Pathway Study WS3 - Home Based Metacognitive Therapy for Cardiac Rehabilitation Patients

University of Manchester108 enrolled

Overview

Depression and anxiety are highly prevalent in people with heart disease, causing immense human and economic burden. Available pharmacological and psychological interventions have limited efficacy and the needs of these patients are not being met in cardiac rehabilitation services despite emphasis in key NHS policy. Extensive evidence shows that a particular style of thinking dominated by rumination (dwelling on the past) and worry maintains emotional distress. A psychological intervention called metacognitive therapy (MCT) that reduces this style of thinking alleviates depression and anxiety in mental health settings. This is a single-blind feasibility randomised controlled trial of metacognitive therapy delivered in a home-based format (Home-MCT). The aim of the study is to evaluate the acceptability and feasibility of integrating Home-MCT into cardiac rehabilitation services and to provide provisional evidence of effectiveness and cost-effectiveness on Home-MCT.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

108

Conditions

Depression Anxiety Cardiac Rehabilitation

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Patients who are referred to the CR pathway who meet Department of Health (DoH) and/or British Association for Cardiovascular Prevention and Rehabilitation (BACPR) CR eligibility criteria: * Acute coronary syndrome used for any condition brought on by sudden, reduced blood flow to the heart * Following revascularisation is the restoration of perfusion to a body part or organ that has suffered ischemia * Stable heart failure * Stable angina is chest pain or discomfort that most often occurs with activity or stress * Following implantation of cardioverter defibrillators/cardiac resynchronisation devices * Heart valve repair/replacement * Heart transplantation and ventricular assist devices * Adult congenital heart disease identified in adulthood * Other (atypical heart presentation: nausea, dizziness, lower chest discomfort, upper abdominal pressure or discomfort that feels like indigestion and upper back pain) 2. A score of ≥ 8 on either the depression or anxiety subscale of the Hospital Anxiety and Depression Scale 3. Minimum of 18 years old 4. Competent level of English language skills Exclusion Criteria: 1. Cognitive impairment which precludes informed consent or ability to participate 2. Acute suicidality 3. Active psychotic disorders (i.e., two \[or more\] of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour, negative symptoms). 4. Current drug/alcohol abuse (A maladaptive pattern of drinking, leading to clinically significant impairment or distress) 5. Concurrent psychological intervention for emotional distress that is not part of usual care 6. Antidepressant or anxiolytic medications initiated in the previous 8 weeks 7. Life expectancy of less than 12 months

Outcomes

Primary Outcomes

Acceptability

Acceptability of the intervention is defined as the completion of the first 4 modules of the Home-MCT manual, which includes 6 modules in total. Acceptability will be expressed as a % of all patients randomised to the treatment arm, minus deaths. This will be compared to the % of controls (minus deaths) who complete the 4-month follow up.

Time frame: From the completion of the manual till 4 months