Atrial fibrillation (AF) is associated with distressing symptoms and diminished quality-of-life (QoL). In a recent randomized controlled trial (RCT), online exposure-based cognitive behavioral therapy (AF-CBT) targeting symptoms preoccupation, i.e., cardiac-related fear, hypervigilance, and avoidance behavior, in patients with symptomatic paroxysmal (i.e., intermittent) AF significantly improved AF-specific QoL relative to a control group receiving standardized AF education. This study aims to investigate whether a reduction in symptom preoccupation can explain the treatment effect of AF-CBT on self-rated AF symptoms and AF disability. We used data from a recent RCT involving 127 patients diagnosed with paroxysmal AF, randomized to undergo AF-CBT over 10 weeks (n = 65) or to receive AF education (n = 62). Two putative mediators, cardiac-related fear/hypervigilance and avoidance behavior, along with a competing mediator, perceived stress, were measured weekly. Outcome variables included self-rated AF symptoms and AF-related disability. Results from parallel process growth models indicated that the reduction in symptom preoccupation-but not perceived stress-mediated the controlled effect of AF-CBT on both AF symptoms and disability. In cross-lagged panel models, of the within-individual week-by-week change, a reduction in cardiac-related fear predicted subsequent improvement in AF symptoms, while a decrease in avoidance behavior predicted subsequent improvement in AF-related disability. Our findings suggest that symptom preoccupation plays a significant role in AF symptoms and disability and can be effectively targeted by online AF-CBT. Integrating this understanding into the clinical management of AF holds promise for improving patient outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Särnholm et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: