Brief Internet-delivered CBT After ACS
Brief Internet-delivered Exposure-based Therapy to Reduce Post-traumatic Stress Symptoms and Cardiac Anxiety After Acute Coronary Syndrome: a Pilot Randomized Clinical Trial
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Josefin Särnholm
- Phone Number: + 46 852483258
- Email: josefin.sarnholm@ki.se
Study Locations
-
-
-
Stockholm, Sweden
- Karolinska Institutet
-
Stockholm, Sweden, 11635
- Karolinska University Hospital
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- (A) ACS ≥ four weeks to six months before assessment (MI type 1 STEMI/NSTEMI and UA)
- (B) Age 18-80 years
- (C) Symptoms of PTSD and/or cardiac anxiety that leads to distress and/or interferes with daily life (PCL5; ≥ 10, CAQ: ≥20)
- (D) On standard of care medical treatment for the cardiac condition according to Swedish cardiovascular guidelines
- (E) Ability to read and write in Swedish.
Exclusion Criteria:
- (F) Heart failure with severe systolic dysfunction (ejection fraction ≤ 35%)
- (G) Significant valvular disease
- (H) Planned coronary artery bypass surgery or percutaneous interventions
- (I) Any medical restriction to physical exercise
- (J) Severe uncontrolled medical illness i.e., advanced cancer
- (K) Grade 3 hypertension (i.e., blood pressure ≥ 180 systolic and/or 110 diastolic)
- (L) Severe psychiatric disorder, active suicidal ideations or cognitive impairment that precludes provision of informed consent or study activities
- (M) Alcohol dependency
- (N) Ongoing psychological treatment.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Brief exposure-based CBT
|
The 5-week intervention is psychologist-guided and delivered via text-based interactive online treatment modules, where patients complete weekly homework assignments and have regular online contact with psychologists with training in CBT for cardiac disease.
Key components include imaginal exposure of the ACS event, interoceptive exposure through at home physical activity that stimulats the CV system, exposure in-vivo to reduce avoided situations, and activities to enhance physical activity wellbeing.
Labeling (i.e., describing cardiac-related symptoms, thoughts, and feelings) will be used continuously during treatment to enhance the effect of exposure.
|
|
No Intervention: Waitlist control
The waitlist control will be offered an opportunity to participate in the intervention after the 2-month intervention evaluation period.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Seattle Angina Questionnaire
Time Frame: Baseline to 3 months
|
A measure of coronary artery disease on five scales: physical limitation scale, anginal stability scale, anginal frequency scale, treatment satisfaction scale, and the disease perception scale.
With a score ranging from 0 to 100.
A higher score indicating a better quality of life.
|
Baseline to 3 months
|
|
Acceptability: Client satisfaction Questionnaire
Time Frame: Baseline to 5 weeks
|
Treatment satisfaction, score ranging from 0 to 32, with a higher score indication more satisfaction with the treatment.
|
Baseline to 5 weeks
|
|
Percentage of enrolled participants who complete the treatment
Time Frame: Baseline to 5 weeks
|
Feasibility of the intervention components will be assessed by >60% assessed as treatment completers.
Descriptive analysis will also provide number of messages and therapist time.
|
Baseline to 5 weeks
|
|
Adverse events
Time Frame: Baseline to 5 weeks
|
Potential adverse reactions to the treatment.
Participants will be asked to report and rate the short- and long term discomfort of the adverse event on a scale from 0 ('did not affect me at all') and 3 ('affected me very negatively').
|
Baseline to 5 weeks
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Seattle Angina Questionnaire
Time Frame: Baseline to 5 weeks
|
A measure of coronary artery disease on five scales: physical limitation scale, anginal stability scale, anginal frequency scale, treatment satisfaction scale, and the disease perception scale.
With a score ranging from 0 to 100.
A higher score indicating a better quality of life.
|
Baseline to 5 weeks
|
|
Seattle Angina Questionnaire
Time Frame: Baseline to 7 months
|
A measure of coronary artery disease on five scales: physical limitation scale, anginal stability scale, anginal frequency scale, treatment satisfaction scale, and the disease perception scale.
With a score ranging from 0 to 100.
A higher score indicating a better quality of life.
|
Baseline to 7 months
|
|
Seattle Angina Questionnaire
Time Frame: Change over 5 measurement points measured from baseline and weekly for 5 weeks during treatment
|
A measure of coronary artery disease on five scales: physical limitation scale, anginal stability scale, anginal frequency scale, treatment satisfaction scale, and the disease perception scale.
With a score ranging from 0 to 100.
A higher score indicating a better quality of life.
|
Change over 5 measurement points measured from baseline and weekly for 5 weeks during treatment
|
|
The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5
Time Frame: Baseline to 5 weeks
|
Measure of post traumatic stress, score ranging from 0-80, with a higher score indicating more post traumatic stress.
|
Baseline to 5 weeks
|
|
The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5
Time Frame: Baseline to 3 months
|
Measure of post traumatic stress, score ranging from 0-80, with a higher score indicating more post traumatic stress.
|
Baseline to 3 months
|
|
The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5
Time Frame: Baseline to 7 months
|
Measure of post traumatic stress, score ranging from 0-80, with a higher score indicating more post traumatic stress.
|
Baseline to 7 months
|
|
The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5
Time Frame: Change over 5 measurement points measured from baseline and weekly for 5 weeks during treatment
|
Measure of post traumatic stress, score ranging from 0-80, with a higher score indicating more post traumatic stress.
|
Change over 5 measurement points measured from baseline and weekly for 5 weeks during treatment
|
|
Cardiac anxiety questionnaire
Time Frame: Baseline to 5 weeks
|
Measure of cardiac anxiety, fear, avoidance and attention.
The score ranges between 0 and 72, with a greater score indicating elevated cardiac anxiety.
|
Baseline to 5 weeks
|
|
Cardiac anxiety questionnaire
Time Frame: Baseline to 3 months
|
Measure of cardiac anxiety, fear, avoidance and attention.
The score ranges between 0 and 72, with a greater score indicating elevated cardiac anxiety.
|
Baseline to 3 months
|
|
Cardiac anxiety questionnaire
Time Frame: Baseline to 7 months
|
Measure of cardiac anxiety, fear, avoidance and attention.
The score ranges between 0 and 72, with a greater score indicating elevated cardiac anxiety.
|
Baseline to 7 months
|
|
Cardiac anxiety questionnaire
Time Frame: Change over 5 measurement points measured from baseline and weekly for 5 weeks during treatment
|
Measure of cardiac anxiety, fear, avoidance and attention.
The score ranges between 0 and 72, with a greater score indicating elevated cardiac anxiety.
|
Change over 5 measurement points measured from baseline and weekly for 5 weeks during treatment
|
|
Myocardial infarction behavior questionnaire
Time Frame: Baseline to 8 weeks.
|
MI-related avoidance questionnaire behaviors developed by the research group.
score ranging from 0 to 68 .
Higher scores indicate more avoidance behavior.
|
Baseline to 8 weeks.
|
|
Myocardial infarction behavior questionnaire
Time Frame: Baseline to 3 months
|
MI-related avoidance questionnaire behaviors developed by the research group.
score ranging from 0 to 68 .
Higher scores indicate more avoidance behavior.
|
Baseline to 3 months
|
|
Myocardial infarction behavior questionnaire
Time Frame: Baseline to 7 months
|
MI-related avoidance questionnaire behaviors developed by the research group.
score ranging from 0 to 68 .
Higher scores indicate more avoidance behavior.
|
Baseline to 7 months
|
|
Body Sensation Questionnaire
Time Frame: Baseline to 8 weeks
|
Fear of bodily symptoms, score ranging from 0 to 72 .
Higher scores indicate more fear of body sensations.
|
Baseline to 8 weeks
|
|
Body Sensation Questionnaire
Time Frame: Baseline to 3 months
|
Fear of bodily symptoms, score ranging from 0 to 72 .
Higher scores indicate more fear of body sensations.
|
Baseline to 3 months
|
|
Body Sensation Questionnaire
Time Frame: Baseline to 7 months
|
Fear of bodily symptoms, score ranging from 0 to 72 .
Higher scores indicate more fear of body sensations.
|
Baseline to 7 months
|
|
Symptom checklist Severity and Frequency Scale (SCL, adapted to coronary artery disease)
Time Frame: Baseline to 8 weeks.
|
Cardiac-related symptoms in two sub scales A) frequency: score ranging from 0-48, with higher score indicating higher frequency of symptoms, B) severity of experienced symptom: score ranging from 0- 48, with a higher score indicating more severe symptoms
|
Baseline to 8 weeks.
|
|
Symptom checklist Severity and Frequency Scale (SCL, adapted to coronary artery disease)
Time Frame: Baseline to 3 months
|
Cardiac-related symptoms in two sub scales A) frequency: score ranging from 0-48, with higher score indicating higher frequency of symptoms, B) severity of experienced symptom: score ranging from 0- 48, with a higher score indicating more severe symptoms
|
Baseline to 3 months
|
|
Symptom checklist Severity and Frequency Scale (SCL, adapted to coronary artery disease)
Time Frame: Baseline to 7 months
|
Cardiac-related symptoms in two sub scales A) frequency: score ranging from 0-48, with higher score indicating higher frequency of symptoms, B) severity of experienced symptom: score ranging from 0- 48, with a higher score indicating more severe symptoms
|
Baseline to 7 months
|
|
12-Item Short-Form Health Survey
Time Frame: Baseline to 5 weeks
|
General quality of life, with a score ranging from 0 to 100.
A higher score indicating a better quality of life General quality of life, with a score ranging from 0 to 100.
A higher score indicating a better quality of life
|
Baseline to 5 weeks
|
|
12-Item Short-Form Health Survey
Time Frame: Baseline to 3 months
|
General quality of life, with a score ranging from 0 to 100.
A higher score indicating a better quality of life General quality of life, with a score ranging from 0 to 100.
A higher score indicating a better quality of life
|
Baseline to 3 months
|
|
12-Item Short-Form Health Survey
Time Frame: Baseline to 7 months
|
General quality of life, with a score ranging from 0 to 100.
A higher score indicating a better quality of life General quality of life, with a score ranging from 0 to 100.
A higher score indicating a better quality of life
|
Baseline to 7 months
|
|
Patient Health Questionnaire-9
Time Frame: Baseline to 5 weeks
|
Measure of depression, score ranging 0 to 27 with a higher score indicating higher level of depression
|
Baseline to 5 weeks
|
|
Patient Health Questionnaire-9
Time Frame: Baseline to 3 months
|
Measure of depression, score ranging 0 to 27 with a higher score indicating higher level of depression
|
Baseline to 3 months
|
|
Patient Health Questionnaire-9
Time Frame: Baseline to 7 months
|
Measure of depression, score ranging 0 to 27 with a higher score indicating higher level of depression
|
Baseline to 7 months
|
|
Generalized Anxiety Disorder 7-item
Time Frame: Baseline to 5 weeks.
|
General anxiety, score ranging from 0-21, with a higher score indicating more anxiety and worry.
|
Baseline to 5 weeks.
|
|
Generalized Anxiety Disorder 7-item
Time Frame: Baseline to 3 months
|
General anxiety, score ranging from 0-21, with a higher score indicating more anxiety and worry.
|
Baseline to 3 months
|
|
Generalized Anxiety Disorder 7-item
Time Frame: Baseline to 7 months
|
General anxiety, score ranging from 0-21, with a higher score indicating more anxiety and worry.
|
Baseline to 7 months
|
|
Perceived stress scale 4-item
Time Frame: Baseline to 5 weeks
|
Stress reactivity.
A greater score indicate more perceived stress.
|
Baseline to 5 weeks
|
|
Perceived stress scale 4-item
Time Frame: Baseline to 3 months
|
Stress reactivity.
A greater score indicate more perceived stress.
|
Baseline to 3 months
|
|
Perceived stress scale 4-item
Time Frame: Baseline to 7 months
|
Stress reactivity.
A greater score indicate more perceived stress.
|
Baseline to 7 months
|
|
The Godin Leisure-time Exercise and International Physical Activity Questionnaire 1 item on inactivity
Time Frame: Baseline to 5 weeks
|
Level of physical activity and inactivity: On the Godin leisure-time excercise: The participant rate numbers of time per week that they engage in physical activity.
The numb ers are the categorized in to low, moderate, and high levels of physical activity.
And from International Physical Activity Questionnaire we will use 1 item on inactivity
|
Baseline to 5 weeks
|
|
The Godin Leisure-time Exercise and International Physical Activity Questionnaire 1 item on inactivity
Time Frame: Baseline to 3 months
|
Level of physical activity and inactivity: On the Godin leisure-time excercise: The participant rate numbers of time per week that they engage in physical activity.
The numb ers are the categorized in to low, moderate, and high levels of physical activity.
And from International Physical Activity Questionnaire we will use 1 item on inactivity
|
Baseline to 3 months
|
|
The Godin Leisure-time Exercise and International Physical Activity Questionnaire 1 item on inactivity
Time Frame: Baseline to 7 months
|
Level of physical activity and inactivity: On the Godin leisure-time excercise: The participant rate numbers of time per week that they engage in physical activity.
The numb ers are the categorized in to low, moderate, and high levels of physical activity.
And from International Physical Activity Questionnaire we will use 1 item on inactivity
|
Baseline to 7 months
|
|
Lifestyle factors: The national Board of health and Welfare questionnaire
Time Frame: Baseline to 8 weeks
|
Questionnaire regarding diet (5 item), tobacco (2 item) and alcohol (3 item) diet (5 item), tobacco (2 item) and alcohol (3 item)
|
Baseline to 8 weeks
|
|
Lifestyle factors: The national Board of health and Welfare questionnaire
Time Frame: Baseline to 3 months
|
Questionnaire regarding diet (5 item), tobacco (2 item) and alcohol (3 item) diet (5 item), tobacco (2 item) and alcohol (3 item)
|
Baseline to 3 months
|
|
Lifestyle factors: The national Board of health and Welfare questionnaire
Time Frame: Baseline to 7 months
|
Questionnaire regarding diet (5 item), tobacco (2 item) and alcohol (3 item) diet (5 item), tobacco (2 item) and alcohol (3 item)
|
Baseline to 7 months
|
|
University of Toronto Atrial fibrillation Severity Scale (AFSS)
Time Frame: Baseline to 5 weeks
|
3 item on cardiac-specific healthcare consumption.
Scores ranges 0-15 with a higher score indicating more cardiac-related healthcare consumption.
|
Baseline to 5 weeks
|
|
University of Toronto Atrial fibrillation Severity Scale (AFSS)
Time Frame: Baseline to 3 months
|
3 item on cardiac-specific healthcare consumption.
Scores ranges 0-15 with a higher score indicating more cardiac-related healthcare consumption.
|
Baseline to 3 months
|
|
University of Toronto Atrial fibrillation Severity Scale (AFSS)
Time Frame: Baseline to 7 months
|
3 item on cardiac-specific healthcare consumption.
Scores ranges 0-15 with a higher score indicating more cardiac-related healthcare consumption.
|
Baseline to 7 months
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Adverse events
Time Frame: Baseline to 3 months
|
Potential adverse reactions to the treatment.
Participants will be asked to report and rate the short- and long term discomfort of the adverse event on a scale from 0 ('did not affect me at all') and 3 ('affected me very negatively').
|
Baseline to 3 months
|
|
Adverse events
Time Frame: Baseline to 7 months
|
Potential adverse reactions to the treatment.
Participants will be asked to report and rate the short- and long term discomfort of the adverse event on a scale from 0 ('did not affect me at all') and 3 ('affected me very negatively').
|
Baseline to 7 months
|
|
Adverse events
Time Frame: 5 measurement points measured from baseline and weekly for 5 weeks during treatment
|
Potential adverse reactions to the treatment.
Participants will be asked to report and rate the short- and long term discomfort of the adverse event on a scale from 0 ('did not affect me at all') and 3 ('affected me very negatively').
|
5 measurement points measured from baseline and weekly for 5 weeks during treatment
|
|
AFFS/SCL-4
Time Frame: Change over 5 measurement points measured from baseline and weekly for 8 weeks during treatment ]
|
4 items derived from the Symptoms Checklist (SCL) and the Atrial Fibrillation Severity Scale (AFSS) measuring disabling cardiac symptoms
|
Change over 5 measurement points measured from baseline and weekly for 8 weeks during treatment ]
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- P30AG064198 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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