Key result
Internet-based CBT shows no benefit over usual care for depression or anxiety after recent MI.
Why the study?
Symptoms of depression and anxiety are common after myocardial infarction, and while internet-based cognitive behavioral therapy has shown good results in other patient populations, its effectiveness in post-MI patients required evaluation.
Does therapist-guided internet-based cognitive behavioral therapy reduce symptoms of depression and anxiety in patients with a recent myocardial infarction?
RCT (n=239)
randomly allocated
Yes
Does therapist-guided internet-based cognitive behavioral therapy reduce symptoms of depression and anxiety in patients with a recent myocardial infarction?
Mean Difference: -0.47 (95% CI -1.95–1)
p-value: p=.53
Internet-based cognitive behavioral therapy did not significantly reduce symptoms of depression or anxiety compared to treatment as usual in patients with a recent MI, though low adherence may have impacted the results.
Does not support internet-based CBT post-MI; challenges efficacy assumptions for digital interventions in recent MI.
BACKGROUND Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitive behavioral therapy (iCBT) has shown good results in other patient groups. OBJECTIVE The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms of depression and anxiety among patients with a recent MI. METHODS In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239 women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided, 14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessed over the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For the main analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS. RESULTS There was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no difference between the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of 46.2% (54/117) of the iCBT group did not complete the introductory module. CONCLUSIONS iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety compared with TAU. Low treatment adherence might have influenced the result. CLINICALTRIAL ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webcite at http://www.webcitation.org/6xWWSEQ22)
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Norlund et al. (2017) conducted an RCT in recent myocardial infarction with symptoms of depression or anxiety (n=239). Internet-based cognitive behavioral therapy (iCBT) vs. Treatment as usual (TAU) was evaluated on Total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline (beta -0.47, 95% CI -1.95 to 1.00, p=.53). Internet-based cognitive behavioral therapy did not reduce depression or anxiety symptoms compared with usual care in patients with recent MI (beta -0.47; 95% CI -1.95 to 1.00; P=.53).