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

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

Abstract

Background: Anxiety 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).

Methods: PATHWAY was a series of feasibility trials, single-blind, multicenter, randomized controlled trials (RCTs), qualitative, stated preferences for therapy and health economics studies.

Findings: Patients 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.

Conclusion: There 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.

Registration: URL: NCT02420431; ISRCTN74643496; NCT03129282.

Keywords: anxiety; cardiac rehabilitation; depression; health economic; metacognitive therapy; qualitative; randomized control trial.

Conflict of interest statement

AW is the director of the MCT-Institute and developer of MCT. AW has also written books on CBT and MCT. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Wells, Reeves, Heal, Davies, Shields, Heagerty, Fisher, Doherty and Capobianco.

References

    1. World Health Organization (WHO) . WHO Global NCD Action Plan 2013–2020. WHO; (2013). Available online at: (accessed June 10, 2020).
    1. Meijer A, Conradi HJ, Bos EH, Thombs BD, van Melle JP, de Jonge P. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research. Gen Hosp Psychiatry. (2011) 33:203–16. 10.1016/j.genhosppsych.2011.02.007
    1. Palacios J, Khondoker M, Mann A, Tylee A, Hotopf M. Depression and anxiety symptom trajectories in coronary heart disease: associations with measures of disability and impact on 3-year health care costs. J Psychosom Res. (2018) 105:1–8. 10.1016/j.jpsychores.2017.10.015
    1. Department of Health . Cardiac Rehabilitation Commissioning Pack. London: Department of Health; (2010).
    1. Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, et al. . Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. (2017) 4:CD002902. 10.1002/14651858.CD002902.pub4
    1. Anderson L, Oldridge N, Thompson DR, Oldridge N, Zwisler AD, Rees K, et al. . Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. (2016) 67:1–12. 10.1016/j.jacc.2015.10.044
    1. Shields G, Wells A, Doherty P, Heagerty A, Buck D, Davies L. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart. (2018) 104:1403–10. 10.1136/heartjnl-2017-312809
    1. Wells A. Metacognitive Therapy for Anxiety and Depression. New York, NY; Guilford Press; (2009).
    1. Wells A. Breaking the cybernetic code: understanding and treating the human metacognitive control system to enhance mental health. Front Psychol. (2019) 10:2621. 10.3389/fpsyg.2019.02621
    1. McPhillips R, Salmon P, Wells A, Fisher P. Cardiac rehabilitation patients' accounts of their emotional distress and psychological needs: a qualitative study. J Am Heart Assoc. (2019) 8:e011117. 10.1161/JAHA.118.011117
    1. Normann N, Morina N. The efficacy of metacognitive therapy: a systematic review and meta-analysis. Front Psychol. (2018) 9:2211. 10.3389/fpsyg.2018.02211
    1. McPhillips R, Salmon P, Wells A, Fisher P. Qualitative analysis of emotional distress in cardiac patients from the perspectives of cognitive behavioral and metacognitive theories: why might cognitive behavioral therapy have limited benefit, and might metacognitive therapy be more effective?. Front Psychol. (2019) 9:2288. 10.3389/fpsyg.2018.02288
    1. Beck AT. Cognitive Therapy and the Emotional Disorders. New York, NY: International Universities Press; (1976).
    1. Wells A, Reeves D, Heal C, Fisher P, Davies L, Heagerty A, et al. . Establishing the feasibility of group metacognitive therapy for anxiety and depression in cardiac rehabilitation: a single bind randomized pilot study. Front Psychiatry. (2020) 11:582. 10.3389/fpsyt.2020.00582
    1. Wells A. MCT-PATHWAY: Group Metacognitive Therapy Treatment Manual. Manchester: University of Manchester; (2015).
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. (1983) 67:361–70. 10.1111/j.1600-0447.1983.tb09716.x
    1. Wells A, McNicol K, Reeves D, Salmon P, Davies L, Heagerty A, et al. . Improving the effectiveness of psychological interventions for depression and anxiety in the cardiac rehabilitation pathway using group-based metacognitive therapy (PATHWAY Group MCT): study protocol for a randomised controlled trial. Trials. (2018) 19:215. 10.1186/s13063-018-2593-8
    1. National Audit of Cardiac Rehabilitation (NACR) . Annual Report. York: British Heart Foundation, University of York; (2018). Available online at: .
    1. McPhillips R, Capobianco L, Cooper B, Husain Z, Wells A. Cardiac rehabilitation patients experiences and understanding of group metacognitive therapy: a qualitative study. Open Heart. (2021) 8:e001708. 10.1136/openhrt-2021-001708
    1. Wells A, Reeves D, Capobianco L, Heal C, Davies L, Heagerty A, et al. . Improving the effectiveness of psychological interventions for depression and anxiety in cardiac rehabilitation: PATHWAY—a single-blind, parallel, randomized, controlled trial of group metacognitive therapy. Circulation. (2021) 144:23–33. 10.1161/CIRCULATIONAHA.120.052428
    1. Shields GE, Wells A, Doherty P, Reeves D, Capobianco L, Heagerty A, et al. . Protocol for the economic evaluation of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression. BMJ Open. (2020) 10:e035552. 10.1136/bmjopen-2019-035552
    1. Whalley B, Thompson D, Taylor R. Psychological interventions for coronary heart disease: cochrane systematic review and meta-analysis. Int J Behav Med. (2012) 21:109–21. 10.1007/s12529-012-9282-x
    1. Wells A, Reeves D, Heal C, Fisher P, Davies L, Heagerty A, et al. . Metacognitive therapy self-help for anxiety-depression: single-blind randomized feasibility trial in cardiovascular disease. Health Psychol. (2022) 41:366-77. 10.1037/hea0001168
    1. Wells A, McNicol K, Reeves D, Salmon P, Davies L, Heagerty A, et al. . Metacognitive therapy home-based self-help for cardiac rehabilitation patients experiencing anxiety and depressive symptoms: study protocol for a feasibility randomised controlled trial (PATHWAY Home-MCT). Trials. (2018) 19:444. 10.1186/s13063-018-2826-x
    1. de Bekker-Grob EW, Ryan M, Gerard K. Discrete choice experiments in health economics: a review of the literature. Health Econ. (2012) 21:145–72. 10.1002/hec.1697
    1. Soekhai V, de Bekker-Grob EW, Ellis AR, et al. . Discrete choice experiments in health economics: past, present and future. Pharmacoeconomics. (2019) 37:201–26. 10.1007/s40273-018-0734-2
    1. Shields GE, Brown L, Wells A, Capobianco L, Vass C. Utilising patient and public involvement in stated preference research in health: learning from the existing literature and a case study. Patient. (2021) 14:399–412. 10.1007/s40271-020-00439-2
    1. Shields GE, Wright S, Wells A, Doherty P, Capobianco L, Mary L. Delivery preferences for psychological intervention in cardiac rehabilitation: a pilot discrete choice experiment. Open Heart. (2021) 8:e001747. 10.1136/openhrt-2021-001747
    1. Callesen P, Reeves D, Heal C, Wells A. Metacognitive therapy versus cognitive behaviour therapy in adults with major depression: a parallel single-blind randomised controlled trial. Sci Rep. (2020) 10:7878. 10.1038/s41598-020-64577-1

Source: PubMed

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