Long-term effects and predictors of change of internet-delivered cognitive behavioural therapy on cardiac anxiety in patients with non-cardiac chest pain: a randomized controlled trial

• Published in: BMC psychiatry 2024-03, Vol.24 (1), p.216-12, Article 216
• Main Authors: Eriksson-Liebon, Magda, Westas, Mats, Johansson, Peter, Mourad, Ghassan
• Format: Article
• Language: English
• Subjects: Anxiety; Anxiety - complications; Anxiety - psychology; Anxiety - therapy; Anxiety Disorders - therapy; Behavior modification; Body measurements; Cardiac anxiety; Care and treatment; Causes of; Chest; Chest pain; Chest Pain - psychology; Chest Pain - therapy; Clinical outcomes; Clinical trials; Cognitive ability; Cognitive Behavioral Therapy; Cognitive behavioural therapy; Cognitive therapy; Emergency medical care; Exercise; Health-related quality of life; Heart; Heart diseases; Humans; Internet; Intervention; Long-term effects; Methods; Mindfulness; Multiple regression analysis; Non-cardiac chest pain; Pain; Patient outcomes; Patients; Psychological distress; Quality of life; Questionnaires; Statistical analysis; Telemedicine; Treatment Outcome
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-024-05661-y

Approximately half of patients who seek care at Emergency Departments due to chest pain are diagnosed with Non-Cardiac Chest Pain (NCCP). Concerns for heart disease and misinterpretation of the symptoms increase cardiac anxiety and have a negative impact on patients' lives. Psychological interventions such as internet-delivered cognitive behavioral therapy (iCBT) are effective in treating psychological conditions such as anxiety, by helping patients to learn how to manage chest pain. To evaluate the effects of a nurse-led iCBT program on cardiac anxiety and secondary outcomes, as bodily sensations, depressive symptoms, health-related quality of life and chest pain frequency in patients with NCCP at 6- and 12-month follow-up, and to explore predictors that can have impact on the effects of the iCBT program on psychological distress. A longitudinal study of a Randomized Controlled Trial (RCT) evaluating the long-term effects of an iCBT program (n = 54) in patients with NCCP, compared to psychoeducation (n = 55). The primary outcome, cardiac anxiety was measured using the Cardiac Anxiety Questionnaire (CAQ), and the secondary outcomes were measured with The Body Sensations Questionnaire (BSQ), Patient Health Questionnaire-9 (PHQ-9), The EuroQol Visual Analog Scale (EQ-VAS) and a self-developed question to measure chest pain frequency. All measurements were performed before and after the intervention, and 3, 6 and 12 months after the intervention. Linear mixed model was used to test between-group differences in primary and secondary outcomes and multiple regression analysis was used to explore factors that may have an impact on the treatment effect of iCBT on cardiac anxiety. A total of 85% (n = 93/109) participants completed the 12-month follow-up. Mixed model analysis showed no statistically significant interaction effect of time and group between the iCBT and psychoeducation groups regarding cardiac anxiety over the 12-month follow-up. However, there was a statistically significant interaction effect of time and group (p = .009) regarding chest pain frequency favouring the iCBT group. In addition, we found a group effect in health-related quality of life (p = .03) favouring the iCBT group. The regression analysis showed that higher avoidance scores at baseline were associated with improvement in cardiac anxiety at 12-month follow-up. Cardiac anxiety was reduced in patients with NCCP, but iCBT was not more effective than psychoeducation. Patients with a high