A randomised study led by Greater Manchester Mental Health NHS Foundation Trust (GMMH) and the University of Manchester (UoM) has found that a psychological therapy called Metacognitive Therapy (MCT) can reduce symptoms of depression, anxiety and post-traumatic stress in patients undergoing cardiac rehabilitation when delivered in a self-help format.
Many patients with cardiovascular disease are referred into a cardiac rehabilitation programme, either at a clinic or remotely from their home, to support their recovery. Currently, psychological support and specific mental health treatment offered as part of these programmes varies by site and is limited. Yet, treating anxiety and depression is crucial as research shows that this type of distress reduces quality of life, and increases the risk of further heart problems and even death, according to the research team.
The findings from the MCT-PATHWAY study, published in PLOS Medicine, build on previous research which found that group-based MCT was effective in reducing symptoms of anxiety and depression in cardiac patients. This study shows that MCT can be delivered both in a group-based and home-based treatment, widening patient choice for mental health support in cardiac rehabilitation services.
In this study, 118 cardiac patients were randomly allocated to receive Home-MCT plus standard cardiac rehabilitation treatment, while 122 patients were allocated to standard cardiac rehabilitation. Patients receiving Home-MCT were provided with a self-help manual that they worked through at their own pace.
The manual included modules on developing techniques to reduce worry and rumination (dwelling on the past), and new ways to react to negative or distressing thoughts. In addition to the manual, patients receiving Home-MCT also received support phone calls from trained staff to provide opportunities for reflection and to consolidate learning.
Patients in the trial who received home-based MCT experienced significant reductions in symptoms of anxiety, depression and post-traumatic stress, compared to those receiving standard cardiac rehabilitation only. The results indicate that Metacognitive Therapy can be effective when delivered both by a therapist in a group setting (as shown in previous research), and when accessed remotely from home, according to the study team. This flexibility in how MCT can be delivered will enable healthcare providers to offer patients greater choice in how they access psychological components of cardiac rehabilitation programmes.
PATHWAY chief investigator, Adrian Wells (The University of Manchester, Manchester, UK), commented: “It is not surprising that people living with or recovering from serious heart problems experience symptoms of anxiety, depression and trauma. They are often recovering from potentially life-limiting conditions and uncertainty which understandably causes distress. What is important is that we recognise this and provide patients with effective, evidence-based treatment options. The results of our trial have shown that home-based MCT can help cardiac patients discover new and more helpful ways to process their distressing thoughts, whether they are undergoing treatment at home or at a clinic.”
Research published in JAMA Network Open last month has concluded that patients with depression were 10–20% less likely to adhere to guideline-directed medical therapy after percutaneous coronary intervention (PCI).