Treating Anxiety in Patients with Coronary Heart Disease: A Randomized Controlled Trial

Abstract

Background: Anxiety is frequent in patients with coronary heart disease (CHD) and influences the course of the disease, but no randomized controlled trial has investigated the effects of a psychotherapy intervention in CHD patients with elevated anxiety scores. The main aim of this study was to evaluate the effects of a 6-month psychotherapy intervention on anxiety in this group of patients. Methods: Fifty-two patients (61 ± 8.0 years, 14 female) with CHD and elevated levels of anxiety completed the study after randomization into a 6-month psychotherapy intervention or a control condition. Medically eligible patients were screened for anxiety with the Hospital Anxiety and Depression Scale (HADS) and were included if they had a score of 8 or higher. Anxiety scores were reevaluated at 6-month follow-up (after the treatment). Results: At 6-month follow-up significant reductions (intervention group: –2.0 ± 2.3; control group: –1.8 ± 2.8; p < 0.01) were found in both groups in the HADS anxiety scale but no significant differences between the groups were observed. Adjustment for baseline differences and disease severity did not change these results. Conclusions: Our study showed that elevated anxiety scores were reduced over time but there was no statistically significant effect of the psychotherapy intervention in anxious patients with CHD. Changes in the design of the intervention and study might be useful to further investigate this topic in the future.

Treatment of Anxiety in Patients With Coronary Heart Disease: A Systematic Review

“…For the majority of studies (93 studies, out of 119), the inclusion criteria did not specifically include a psychiatric diagnosis of an anxiety disorder. Of the remaining 26 studies, 4 included elevated anxiety in their inclusion criteria (30, 31, 39, 43), 9 included patients with anxiety and/or depression (44-52), 8 included patients with depression, depressive symptoms, or mood disorder only (36, 37, 40, 53-57), 3 included patients with ‘distress’ (10, 58, 59), one included patients with “psychosomatic symptoms” including restlessness, anxiety, altered mood, and insomnia (60), and another included patients with “exhaustion” (61).…”

“…Ten interventions primarily involved forms of cognitive-behavioral therapy (CBT) (47, 48, 54, 55, 90-92). Two of these CBT-focused studies also provided stress management training (53, 93) and one included antidepressant medication (68); eight involved skills training such as problem-solving and self-management strategies (10, 36, 61, 62, 94-97); three studies provided social support or ‘mentorship’ to patients (38, 98, 99), two provided psychotherapy (30, 100); and one involved future care planning and related counseling (65). One offered patients a choice between problem solving counseling, antidepressant therapy, or both (37).…”

“…Although anxiety is common in the CHD population and has been associated with increased risk for adverse events in some studies, the value of treating anxiety in these patients has received considerably less attention compared to depression(30, 31). Several meta-analyses show that exercise-based cardiac rehabilitation programs (CR) (32, 33), and music therapy (34) may reduce anxiety in CHD patients, but these reports are based on relatively few published studies employing a variety of different interventions.…”

Qualitative Analysis of Emotional Distress in Cardiac Patients From the Perspectives of Cognitive Behavioral and Metacognitive Theories: Why Might Cognitive Behavioral Therapy Have Limited Benefit, and Might Metacognitive Therapy Be More Effective?

“…A recently updated Cochrane review assessed the efficacy of psychological interventions in CHD patients compared with usual care (Richards et al, 2017). Although this review did not report effects for CBT specifically, we calculated the effect size across those reviewed studies that evaluated interventions based on CBT and that reported outcomes for depression and/or anxiety (Burgess et al, 1987; Black et al, 1998; Berkman et al, 2003; Claesson et al, 2005; McLaughlin et al, 2005; Michalsen et al, 2005; Koertge et al, 2008; Freedland et al, 2009; Merswelken et al, 2011; Turner et al, 2012, 2014; O'Neil et al, 2015). Again, effect sizes were small: 0.29 and 0.24 for anxiety and depression, respectively.…”

Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart): study protocol for a randomized controlled trial

“…Despite the fact that anxiety is a risk factor for MI, very few treatment studies on anxiety in patients with a recent MI have been conducted [ 11 ]. To our knowledge, there is only one randomized controlled clinical trial (RCT), which showed no effect of the intervention [ 13 ]. There are several studies that have used group-based interventions focusing on a broader range of psychosocial risk factors with good results.…”