Background
Clinically significant symptoms of depression and anxiety in coronary heart disease (CHD) patients are common and associated with poor quality of life and increased risk of cardiovascular events and health care utilization. Psychological treatments have yet shown limited effectiveness, and more effective treatments have therefore been requested. Attention training technique (ATT), a component of metacognitive therapy, can potentially be effective as a stand-alone treatment for anxiety and depression. In an open study, we have previously shown that ATT delivered face-to-face in a group format was feasible and potentially effective for improving symptoms of depression and anxiety in patients with CHD. The next progressive step is to test the effectiveness of ATT in a randomized controlled trial.
Aims
The overall aim of this study is to provide evidence for the effectiveness of ATT delivered in a group format for patients with CHD.
The primary objective is to test the effectiveness of ATT delivered in a group format in alleviating symptoms of anxiety and depression in CHD outpatients who experience significant symptoms of anxiety and depression following a CHD event.
Secondary objectives are to (i) evaluate the impact of ATT on secondary outcomes such as psychiatric disorders, rumination, worry, type D-personality, insomnia, quality of life and metacognitions (ii) explore whether the biological marker C-Reactive protein (CRP) that may link psychological factors to cardiac prognosis is correlated with treatment outcome, and (iii) provide qualitative data on the patients experience with ATT including processes that may facilitate or serve as barriers to effectiveness in order to help further improvement in effective delivery and implementation of ATT in cardiac practice.
Methods
ATT-CHD is a randomized wait-list (WL) controlled study. Eligible patients with CHD from two hospitals with Hospital Anxiety and Depression Scale (HADS)-Anxiety and/or HADS-Depression subscales scores ≥8 will be randomized into ATT (n = 32) or WL control (n = 32). After 6–8 weeks, WL patients will be allocated to ATT. The ATT treatment will consist of six weekly group sessions with 5-6 participants. The participants will be evaluated pre-, mid- and post-treatment, and at 6-months follow-up after end of treatment. Study data will be collected from hospital medical records, self-report questionnaires, clinical examinations with blood samples, and qualitative interviews. Changes in HADS are the primary outcome. Secondary outcomes include changes in psychiatric disorders, rumination, worry, type D-personality, metacognitions, insomnia, quality of life, and CRP.
Discussion
To our knowledge, this will be the first WL-controlled randomized study testing the effectiveness of group-based ATT as treatment of symptoms of anxiety and depression in CHD patients. Identifying therapeutic strategies that are both feasible, effective as well as implementable, could help reduce levels of psychological distress such as anxiety and depression in this patient group. If effective, this treatment has a great potential to be implemented in outpatient care including cardiac rehabilitation units. A reduction in psychological distress could potentially lead to better psychological and cardiac outcomes, improved quality of life, and be cost-effective to health care systems.
Project leader
Participants
Costas Papageorgiou
John Munkhaugen
Kristoffer Tunheim
Ole Klungsøyr
Kari Peersen
Collaboration
Oslo University Hospital
Drammen Hospital
Vestfold Hospital
University of Oslo
Publications
- Frontiers | The Attention Training Technique Reduces Anxiety and Depression in Patients With Coronary Heart Disease: A Pilot Feasibility Study (frontiersin.org)
- Attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: study protocol for a waiting-list randomized controlled trial - PMC (nih.gov)