Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial

Abstract

Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlled trial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heart disease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aim of this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vital exhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events. Methods: A total of 362 patients were randomly assigned to intervention or usual care groups. The psychological outcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of the outcomes were analysed using joint modelling of the longitudinal and time to event data. Results: The intervention had a positive effect on somatic anxiety (p < 0.05), reflecting a beneficial development over time compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time. Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events. Conclusions: The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustion or depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardiovascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, the mechanisms between the intervention and the protective cardiovascular outcome remain to be identified.

Utilization of Mental Health Care, Treatment Patterns, and Course of Psychosocial Functioning in Northern German Coronary Artery Disease Patients with Depressive and/or Anxiety Disorders

“…Although anxiety disorders are as common in CAD patients as depressive disorders (unpublished data), research on their treatment is even scarcer ( 14 ). Panic disorder was successfully treated in CAD patients in the small PATCHD trial ( 15 ) and additional CBT reduced somatic anxiety in the SUPRIM trial ( 12 , 13 ). In addition, little is known about the utilization rates of mental health-care services by patients with CAD and comorbid affective or anxiety disorders, as well as about effectiveness of general mental health care in CAD patients outside of the research setting.…”

The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary heart disease—results from the SUPRIM-trial

“…Inflammatory processes are therefore unlikely as mediators between the CBT program and the positive results previously reported ( 7 ). It has also been shown that other measures—such as psychological outcomes, social support, physical activity, blood pressure, blood lipid levels, smoking, and use of secondary preventive medications or anti-depressants—were likewise unaffected by the treatment and therefore unlikely to explain the reduction in CV events and MIs ( 8 ). In order to explain the SUPRIM study’s main finding, the most important mechanisms are still to be revealed.…”

“…The outcome could not be explained by use of antihypertensives, lipid-lowering drugs, anti-depressants, or nicotine ( 7 ). Nor could it be explained by changes in stress behaviors, depression, or vital exhaustion ( 8 ). Only a minor positive effect of the program was found regarding somatic symptoms of anxiety.…”

mhealth and psycho-physical well-being

“…For instance, in coping with chronic illness and the complications associated with them, it has been shown that health monitoring and prognosis can significantly be improved with cognitive behavioural approaches (CBT) [12]. Combining mobile technologies with CBT for chronic patients can help those seeking treatment to improve their ability to cope with conditions [6]. Literature also suggests that mindfulness and other positive behavioural changes can be seen in patients that get mindfulness-based cognitive therapy (MBCT) [1].…”