Cognitive behavioural therapy for co-morbid anxiety and depression in heart failure: a case report

Heart failure increases the likelihood of an individual experiencing co-morbid anxiety and depression, which can affect their physical as well as mental health. There is a need to develop non-pharmacological interventions for the psychological consequences of heart failure. Evidence shows that cognitive behavioural therapy (CBT) can be helpful, but there is less clarity about CBT’s effectiveness for people with heart failure who have complex multi-morbid difficulties. This paper presents a case report of a man with heart failure. He was part of a research trial for cardiac resynchronisation therapy with defibrillation (CRT-D), after other physical procedures had been unsuccessful, and was experiencing severe anxiety and moderately severe depression. The intervention used was based on transdiagnostic CBT, provided at home over six sessions. Self-report measures were completed at each session and at 3-month follow-up. A measure of his use of clinical services was also carried out at pre-, post- and 3-month follow up. Post-intervention, the client showed non-clinical levels of depression and anxiety and these improvements were maintained at 3 months. Use of clinical services also reduced, with fewer admissions to hospital and fewer visits by specialist nurses and GPs. This case suggests that CBT, and particularly transdiagnostic CBT, can be helpful in reducing anxiety and depression in people with heart failure. Further work evaluating the impact on quality of life and the utility of this approach with a wider group of people with heart failure and psychological distress would be advantageous. Key learning aims (1) Depression and anxiety are prevalent in people with heart failure. (2) Cognitive behavioural therapy can be an effective intervention for reducing depression and anxiety in people living with heart failure. (3) There are benefits to integrating care with this population because they present with interlinked physical and psychological needs.