Metacognitive Therapy Can Ease Depression and Anxiety in Heart Disease Patients

home-based metacognitive therapy

Self-help versions of metacognitive therapy (MCT) can reduce symptoms of depression, anxiety, and post-traumatic stress in heart disease patients, according to a a single-blind parallel randomized controlled trial conducted by Greater Manchester Mental Health NHS Foundation Trust (GMMH) and the University of Manchester (UoM).

Due to their medical condition, people with heart disease or who have experienced a serious heart problem, such as a heart attack or open-heart surgery, frequently experience stress and anxiety. To support their recovery, many of these patients are referred to a cardiac rehabilitation (CR) program, either at a clinic or remotely.

Currently, these programs’ psychological support and specialized mental health treatment vary by location and are limited. Cognitive behavioral therapy techniques are used when home-based psychological therapies are provided, but their efficacy is limited.

Nevertheless, anxiety and depression must be treated because, according to research, they reduce quality of life and can increase the risk of heart disease and death.

Effective in Reducing Anxiety and Depression

The findings of the MCT-PATHWAY study build on previous research that found group-based MCT to be effective in reducing anxiety and depression symptoms in cardiac patients. This study demonstrates that metacognitive therapy can be delivered in both group and home-based settings, expanding patient options for mental health support in cardiac rehabilitation services.

In this study, 118 cardiac patients were randomly assigned to receive Home-MCT plus standard cardiac rehabilitation treatment, while 122 patients received standard cardiac rehabilitation treatment. Patients who received Home-MCT were given a self-help manual to work through at their own pace.

Modules on developing techniques to reduce worry and rumination (dwelling on the past), as well as new ways to react to negative or distressing thoughts, were included in the manual. Patients receiving Home-MCT received support phone calls from trained staff in addition to the manual to provide opportunities for reflection and learning consolidation.

Home-based Metacognitive Therapy

Graph illustrating how self-help home-based MCT was effective in reducing total anxiety/depression in patients
Mean HADS (Hospital Anxiety and Depression Scale) total scores and 95% confidence intervals for each trial arm at each assessment point, for complete cases only.
Credit: PLOS Medicine (2023). DOI: 10.1371/journal.pmed.1004161

Compared to patients receiving only standard cardiac rehabilitation, trial participants who received home-based metacognitive therapy saw a significant decline in symptoms of anxiety, depression, and post-traumatic stress.

According to the findings, metacognitive therapy can be beneficial when given by a therapist in a group setting (as demonstrated by prior research) as well as when accessed remotely from home. Healthcare providers will be able to give patients more options for how they access the psychological components of cardiac rehabilitation programs thanks to the flexibility with which MCT can be delivered.

When a hole in Harriet Dawson’s heart was discovered, she underwent open heart surgery at the age of 22. Later, she participated in the MCT-PATHWAY study.

“It was very self-guided. You had check-in calls every couple of weeks and I liked that…I preferred that it was home-based because I didn’t have to compare and contrast my answer. A lot of it was about managing your stress, managing your worry, and how much of it us under your control. There weren’t many resources out there for me, for someone at the younger end of the spectrum and female. My heart event is a life milestone for me now, but home-based metacognitive therapy has allowed me to take control of it and has allowed me to reflect on it properly,”

she commented.

Understandably Distressing

Cardiovascular disease is the leading cause of death globally. It is not surprising that those who have serious heart conditions or are recovering from them experience anxiety, depression, and trauma symptoms. They are frequently recovering from illnesses that could end their lives, which is understandably distressing.

“Being involved in the Pathway Study was of great benefit to many of our patients. We had never had the option of offering a home-based therapy that could greatly aid our patients’ understanding of the psychological issues caused by their¬†heart attack and help their overall recovery. As a team we enjoyed taking part and being able to offer this, and saw many positive outcomes from our patients,”

said Joanne Varker, a specialist nurse in cardiac rehabilitation at Royal Bolton Hospital, one of the NHS sites involved in the study.

The trial’s findings demonstrated that, whether receiving care at home or in a clinic, home-based metacognitive therapy can assist cardiac patients in learning new and more advantageous ways to deal with their upsetting thoughts.

The study’s main limitation is the lack of longer-term (such as 12-month) follow-up data. Furthermore, it should be noted that the current study is designed to test the additional benefit of MCT when added to existing cardiac rehabilitation, which contained various psychological interventions itself.

Because they rely on opposing mental processes, combining metacognitive therapy with the psychological techniques included in some CR packages may impair rather than enhance metacognitive therapy effects.

  1. Wells A, Reeves D, Heal C, Fisher P, Doherty P, Davies L, et al. (2023) Metacognitive therapy home-based self-help for anxiety and depression in cardiovascular disease patients in the UK: A single-blind randomised controlled trial. PLoS Med 20(1): e1004161.