The effect of Internet-delivered cognitive behavioural therapy vs. psychoeducation only on psychological distress in patients with non-cardiac chest pain: a randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Ghassan Mourad ◽  
Magda Eriksson-Liebon ◽  
Patric Karlström ◽  
Peter Johansson
Keyword(s):  
Physical Activity ◽  
Psychological Distress ◽  
Depressive Symptoms ◽  
Chest Pain ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Cardiac Anxiety ◽  
Cognitive Behavioural ◽  
Secondary Outcomes

BACKGROUND Patients with recurrent episodes of non-cardiac chest pain (NCCP) suffer from cardiac anxiety, as they misinterpret the pain to be cardiac-related and avoid physical activity that they think could threaten their lives. Psychological interventions, such as Internet-delivered cognitive behavioural therapy (iCBT), targeting anxiety can be a feasible solution by supporting patients to learn how to perceive and handle their chest pain. OBJECTIVE To evaluate the effects of a nurse-led iCBT program on cardiac anxiety and other patient-reported outcomes in patients with NCCP. METHODS Patients with at least two healthcare consultations due to NCCP during the last 6 months, and who were suffering from cardiac anxiety (Cardiac Anxiety Questionnaire (CAQ) score ≥24), were randomized into 5 weeks of iCBT (n=54) or psychoeducation (n=55). Patients were 54 (±17) vs 57 (±16) years old and mainly women (59% vs 64%). The iCBT program comprised psychoeducation, mindfulness, and exposure to physical activity, with weekly homework assignments. The primary outcome was cardiac anxiety. The secondary outcomes were fear of body sensations, depressive symptoms, health-related quality of life (HRQoL), and chest pain frequency. Intention-to-treat analysis was applied, and patients were followed-up for three months. A mixed model analysis was used to determine between-group differences in primary and secondary outcomes. RESULTS No significant differences were found between the iCBT and psychoeducation groups regarding cardiac anxiety or any of the secondary outcomes in terms of interaction effect of time and group over the 3-months follow-up. iCBT demonstrated a small effect size on cardiac anxiety (Cohen’s d=0.31). In the iCBT group, 16 patients (36%) reported a positive reliable change score (≥11 points on the CAQ), and thus an improvement in cardiac anxiety, to be compared with 13 patients (27 %) in the psychoeducation group. Within-group analysis showed further significant improvement in cardiac anxiety (p=.037), depressive symptoms (p=.007) and of NCCP frequency (p=.005) at 3-months follow-up compared to 5-weeks follow-up in the iCBT group, but not in the psychoeducation group. CONCLUSIONS iCBT was not superior to psychoeducation in decreasing cardiac anxiety in patients with NCCP. However, iCBT tends to have better long-term effects on psychological distress, including cardiac anxiety, HRQoL and NCCP frequency than psychoeducation. The effects need to be followed up in order to draw more reliable conclusions. CLINICALTRIAL The study was registered at ClinicalTrials.gov, NCT03336112; https://www.clinicaltrials.gov/ct2/show/NCT03336112

scholarly journals Trajectories and associations between depression and physical activity in patients with cardiovascular disease during participation in an internet-based cognitive behavioural therapy programme

2020 ◽  
pp. 147451512094725
Author(s):  
Peter Johansson ◽  
Erland Svensson ◽  
Gerhard Andersson ◽  
Johan Lundgren
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Depressive Symptoms ◽  
Cognitive Behavioural Therapy ◽  
Therapy Group ◽  
Behavioural Therapy ◽  
The Internet ◽  
Online Discussion Forum ◽  
Cognitive Behavioural

Background: There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity. Aim: To examine trajectories of depressive symptoms and physical activity, and to explore if these trajectories are linked with the delivery of internet-based cognitive behavioural therapy. Methods: A secondary-analysis of data collected in a randomised controlled trial that evaluated the effects of a 9-week internet-based cognitive behavioural therapy programme compared to an online discussion forum on depressive symptoms in cardiovascular disease patients. Data were collected at baseline, once weekly during the 9-week intervention period and at the 9-week follow-up. The Montgomery Åsberg depression rating scale – self-rating (MADRS-S) was used to measure depressive symptoms. Two modified items from the physical activity questionnaire measuring frequency and length of physical activity were merged to form a physical activity factor. Results: After 2 weeks the internet-based cognitive behavioural therapy group had a temporary worsening in depressive symptoms. At 9-week follow-up, depressive symptoms ( P<0.001) and physical activity ( P=0.02) had improved more in the internet-based cognitive behavioural therapy group. Only in the internet-based cognitive behavioural therapy group, was a significant correlation ( r=–0.39, P=0.002) between changes in depressive symptoms and changes in physical activity found. Structural equation analyses revealed that internet-based cognitive behavioural therapy decreased depressive symptoms, and that a decrease in depression, in turn, resulted in an increase in physical activity. Conclusions: Internet-based cognitive behavioural therapy was more effective than an online discussion forum to decrease depressive symptoms and increase physical activity. Importantly, a decrease in depressive symptoms needs to precede an increase in physical activity.

The Effectiveness of Internet-Based Cognitive Behavioural Therapy with Telephone Support for Non-Cardiac Chest Pain: a Randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Terje Thesen ◽  
Joseph A. Himle ◽  
Egil W. Martinsen ◽  
Liv T. Walseth ◽  
Frode Thorup ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Chest Pain ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Cardiac Anxiety ◽  
Related Quality ◽  
Eq Vas

BACKGROUND Non-cardiac chest pain (NCCP) is highly prevalent and associated with reduced quality of life, anxiety, avoidance of physical activity and high societal costs. There is a lack of an effective low-cost, easy to distribute intervention to assist NCCP patients. OBJECTIVE This study aimed to investigate the effectiveness of internet-based cognitive behavioural therapy (I-CBT) with telephone support for non-cardiac chest pain (NCCP). METHODS A randomized controlled trial comparing I-CBT to a treatment-as-usual (TAU) control condition with 12-month follow-up was conducted at a cardiac department. A total of 162 participants aged 18-70 with a diagnosis of NCCP were randomized to I-CBT (n=81) or TAU (n=81). The participants in the experimental condition received six weekly sessions of I-CBT. The sessions covered different topics related to coping with NCCP (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to the I-CBT sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence and to provide access to the next session. Participants in the TAU group received standard care for their NCCP without any restrictions. Primary outcomes were cardiac anxiety measured by the Cardiac Anxiety Questionnaire (CAQ) and fear of bodily sensations measured by the Body Sensations Questionnaire (BSQ). Secondary outcomes were depression measured using the Patient Health Questionnaire (PHQ-9), health related quality of life measured using EuroQol Visual Analogue Scale (EQ-VAS) and level of physical activity assessed by an investigator-developed self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 ≥5) was conducted. Linear mixed models were used to evaluate treatment effects. Cohen’s d were used to calculate effect sizes. RESULTS In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the I-CBT group had significant improvements in CAQ (-3.4 points, 95% CI -5.7 to -1.1; P=.004, d=0.38) and a non-significant improvement in BSQ (-2.7 points, 95% CI -5.6 to 0.3; P=.073) compared with TAU. EQ-VAS at the 12-month follow-up improved with statistical and clinical significance in the I-CBT group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with TAU. Physical activity was significantly (P<.001) increased during the intervention period for the I-CBT group. Depression was significantly improved at post-treatment and 3-month follow-up, but not at 12-month follow-up. Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on CAQ (d=0.55) and EQ-VAS (d=0.71) at the 12-month follow-up. In the I-CBT group 84 % (n=68) completed at least five of the six sessions. CONCLUSIONS This study provides evidence that I-CBT with minimal therapist contact and focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with NCCP. CLINICALTRIAL ClinicalTrials.gov ID: NTC03096925

scholarly journals Internet-assisted cognitive behavioural therapy for non-cardiac chest pain: a pilot and feasibility study

2021 ◽  
Vol 14 ◽  
Author(s):  
Terje Thesen ◽  
Egil Jonsbu ◽  
Egil W. Martinsen ◽  
Joseph A. Himle ◽  
Frode Thorup ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cognitive Behavioural Therapy ◽  
Psychological Treatment ◽  
Retention Rate ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
List Type ◽  
Structured Interviews ◽  
Cognitive Behavioural

Abstract Nearly half of patients with non-cardiac chest pain (NCCP) experience significant complaints after a negative cardiac evaluation, at considerable costs for society. Due to the lack of treatment capacity and low interest for psychological treatment among patients with somatic complaints, only a minority receive effective treatment. The aim of this study was to assess the feasibility and usefulness of internet-assisted cognitive behavioural therapy (I-CBT), including encouragement of physical activity for this condition. Ten patients with NCCP received a six-session I-CBT intervention with minimal support from a therapist. Questionnaires assessing cardiac anxiety, fear of bodily sensations, depression, interpretation of symptoms, frequency of chest pain and impact of chest pain symptoms were collected at baseline, post-treatment and at 3-month follow-up. Semi-structured interviews employing a phenomenological hermeneutic approach assessed the participants’ experience of the intervention. Quantitative results showed clear improvements in several measures both at end of treatment and at 3-month follow-up. The retention rate was 100% and client satisfaction was high. The intervention was feasible to implement in a cardiac setting. This setting made it easier for patients to accept a psychological approach. Qualitative interviews revealed that the participants felt respected and taken care of, and they obtained a better understanding of their chest pain and how to cope with it. This pilot study yielded promising results regarding feasibility, clinical effect and patient satisfaction from a brief I-CBT intervention for NCCP in a cardiac setting. These results indicate that a randomized controlled trial with a larger sample size is warranted. Key learning aims (1) Feasibility of internet-assisted cognitive behavioural therapy (I-CBT) for non-cardiac chest pain (NCCP). (2) How NCCP patients experience I-CBT. (3) Possible effects of I-CBT. (4) How I-CBT can be delivered at the Cardiac Department.

Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial

2019 ◽  
Vol 50 (1) ◽  
pp. 11-19 ◽  
Author(s):  
Morten Hvenegaard ◽  
Stine B. Moeller ◽  
Stig Poulsen ◽  
Matthias Gondan ◽  
Ben Grafton ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Major Depression ◽  
Cognitive Behavioural Therapy ◽  
Medical Management ◽  
Primary Outcome ◽  
Behavioural Therapy ◽  
Post Treatment ◽  
Cognitive Behavioural ◽  
Group Cbt

AbstractBackgroundAlthough cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression.MethodsA total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224).ResultsRFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03–0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered.ConclusionsThis is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.

scholarly journals Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication

2005 ◽  
Vol 186 (4) ◽  
pp. 324-330 ◽  
Author(s):  
Lucia R. Valmaggia ◽  
Mark van der Gaag ◽  
Nicholas Tarrier ◽  
Marieke Pijnenborg ◽  
Cees J. Slooff
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Rating Scale ◽  
Behavioural Therapy ◽  
Controlled Study ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
Cognitive Behavioural ◽  
Supportive Counselling ◽  
Treatment Refractory

BackgroundThere is increasing evidence that cognitive–behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.AimsTo investigate the effects of cognitive–behavioural therapy on in-patients with treatment-refractory psychotic symptoms.MethodManualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.ResultsParticipants receiving cognitive–behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.ConclusionsCognitive–behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

Long-term Effects of Cognitive-Behavioural Therapy and Lithium Therapy on Depression in the Elderly

1995 ◽  
Vol 167 (5) ◽  
pp. 653-658 ◽  
Author(s):  
K. C. M. Wilson ◽  
M. Scott ◽  
M. Abou-Saleh ◽  
R. Burns ◽  
J. R. M. Copeland
Keyword(s):  
Maintenance Therapy ◽  
Cognitive Behavioural Therapy ◽  
Rating Scale ◽  
Behavioural Therapy ◽  
Lithium Therapy ◽  
Controlled Study ◽  
Depression Severity ◽  
Cognitive Behavioural

BackgroundWe examine the effects of cognitive-behavioural therapy (CBT) as an adjuvant to acute physical treatment and lithium maintenance therapy in reducing depression severity over a follow-up year in elderly depressed patients.MethodThe study consists of three phases. During the acute treatment and continuation phase, 17 of 31 patients received CBT as an adjuvant to treatment as usual. During the maintenance phase of 1 year, subjects were entered into a double-blind, placebo-controlled study of low-dose lithium therapy.ResultsReceiving adjuvant CBT significantly reduced patients' scores on the Hamilton Rating Scale for Depression during the follow-up year (repeated measures analyses of variance; P = 0.007). No significant differences were found between lithium and placebo maintenance therapy.ConclusionsCBT can be adapted as an adjuvant therapy in the treatment of severely depressed elderly patients and reduces depression severity during follow-up. The prophylactic failure of long-term lithium therapy may be explained through poor compliance.

scholarly journals Cognitive behavioural therapy significantly reduces anxiety in patients with implanted cardioverter defibrillator compared with usual care: Findings from the Screen-ICD randomised controlled trial

2019 ◽  
Vol 27 (3) ◽  
pp. 258-268 ◽  
Author(s):  
Selina K Berg ◽  
Trine B Rasmussen ◽  
Margrethe Herning ◽  
Jesper H Svendsen ◽  
Anne V Christensen ◽  
...  
Keyword(s):  
Usual Care ◽  
Cognitive Behavioural Therapy ◽  
Primary Outcome ◽  
Depression Scale ◽  
Behavioural Therapy ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Cardioverter Defibrillator ◽  
Cognitive Behavioural ◽  
Secondary Outcomes

Aim The aim of this study was to investigate the effect of a cognitive behavioural therapy intervention provided by trained cardiac nurses plus usual care compared with usual care alone in patients with an implanted cardioverter defibrillator who, prior to randomization, had presented with symptoms of anxiety measured by the Hospital Anxiety and Depression Scale. Background Around 20–25% of all patients with an implanted cardioverter defibrillator experience anxiety. Among these patients anxiety is associated with mortality, presumably explained by risk behaviour and activation of the autonomic nervous system. We hypothesised that cognitive behavioural therapy provided by cardiac nurses in an out-patient setting would be an effective treatment of anxiety. Methods This was an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive behavioural therapy plus usual care or to usual care. The primary outcome was Hospital Anxiety and Depression Scale-Anxiety mean score at 16 weeks. Secondary outcomes included Hospital Anxiety and Depression Scale-Depression, Becks Anxiety Inventory, HeartQoL and Hamilton Anxiety Scale. Primary outcome analysis was based on the intention-to-treat principle. Results A total of 88 participants were included, 66% men, mean age 64.3 years and 61% had primary indication implantable cardioverter defibrillator. A significant difference after 16 weeks was found between groups: intervention group (Hospital Anxiety and Depression Scale-A mean (standard deviation) 4.95 points (3.30) versus usual care group 8.98 points (4.03) ( p < 0.0001)). Cohen's d was –0.86, indicating a strong clinical effect. The effect was supported by secondary outcomes. Conclusion Cognitive behavioural therapy provided by cardiac nurses to patients with a positive screening for anxiety had a statistically and clinically significant effect on anxiety compared with patients not receiving cognitive behavioural therapy.

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