Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: A meta-analysis

Abstract

BACKGROUND Recently, the efficacy of cognitive behavioral therapy (CBT)-based intervention on health outcomes in patients with coronary heart disease (CHD) has been recognized in randomized controlled trials (RCTs), but no comprehensive systematic review has been conducted. To address this research gap, our study aimed to evaluate whether comprehensive CBT-based interventions positively affect health outcomes in CHD patients. It was hypothesized that CBT-based interventions are effective in: (1) Reducing depression, anxiety, and stress symptoms; (2) Reducing body mass index, blood pressure, and lipid levels; and (3) Improving quality of life, and exercise endurance. AIM To verify the effectiveness of CBT-based interventions on CHD patients through a meta-analysis of previous publications. METHODS Relevant RCTs published in English were obtained by searching electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Proquest, with the retrieval time from inception to August 2020. The primary outcomes were psychological factors (depression, anxiety, and stress symptoms), physiological factors (body mass index, blood pressure, blood lipids). The secondary outcomes included quality of life and exercise endurance. We used Review Manager 5.3 to conduct the meta-analysis and used the Physiotherapy Evidence Database tool to evaluate the quality of studies. RESULTS A total of 22 RCTs comprising 4991 patients with CHD were included in the systematic review and meta-analysis. The main analysis revealed that CBT-based intervention can reduce depression symptoms: -2.00 [95% confidence interval (CI): -2.83 to -1.16, P < 0.001]; anxiety symptoms: -2.07 (95%CI: -3.39 to -0.75, P = 0.002); stress symptoms: -3.33 (95%CI: -4.23 to -2.44, P < 0.001); body mass index: -0.47 (95%CI: -0.81 to -0.13, P = 0.006); and improve physical functioning: 3.36 (95%CI: 1.63 to 5.10, P = 0.000) and mental functioning: 6.91 (95%CI: 4.10 to 9.73, P < 0.001). Moreover, subgroup analysis results showed that CBT-based interventions were more effective for symptoms of depression and anxiety in CHD patients when individual, as opposed to group treatment, and psycho-education, behavioral and cognitive strategies were applied as the core treatment approaches. CONCLUSION CBT-based interventions are effective treatment strategies for CHD patients, significantly improving their symptoms of depression, anxiety and stress, body mass index, and health-related quality of life.

Psychological and Psychopharmacological Interventions in Psychocardiology

“…Common components of these treatment strategies are the enabling of patients to reduce or remove the stressor, interventions to improve stress coping, and stress reduction strategies ( 173 ). Although there is limited empirical evidence, CBT and CBT-derived strategies are promising treatment interventions in patients with CVD and adjustment disorders ( 172 , 173 ) and for CVD disorders per se ( 160 , 161 ).…”

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Effects of Perinatal Cognitive Behavioral Therapy on Delivery Mode, Fetal Outcome, and Postpartum Depression and Anxiety in Women

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