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Title: Cognitive behavioural therapy targeting cardiac anxiety post-myocardial infarction: results from two sequential pilot studies

Journal Article · · European Heart Journal Open

Abstract Aims Cardiac anxiety, which is cardiac-related fear and avoidance behaviours, is common following myocardial infarction (MI) and has been associated with increased risk for cardiovascular events. However, there are currently no treatments specifically designed to target cardiac anxiety. The aim of the two pilot studies was to evaluate an exposure-based cognitive behavioural therapy protocol (MI-CBT) targeting cardiac anxiety following MI, assessing feasibility, acceptability, and the intervention's potential for reducing cardiac anxiety and improving health-related quality of life (QoL). Methods and results A series of two sequential, uncontrolled pilot studies were conducted. In Pilot Study 1 (n = 15), MI-CBT was delivered via face-to-face videoconference, while Pilot Study 2 (n = 23) was delivered online. Patients with a history of MI (≥6 months before assessment, type 1 ST- or non-ST-segment elevation MI, and elevated cardiac anxiety as per clinical interview) were included. The interventions lasted 8 weeks and were therapist-led, with key components including exposure to cardiac-related symptoms and reduction of avoidance behaviours. Participants completed self-rated assessments, including the Cardiac Anxiety Questionnaire (CAQ) and the 12-Item Short Form Health Survey (SF-12), at baseline, post-treatment, and 6-month follow-up. Treatment adherence and satisfaction were high. Cognitive behavioural therapy led to a large reduction in cardiac anxiety, as measured by the CAQ (P < 0.001), and significant improvements in health-related QoL, as measured by the SF-12 (P < 0.001), in both pilot studies. Conclusion These studies suggest that exposure-based CBT is a feasible, acceptable, and promising approach to reduce cardiac anxiety and improve QoL following MI. A randomized controlled trial should be conducted to evaluate the efficacy of the intervention.

Sponsoring Organization:
USDOE Office of Electricity (OE), Advanced Grid Research & Development. Power Systems Engineering Research
OSTI ID:
2545944
Journal Information:
European Heart Journal Open, Journal Name: European Heart Journal Open Journal Issue: 2 Vol. 5; ISSN 2752-4191
Publisher:
Oxford University PressCopyright Statement
Country of Publication:
Country unknown/Code not available
Language:
English

References (37)

A Brief Measure for Assessing Generalized Anxiety Disorder journal May 2006
Randomized Controlled Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent Recurrent Cardiovascular Events in Patients With Coronary Heart Disease journal January 2011
Anxiety Disorders journal December 2022
Exposure Therapy and Its Mechanisms book January 2023
The client satisfaction questionnaire journal January 1982
The Cardiac Anxiety Questionnaire: development and preliminary validity journal October 2000
Psychometric evaluation of the 12-item short-form health survey (SF-12) in osteoarthritis and rheumatoid arthritis clinical trials journal July 2001
Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: An Uncontrolled Pilot Study journal November 2017
Provoking symptoms to relieve symptoms: A randomized controlled dismantling study of exposure therapy in irritable bowel syndrome journal April 2014
Maximizing exposure therapy: An inhibitory learning approach journal July 2014
Association of anxiety or depression with risk of recurrent cardiovascular events and death after myocardial infarction: A nationwide registry study journal June 2023
Efficacy of internet-delivered cognitive behavioural therapy following an acute coronary event: A randomized controlled trial journal September 2020
Effectiveness and prediction of treatment adherence to guided internet-based cognitive behavioral therapy for health anxiety: A cohort study in routine psychiatric care journal December 2024
Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019 journal December 2020
Cognitive Behavioral Therapy Improves Quality of Life in Patients With Symptomatic Paroxysmal Atrial Fibrillation journal July 2023
Global prevalence of depression, anxiety, and stress in cardiac patients: A systematic review and meta-analysis journal March 2023
One-year follow up of cardiac anxiety after a myocardial infarction: A latent class analysis journal November 2012
Association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease journal April 2020
Efficacy of psychological interventions on clinical outcomes of coronary artery disease: Systematic review and meta-analysis journal February 2022
Assessment of fear of fear in agoraphobics: The Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. journal December 1984
The PHQ-9: Validity of a brief depression severity measure journal September 2001
Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis journal December 2017
Psychological treatments for irritable bowel syndrome: a comprehensive systematic review and meta-analysis journal June 2023
2023 ESC Guidelines for the management of acute coronary syndromes journal August 2023
2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation journal August 2017
Association of anxiety and recurrent cardiovascular events: investigating different aspects of anxiety journal March 2024
Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II journal June 1993
Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association journal March 2021
The prevalence and impact of depression and anxiety in cardiac rehabilitation: A longitudinal cohort study journal October 2019
Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction journal November 2016
Internet-Delivered Exposure-Based Therapy for Symptom Preoccupation in Atrial Fibrillation: Uncontrolled Pilot Trial journal March 2021
Cognitive Behavioral Therapy for Symptom Preoccupation Among Patients With Premature Ventricular Contractions: Nonrandomized Pretest-Posttest Study journal May 2024
Internet-Based Cognitive Behavioral Therapy for Symptoms of Depression and Anxiety Among Patients With a Recent Myocardial Infarction: The U-CARE Heart Randomized Controlled Trial journal March 2018
A Global Measure of Perceived Stress journal December 1983
Validation of a questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease journal January 2012
The Godin-Shephard Leisure-Time Physical Activity Questionnaire: Validity Evidence Supporting its Use for Classifying Healthy Adults into Active and Insufficiently Active Categories journal April 2015
Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: A meta-analysis journal November 2021