA) and Bonferroni post hoc tests were performed using SPSS-25 to examine group differences.Findings: The ANCOVA results showed a statistically significant difference between the groups in mental toughness scores after controlling for pre-test scores (F = 12.391, p = 0.002, η² = 0.315), with the CBT group outperforming both the STPP and control groups. Theeffect of group on BIS approached significance (F = 3.990, p = 0.056), and post hoc analysis revealed a significant difference between the CBT and control groups (p = 0.004). Regarding BAS, although the overall ANCOVA was not significant (p = 0.308), pairwise comparisons showed that the CBT group had significantly higher post-test BAS scores compared to both STPP (p = 0.045) and control (p = 0.003) groups.Conclusion: CBT demonstrated superior efficacy over STPP in enhancing mental toughness and behavioral activation in CAD patients, while both interventions were beneficial compared to no treatment. Integrating psychological therapies into cardiac care may improve emotional regulation and resilience
