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

Abstract

BackgroundSymptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitive behavioral therapy (iCBT) has shown good results in other patient groups.ObjectiveThe aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms of depression and anxiety among patients with a recent MI.MethodsIn total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239 women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided, 14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessed over the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For the main analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS.ResultsThere was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no difference between the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of 46.2% (54/117) of the iCBT group did not complete the introductory module.ConclusionsiCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety compared with TAU. Low treatment adherence might have influenced the result.Trial RegistrationClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webcite at http://www.webcitation.org/6xWWSEQ22)

The Impact of Continuous Care Model on Main Symptoms of Myocardial Infarction

“…The comparison of the mean scores of various parameters regarding the main symptoms of myocardial infarction in the studied groups before intervention was indicative of the consistency of these two groups and the comparison of the mean scores of the different parameters of the main symptoms of myocardial infarction in the subsequent study groups. The intervention in the test group has signif icantly increased while compared with the control group, which is consistent with the results of the study by Norlund (2018); reported that the behavioral and physical counseling after few months improved the patient's physical and behavioral behavior and after a year of quality of life improved the quality of patients. Also, in a study of Baghaei (2015) the implementation of this model evidenced the improvement in the quality of life of patients in the test group in all aspects of the physical, emotional and general, and the test group which differed statistically from the control group.…”

Internet- and mobile-based aftercare and relapse prevention in mental disorders: A systematic review and recommendations for future research

“…Six studies provided an online or phone crisis management system ( Bauer et al, 2012 ; Ebert et al, 2013 ; Fichter et al, 2012 ; Gulec et al, 2014 ; Holländare et al, 2011 ; Kordy et al, 2016 ). Interventions differed regarding the sequence of intervention elements with consecutive ( Fichter et al, 2012 ; Holländare et al, 2011 ; Zwerenz et al, 2017b ) or flexible order ( Norlund et al, 2018 ; Willems et al, 2017a ).…”

“…The majority of studies ( n = 10) reported at least a medium follow-up period (6–12 months). Six studies reported a short (<6 months) ( Gulec et al, 2014 ; Kraft et al, 2017 ; Norlund et al, 2018 ; Schmädeke and Bischoff, 2015 ; Zwerenz et al, 2017b ; Zwerenz et al, 2017c ), and four studies a long-term follow-up period (>12 months) ( Fichter et al, 2013 ; Holländare et al, 2013 ; Jacobi et al, 2017 ; Kordy et al, 2016 ). Table 1 provides an overview of relevant characteristics of included studies ordered by the diagnostic focus of the studies (for a list of abbreviations of instruments, see Appendix D ).…”

Effect of exercise-based cardiac rehabilitation on anxiety and depression in patients with myocardial infarction: A systematic review and meta-analysis

“…In addition, the latest research shows internet-based CBT (iCBT) may improve patient access to acceptable, effective, and cost-effective psychological treatment, 55 and has been found to reduce symptoms of depression and anxiety among patients with MI. 56 On the other hand, there are cultural differences in how patients address anxiety and depression, such as the forest therapy used among Koreans and Japanese, Taijiquan and Baduanjin exercises for Chinese, and religious beliefs of American and Indian, among others. 57 The limitations of this meta-analysis and our systematic review should be considered.…”