Metacognitive therapy self-help for anxiety-depression: Single-blind randomized feasibility trial in cardiovascular disease

Adrian Wells, David Reeves, Calvin Heal, Peter Fisher, Patrick Doherty, Linda Davies, Anthony Heagerty, Lora Capobianco, Adrian Wells, David Reeves, Calvin Heal, Peter Fisher, Patrick Doherty, Linda Davies, Anthony Heagerty, Lora Capobianco

Abstract

Background: One in three cardiovascular disease (CVD) patients experience significant anxiety and depression. Current psychological interventions have limited efficacy in reducing such symptoms and are offered as a face-to-face intervention that may be a barrier to accessing treatment. We evaluated the feasibility and acceptability of delivering assisted home-based self-help metacognitive therapy (home-MCT) to cardiac rehabilitation (CR) patients experiencing anxiety and depression.

Method: One hundred eight CR patients with elevated anxiety and/or depression were recruited to a single-blind randomized feasibility trial across two United Kingdom National Health Service Trusts and were randomized to usual CR or usual CR plus home-MCT. The feasibility and acceptability of adding home-MCT to CR was based on credibility or expectancy ratings, recruitment rate, drop-outs, number of CR and home-MCT modules completed, and ability of outcome measures to discriminate between patients. The study was used to refine the sample size estimate for a full-scale trial. The quality of telephone support calls delivered by CR staff trained in MCT was assessed.

Results: Home-MCT was found to be feasible and acceptable for the current CR patients with anxiety and depression. Recruitment and retention of participants was high, and attendance at CR was similar for both groups. Completion of home-MCT was high, but the quality of telephone support calls delivered was lower than expected.

Conclusions: Home-MCT was acceptable and feasible to deliver to CR patients experiencing anxiety and depression, and the feasibility of conducting a full-scale trial of the intervention was established. Home-MCT may provide additional treatment options for cardiac patients experiencing psychological distress. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Figures

Figure 1. Consolidated Standards of Reporting Trials…
Figure 1. Consolidated Standards of Reporting Trials (CONSORT) Diagram of Patients in Cardiac Rehabilitation (CR)
Note. HADS = Hospital Anxiety and Depression Scale; RA = research assistant; MCT = metacognitive therapy.
Figure 2. Outcome Measure Histograms
Figure 2. Outcome Measure Histograms
Note. HADS = Hospital Anxiety and Depression Scale; ISE-R = Impact of Events Scale-Revised; MCQ-30 = Metacognitions Questionnaire-30.
Figure 3. Patient Flow in Home-Metacognitive Therapy…
Figure 3. Patient Flow in Home-Metacognitive Therapy (MCT)
Note. CR = cardiac rehabilitation.

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