Self-ratings of anxiety and depression were studied over six months in 60 male patients, under 66 yr of age, who were admitted to a coronary care unit with a first time acute myocardial infarction. Patients were randomly assigned to either a treatment group, where they received a simple programme of in-hospital counselling in addition to routine care, or to a control group, where they received routine care only. All patients completed the Hospital Anxiety and Depression scale and a battery of visual analogue scales measuring anxiety on a range of topics related to recovery from a myocardial infarction. Patients who received in-hospital counselling reported statistically significantly less anxiety and depression than those who received routine care alone. This effect was sustained for six months after leaving hospital. It is concluded that a simple programme of in-hospital counselling, provided by a coronary care nurse, is efficacious and should be routinely offered to first myocardial infarction patients in hospital.