Evaluating Metacognitive Therapy to Improve Treatment of Anxiety and Depression in Cardiovascular Disease: The NIHR Funded PATHWAY Research Programme

Abstract

BackgroundAnxiety and depression contribute to poorer physical and mental health outcomes in cardiac patients. Psychological treatments are not routinely offered in cardiac care and have mixed and small effects. We conducted a series of studies under the PATHWAY research programme aimed at understanding and improving mental health outcomes for patients undergoing cardiac rehabilitation (CR) through provision of metacognitive therapy (MCT).MethodsPATHWAY was a series of feasibility trials, single-blind, multicenter, randomized controlled trials (RCTs), qualitative, stated preferences for therapy and health economics studies.FindingsPatients felt their psychological needs were not met in CR and their narratives of distress could be parsimoniously explained by the metacognitive model. Patients reported they would prefer therapy over no therapy as part of CR, which included delivery by a cardiac professional. Two feasibility studies demonstrated that RCTs of group-based and self-help MCT were acceptable, could be embedded in CR services, and that RCTs of these interventions were feasible. A definitive RCT of group-MCT within CR (n = 332) demonstrated significantly greater reductions in the severity of anxiety and depression, exceeding CR alone, with gains maintained at 12 month follow-up (SMD HADS total score = 0.52 at 4 months and 0.33 at 12 months). A definitive trial of self-help MCT is ongoing.ConclusionThere is a need to better meet the psychological needs of CR patients. Embedding MCT into CR demonstrated high acceptability and improved efficacy on psychological outcomes. Results support roll-out of MCT in CR with evaluation of national implementation.RegistrationURL: NCT02420431; ISRCTN74643496; NCT03129282.

A meta-review of systematic reviews and meta-analyses on outcomes of psychosocial interventions in heart failure

“…Another aspect to take into consideration is the format of how the psychosocial intervention is delivered. Patients with CHF might Home-based meta-cognitive therapy for cardiac patients have been found to be a feasible approach (20).…”

Discrete choice experiment to investigate preferences for psychological intervention in cardiac rehabilitation

“…19 The PATHWAY Programme funded under the UK NIHR Programme Grants for Applied Research (RP-PG-1211-20011), aims to improve access to more effective psychological interventions for patients attending CR who present with symptoms of depression and/or anxiety. [20][21][22][23] A multicentre, two-arm, single-blind, randomised controlled trial was conducted to compare the clinicaleffectiveness and cost-effectiveness of group-based metacognitive therapy (MCT) plus CR to CR alone. 21 This found that group MCT+CR significantly improved depression and anxiety compared with CR alone.…”

Effect of metacognitive therapy on depression in patients with chronic disease: a protocol for a systematic review and meta-analysis

“…Metacognitive therapy (MCT) was initially developed by Wells12 and is an emerging theoretical based transdiagnostic psychotherapy that has been proven effective in alleviating depression 13. According to Self-Regulation Executive Function model (S-REF),14 depression will occur, persist and reoccur due to the development of unmanageable, repeated negative thinking pattern 15. This thinking strategy called cognitive attentional syndrome (CAS), which focuses on the inner (attention, thinking and physical sensations), reflects on the past and worries about the future, accompanied by avoidance and maladaptation behaviours.…”