What is the clinical evidence from this study?

Study design: Other. Population: Cardiac rehabilitation practitioners (n=9). Intervention: Group metacognitive therapy (MCT) training. Primary outcome: Experiences and perceptions of group metacognitive therapy training (facilitators and barriers).

What does this research mean for the field?

Group metacognitive therapy training for cardiac rehabilitation practitioners is positively received and enhances their understanding of the intervention, with uptake facilitated by online delivery styles but hindered by training structure issues and staff skepticism. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 18, 2026Journal of the American Heart AssociationOpen Access

Metacognitive Therapy in Cardiac Rehabilitation: Staff Barriers and Enablers to Training in an Evidence‐Based Psychological Treatment for Anxiety and Depression

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Key result

Online group metacognitive therapy training is well received by cardiac rehab staff despite some skepticism.

Why the study?

The study was designed to explore cardiac rehabilitation practitioners' experiences and perceptions of group metacognitive therapy training, identifying encountered facilitators and barriers.

Design

Nested qualitative study using reflexive thematic analysis

Authors

AWAdrian WellsWest Virginia University BABelcher AeGreater Manchester Mental Health NHS Foundation Trust DRDavid ReevesManchester Academic Health Science Centre

Discussion

Member takes

Implication

May guide cardiac rehab training design to address skepticism; leaves open effects on patient outcomes and scalability.

Key Points

To investigate cardiac rehabilitation practitioners' experiences and perceptions of group metacognitive therapy training, identifying barriers and facilitators encountered during implementation.
Nested qualitative study using reflexive thematic analysis within the PATHWAY-Beacons mixed-methods project in England.
Semi-structured interviews were conducted at 3 stages: before training, after training, and after delivering all group sessions across 6 cardiac rehabilitation services.
Nine practitioners enrolled, with 7 completing all 4 interviews, 1 completing 2 interviews, and 1 completing 1 interview.
Enablers for effective training centered on 3 subthemes: training delivery style, essential training components (prerecorded demonstration videos, pilot group delivery, and post-pilot feedback sessions), and the convenient online training format.
Barriers involved challenges with online breakout room role-plays, manual distribution timing, initial staff skepticism regarding therapy techniques, and needs for additional training on distinguishing stress from worry and handling complex group dynamics.

Structured PICO

Population

9 cardiac rehabilitation practitioners (mean age 49.1, 89% female) from 6 services in England who received training in delivering group metacognitive therapy.

Intervention

Group metacognitive therapy (MCT) training consisting of 3 half-days of online sessions, a pilot group delivery, and a review session.

Outcome

Experiences and perceptions of group metacognitive therapy training (facilitators and barriers)

Training cardiac rehabilitation staff in group metacognitive therapy is feasible and positively received, highlighting the importance of structured, multicomponent training to overcome initial skepticism.

Limitations

Small sample size
Underrepresentation of men in the sample
small sample size
underrepresentation of men

Cite This Study

Wells et al. (2026) studied Cardiac rehabilitation practitioners (n=9). Group metacognitive therapy (MCT) training was evaluated on Experiences and perceptions of group metacognitive therapy training (facilitators and barriers). Group metacognitive therapy training was positively received by cardiac rehabilitation practitioners, with key enablers including delivery style and online format, while barriers included staff skepticism.

synapsesocial.com/papers/6a5b39118167787360d24efc https://doi.org/10.1161/jaha.125.044672

Topics

Cardiac Rehabilitation and Lifestyle Interventions

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Metacognitive Therapy in Cardiac Rehabilitation: Staff Barriers and Enablers to Training in an Evidence‐Based Psychological Treatment for Anxiety and Depression

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Metacognitive Therapy in Cardiac Rehabilitation: Staff Barriers and Enablers to Training in an Evidence‐Based Psychological Treatment for Anxiety and Depression

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

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