April 25, 2022Health PsychologyOpen Access

Metacognitive therapy self-help for anxiety-depression: Single-blind randomized feasibility trial in cardiovascular disease.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Cardiovascular disease with elevated anxiety and/or depression (n=108). Intervention: Home-based self-help metacognitive therapy (home-MCT) plus usual cardiac rehabilitation vs. Usual cardiac rehabilitation alone. Primary outcome: Feasibility and acceptability (recruitment rate, retention, adherence, and credibility).

Q: What does this research mean for the field?

Home-based metacognitive therapy is feasible and acceptable to deliver to cardiac rehabilitation patients experiencing anxiety and depression, with high recruitment and retention rates supporting a full-scale trial. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Home-based metacognitive therapy proves feasible and acceptable for cardiac rehab patients with anxiety and depression.

n=108

Why the study?

One in three CVD patients experience anxiety and depression, but current face-to-face psychological interventions have limited efficacy and present access barriers.

Does home-based self-help metacognitive therapy improve feasibility and acceptability outcomes when added to cardiac rehabilitation in patients with anxiety and depression?

Comparison

Usual CR plus home-MCT vs usual CR

Design

Single-blind randomized feasibility trial

Authors

AWAdrian WellsWest Virginia University DRDavid ReevesManchester Academic Health Science Centre CHCalvin HealCross-Cutting Cardiology

Discussion

Member takes

Implication

Supports integration into cardiac rehabilitation; extends feasibility data to justify efficacy RCT.

Study Design

Type

RCT (n=108)

Blinding

Single-blind

Randomization

1:1 ratio using randomized blocks of size 4 and 6, stratified by sex and screening HADS score

Multicenter

Yes

Structured PICO

Does home-based self-help metacognitive therapy improve feasibility and acceptability outcomes when added to cardiac rehabilitation in patients with anxiety and depression?

Population

108 cardiac rehabilitation (CR) patients with elevated anxiety and/or depression (HADS score ≥8 on either subscale), mean age 59.9 years, 69 males (63.9%), 96.3% White. Underlying conditions included acute coronary syndrome (n=80), revascularization (n=33), heart failure (n=15), angina (n=2), implantation of cardioverter defibrillator (n=2), and heart valve repair/replacement (n=7).

Intervention

Assisted home-based self-help metacognitive therapy (home-MCT) consisting of a 6-module paper manual and 3 telephone support calls (up to 30 min each) delivered by CR staff, added to usual cardiac rehabilitation.

Comparator

Usual cardiac rehabilitation alone (8 to 10 weeks of group exercise classes and educational seminars).

Outcome

Feasibility and acceptability of adding home-MCT to CR, based on credibility or expectancy ratings, recruitment rate, drop-outs, number of CR and home-MCT modules completed, and ability of outcome measures to discriminate between patients.

Home-based metacognitive therapy is a feasible and acceptable addition to cardiac rehabilitation for patients experiencing anxiety and depression, supporting the progression to a full-scale efficacy trial.

Limitations

Lack of participation data for patients who dropped out or did not return the credibility questionnaire
The delivery quality of the telephone support calls by cardiac rehabilitation staff was predominantly rated as poor
Higher attrition rate in the home-MCT arm (17%) compared to the control arm
Quality of telephone support calls delivered by CR staff trained in MCT was lower than expected

Cite This Study

Wells et al. (2022) conducted an RCT in Cardiovascular disease with elevated anxiety and/or depression (n=108). Home-based self-help metacognitive therapy (home-MCT) plus usual cardiac rehabilitation vs. Usual cardiac rehabilitation alone was evaluated on Feasibility and acceptability (recruitment rate, retention, adherence, and credibility). Home-based metacognitive therapy was feasible and acceptable to deliver to cardiac rehabilitation patients experiencing anxiety and depression, with high recruitment and retention rates supporting a full-scale trial.

synapsesocial.com/papers/6a17413f95fbca339c8d7524 https://doi.org/10.1037/hea0001168

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Metacognitive therapy self-help for anxiety-depression: Single-blind randomized feasibility trial in cardiovascular disease.

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Metacognitive therapy self-help for anxiety-depression: Single-blind randomized feasibility trial in cardiovascular disease.

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

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