scholarly journals The Experience of Participating in an Internet-Based Cognitive Behavioral Therapy Program Among Patients with Cardiovascular Disease and Depression: A Qualitative Interview Study

2022 ◽  
Author(s):  
Mats Westas ◽  
Ghassan Mourad ◽  
Gerhard Andersson ◽  
Margit Neher ◽  
Johan Lundgren ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Qualitative Interview ◽  
Interview Study ◽  
Cognitive Behavioral ◽  
Qualitative Interview Study ◽  
And Behaviors ◽  
The Impact

Abstract Background Depression in cardiovascular disease (CVD) is associated with poor outcomes and there is a treatment gap of depression in CVD patients. Recently we found that an Internet-based cognitive behavioral therapy (iCBT) tailored for CVD patients led to reduced symptoms of depression. However, we still have little knowledge about CVD patients’ experiences of working with iCBT. The aim of this study was therefore to explore CVD patients experience of engaging with a tailored iCBT program. Methods A qualitative interview study using inductive thematic analysis. Data was obtained from 20 patients with CVD and depressive symptoms who had participated in a randomized controlled trial (RCT) evaluating the impact of a nine-week iCBT program on depression. Results Three main themes emerged: (1) Taking control of the disease, (2) Not just a walk in the park, and (3) Feeling a personal engagement with the iCBT program. The first theme included comments that the tailored program gave the patients a feeling of being active in the treatment process and helped them achieve changes in thoughts and behaviors necessary to take control of their CVD. The second theme showed that patients also experienced the program as demanding and emotionally challenging. However, it was viewed as helpful to challenge negative thinking about living with CVD and to change depressive thoughts. In the third theme patients reported that the structure inherent in the program, in the form of organizing their own health and the scheduled feedback from the therapist created a feeling of being seen as an individual. The feeling of being acknowledged as a person also made it easier to continuously work with the changes necessary to improve their health. Conclusions Engaging in an iCBT program tailored for patients with CVD and depression was by the patients perceived as helpful in the treatment of depression. They experienced positive changes in emotions, thoughts, and behaviors which a result of learning to take control of their CVD, being confirmed and getting support. The patients considered working with the iCBT program as demanding and emotionally challenging, but necessary to achieve changes in emotions, thoughts, and behaviors.

Patients with cardiovascular disease and depression and their experiences of how a tailored internet-based cognitive behavioral therapy influences their emotions, thoughts, and behaviors. (Preprint)

2020 ◽  
Author(s):  
Mats Westas ◽  
Peter Johansson ◽  
Gerhard Andersson ◽  
Johan Lundgren ◽  
Ghassan Mourad ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Depressive Symptoms ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Qualitative Interview ◽  
Poor Quality ◽  
Interview Study ◽  
Cognitive Behavioral ◽  
Qualitative Interview Study ◽  
And Behaviors

BACKGROUND Depression in cardiovascular disease (CVD) is associated with poor quality of life and a worse prognosis. There is also a treatment gap for depression in people living with CVD. Internet-based cognitive behavioral therapy (iCBT) has been suggested as a solution. In a recent study we found that an iCBT treatment tailored for patients with CVD led to reduced levels of depression. However, we still have little knowledge about how patients with CVD and depression experience the changes they go through during iCBT for depressive symptoms. OBJECTIVE The aim of this qualitative interview study was to explore how an iCBT program tailored for patients with CVD and depressive symptoms influenced their emotions, thoughts, and behaviors. METHODS Design A qualitative interview study. Data were analyzed using inductive thematic analysis. Settings 20 patients with CVD from southeast Sweden who had participated in a nine-week iCBT program for depression were included. RESULTS Three main themes emerged: (1) Taking control of the disease, (2) Not just a walk in the park, and (3) Feeling a personal engagement with the iCBT program. The contents of the first theme included comments that the tailored content of the program gave the patients a feeling of being active in the treatment process, and helped them achieve changes in thoughts and behaviors necessary to take control of their cardiovascular disease. In contrast, the second theme showed that patients also experienced the program as demanding and emotionally challenging. However, it was viewed as helpful to challenge negative thinking about living with CVD and to change depressive thoughts. In the third theme patients reported that the structure inherent in the program, in the form of organizing their own health and the scheduled feedback from the therapist, was appreciated and conveyed a feeling of being seen as an individual. The patients described how the feeling of being acknowledged as a person made it easier to continuously work with the changes necessary to improve their health. CONCLUSIONS An iCBT program tailored for patients with CVD and depression was found to influence patients’ emotions, thoughts, and behaviors. This was achieved by learning to take control of their CVD and by feeling acknowledged as a person, including having support. The patients considered working with the iCBT program demanding and emotionally challenging, but necessary to achieve change in emotions, thoughts, and behaviors. CLINICALTRIAL The trial is registered at ClinicalTrials.gov, NCT02778074

scholarly journals An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial

10.2196/14648 ◽  
2019 ◽  
Vol 6 (10) ◽  
pp. e14648 ◽  
Author(s):  
Peter Johansson ◽  
Mats Westas ◽  
Gerhard Andersson ◽  
Urban Alehagen ◽  
Anders Broström ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Randomized Controlled Trial ◽  
Cognitive Behavioral Therapy ◽  
Primary Outcome ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Eq Vas

Background Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression. Objective The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD. Methods A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire–9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale–self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models. Results Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=−2.34 [95% CI −3.58 to −1.10], P<.001, Cohen d=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; P<.001, Cohen d=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (P<.001, Cohen d=0.66) and the EQ-VAS (P<.001, Cohen d=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression. Conclusions Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time. Trial Registration ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074

scholarly journals Sleeping for two: study protocol for a randomized controlled trial of cognitive behavioral therapy for insomnia in pregnant women

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anna L. MacKinnon ◽  
Joshua W. Madsen ◽  
Ashley Dhillon ◽  
Elizabeth Keys ◽  
Gerald F. Giesbrecht ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cognitive Behavioral Therapy ◽  
Pregnant Women ◽  
Sleep Problems ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Randomized Controlled ◽  
The Impact ◽  
In Pregnancy

Abstract Background Insomnia and sleep disturbances are common in pregnancy and have potentially significant consequences for both maternal and infant health. There is limited research examining the effectiveness of cognitive behavioral therapy for insomnia (CBT-I) during pregnancy. With increased distress and limited access to services during the COVID-19 pandemic, there is also an unprecedented need for telehealth delivery of treatment programs for pregnant women. The aims of this trial are to evaluate the impact of the Sleeping for Two adaptation of CBT-I in pregnancy (in-person or telehealth) versus treatment as usual (TAU) in reducing symptoms of insomnia (primary outcome), as well as increasing gestational length and reducing symptoms of depression (secondary outcomes). Methods A two-arm, single-blinded, parallel group randomized controlled trial (RCT) design with repeated measures will be used to evaluate the impact of CBT-I compared to TAU among a sample of 62 pregnant women, enrolled between 12 and 28 weeks of gestation, who self-identify as experiencing insomnia. Five weekly individual sessions of CBT-I will be delivered in person or via telehealth depending on physical distancing guidelines. Assessment of insomnia diagnosis by structured interview, self-reported insomnia symptom severity and sleep problems, and sleep quantity and quality as measured by a daily diary and actigraphy will occur at 12–28 weeks of pregnancy (T1), 1 week post-treatment (T2), and 6 months postpartum (T3). Discussion CBT-I delivered in pregnancy has the potential to reduce symptoms of insomnia and depression and could lead to reduced risk of preterm birth, all of which can minimize risk of negative maternal and child health and developmental consequences in the short (e.g., infant death) and long terms (e.g., developmental delays). This RCT builds on a successful open pilot trial conducted by our team and will provide further evaluation of a novel evidence-based treatment for pregnancy-related insomnia, which can be widely disseminated and used to treat individuals that are most in need of intervention. Findings will enhance understanding of pregnancy-related sleep problems, as well as means by which to improve the health and sleep of mothers and their children. Trial registration ClinicalTrials.gov NCT03918057. Registered on 17 April 2019.

scholarly journals An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Peter Johansson ◽  
Mats Westas ◽  
Gerhard Andersson ◽  
Urban Alehagen ◽  
Anders Broström ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Randomized Controlled Trial ◽  
Cognitive Behavioral Therapy ◽  
Primary Outcome ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Eq Vas

BACKGROUND Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression. OBJECTIVE The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD. METHODS A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire–9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale–self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models. RESULTS Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=−2.34 [95% CI −3.58 to −1.10], <italic>P</italic>&lt;.001, Cohen <italic>d</italic>=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; <italic>P</italic>&lt;.001, Cohen <italic>d</italic>=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (<italic>P</italic>&lt;.001, Cohen <italic>d</italic>=0.66) and the EQ-VAS (<italic>P</italic>&lt;.001, Cohen <italic>d</italic>=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression. CONCLUSIONS Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time. CLINICALTRIAL ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074

Preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders: A randomized controlled trial.

2019 ◽  
Vol 87 (6) ◽  
pp. 521-529 ◽  
Author(s):  
Margo de Jonge ◽  
Claudi L. H. Bockting ◽  
Martijn J. Kikkert ◽  
Maarten K. van Dijk ◽  
Digna J. F. van Schaik ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cognitive Behavioral Therapy ◽  
Cognitive Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Randomized Controlled

The effect of feedback-informed cognitive behavioral therapy on treatment outcome: A randomized controlled trial.

2020 ◽  
Vol 88 (9) ◽  
pp. 818-828
Author(s):  
Pauline D. Janse ◽  
Kim de Jong ◽  
Carola Veerkamp ◽  
Maarten K. van Dijk ◽  
Giel J. M. Hutschemaekers ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Treatment Outcome ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Randomized Controlled
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