Effects of cognitive behavioral therapy on anxiety and depression in patients with myocardial infarction: a systematic review and meta-analysis

Background Anxiety and depressive symptoms are highly prevalent comorbidities among patients with myocardial infarction (MI). Although cognitive behavioral therapy (CBT) is a well-established intervention for depression, its efficacy in MI patients remains inconclusive. Objective To evaluate the effects of CBT on anxiety, depressive symptoms, and sleep quality in patients following MI. Design This is a systematic review and meta-analysis. The study followed the PRISMA 2020 guidelines for reporting. Methods Nine electronic databases were searched from inception to March 2025 to identify randomized controlled trials (RCTs) evaluating CBT in patients with MI. Two independent researchers screened the literature, assessed study quality, and extracted data based on predefined inclusion and exclusion criteria. Random-effects meta-analyses were performed to calculate mean differences, with statistical analyses conducted using Stata 15.0. Results Eleven RCTs involving 1,575 participants were included. The findings showed that CBT led to greater improvements in anxiety and depressive symptoms compared with control interventions. In addition, CBT significantly improved sleep quality among patients after MI. Conclusion CBT is associated with improvements in psychological and sleep outcomes following MI. However, the existing evidence shows high variability and heterogeneity. Further large-scale, high-quality trials are needed to confirm these findings and develop standardized protocols for implementing CBT in this patient population. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42025636352 , identifier CRD42025636352.