Key result
An internet-delivered cognitive behavioral therapy program did not significantly increase the proportion of patients with normalized stress and anxiety levels compared to control (OR 2.37, p=0.088).
Why the study?
Patients with MINOCA or Takotsubo syndrome often suffer from poor mental health and low quality of life post event, but no evidence-based treatments are currently available.
Does an internet-delivered cognitive behavioral therapy program improve stress and anxiety in patients with MINOCA or Takotsubo syndrome?
RCT (n=88)
Open-label
Permuted block randomization (1:1 ratio, block size of 6)
Yes
Does an internet-delivered cognitive behavioral therapy program improve stress and anxiety in patients with MINOCA or Takotsubo syndrome?
Internet-delivered cognitive behavioral therapy reduced continuous measures of stress and anxiety in patients post-MINOCA or Takotsubo syndrome, though it did not significantly increase the composite proportion of patients achieving normalized ratings for both conditions.
Background Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS) often suffer from poor mental health and low quality‐of‐life post event, with no current evidence‐based treatments available. This study aimed to evaluate the effects of an internet‐delivered cognitive behavioral therapy program on stress and anxiety symptoms in patients diagnosed with myocardial infarction with nonobstructive coronary arteries or TS. Methods A parallel, multicenter, randomized controlled trial with a wait‐list control group was conducted. Patients with elevated symptoms of stress or anxiety were included (the 14‐item perceived stress scale ≥25 or hospital anxiety and depression scale, anxiety subscale ≥8). The primary outcome was normalized stress and anxiety levels 10 to 12 weeks after randomization. Secondary outcomes included normalized stress and anxiety separately and symptoms as continuous measures. Results A total of 88 patients were randomized (treatment: 45, control: 43). The treatment group showed a greater, though not statistically significant proportion of normalized patients (odds ratio, 2.37 [95% CI, 0.88–6.38], P =0.09). Secondary analyses indicated treatment effects on anxiety normalization and on symptoms as continuous measures (effect sizes: d=0.44–0.67). There was also an interaction between treatment and diagnosis (TS versus non‐TS), favoring a treatment effect in TS patients ( P =0.016). Conclusions The patient‐tailored internet‐delivered cognitive behavioral therapy program reduced stress and anxiety symptoms in patients with myocardial infarction with nonobstructive coronary arteries or TS and normalized anxiety symptoms in a greater proportion of treated patients than controls. Exploratory analyses indicated that patients with TS may experience greater benefit from the internet‐delivered cognitive behavioral therapy intervention, but this warrants further research.
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Leissner et al. (2026) conducted an RCT in Myocardial infarction with nonobstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS) (n=88). Internet-delivered cognitive behavioral therapy (iCBT) vs. Wait-list control (treatment as usual) was evaluated on Proportion of patients who reported normalized ratings of both stress (PSS-14 < 25) and anxiety (HADS-A < 8) (OR 2.37, 95% CI 0.88-6.38, p=0.088). An internet-delivered cognitive behavioral therapy program did not significantly increase the proportion of patients with normalized stress and anxiety levels compared to control (OR 2.37, p=0.088).
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