Transdiagnostic Cognitive-Behavioral Therapy for Depression and Anxiety Disorders in Cardiovascular Disease Patients: Results From the CHAMPS Pilot-Feasibility Trial

A systematic review and meta-analysis of transdiagnostic cognitive behavioural therapies for emotional disorders

Transdiagnostic cognitive behavioural psychotherapy (TD-CBT) may facilitate the treatment of emotional disorders. Here we investigate short- and long-term efficacy of TD-CBT for emotional disorders in individual, group and internet-based settings in randomized controlled trials (PROSPERO CRD42019141512). Two independent reviewers screened results from PubMed, MEDLINE, PsycINFO, Google Scholar, medRxiv and OSF Preprints published between January 2000 and June 2023, selected studies for inclusion, extracted data and evaluated risk of bias (Cochrane risk-of-bias tool 2.0). Absolute efficacy from pre- to posttreatment and relative efficacy between TD-CBT and control treatments were investigated with random-effects models. Of 56 identified studies, 53 (6,705 participants) were included in the meta-analysis. TD-CBT had larger effects on depression (g = 0.74, 95% CI = 0.57-0.92, P < 0.001) and anxiety (g = 0.77, 95% CI = 0.56-0.97, P < 0.001) than did controls. Across treatment formats, TD-CBT was superior to waitlist and treatment-as-usual. TD-CBT showed comparable effects to disorder-specific CBT and was superior to other active treatments for depression but not for anxiety. Different treatment formats showed comparable effects. TD-CBT was superior to controls at 3, 6 and 12 months but not at 24 months follow-up. Studies were heterogeneous in design and methodological quality. This review and meta-analysis strengthens the evidence for TD-CBT as an efficacious treatment for emotional disorders in different settings.

The effects of cognitive behavioral therapy on health-related quality of life, anxiety, depression, illness perception, and in atrial fibrillation patients: a six-month longitudinal study

BACKGROUND

Atrial fibrillation (AF) often leads to an impaired Health-Related Quality of Life (HRQoL) in many patients. Moreover, psychological factors such as depression, anxiety, and illness perception have been found to significantly correlate with HRQoL. This study aims to evaluate the long-term effectiveness of Cognitive Behavioral Therapy (CBT) in enhancing HRQoL and mitigating psychological distress among AF patients.

METHODS

Employing a prospective, open design with pseudo-randomization, this study encompassed pre-tests, post-treatment evaluations, and a 6-month follow-up. A total of 102 consecutive patients diagnosed with paroxysmal AF were initially enrolled. Out of these, 90 were assigned to two groups; one to receive a 10-week CBT treatment specifically focusing on anxiety, and the other to receive standard care. Outcome measures were evaluated using tools such as the Item Short Form Health Survey (SF-12), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), University of Toronto Atrial Fibrillation Severity Scale (AFSS), and Brief Illness Perception Questionnaire (BIPQ). These assessments were conducted at pre-treatment, post-treatment, and at the 6-month follow-up mark. We explored the effectiveness of CBT using Generalized Estimating Equations (GEE).

RESULTS

Our analysis revealed a notable improvement in the CBT group relative to the control group. All metrics displayed consistent improvement across a 6-month duration. At the 6-month checkpoint, the CBT group exhibited a more favorable SF-12 Mental Component Score (MCS) (50.261 ± 0.758 vs. 45.208 ± 0.887, p < 0.001), reduced GAD-7 (4.150 ± 0.347 vs. 8.022 ± 0.423, p < 0.001), BIPQ (34.700 ± 0.432 vs. 38.026 ± 0.318, p < 0.001), and AFSS (9.890 ± 0.217 vs. 10.928 ± 0.218, p = 0.001) scores when compared to the TAU group. Conversely, the SF-12 PCS (44.212 ± 0.816 vs. 47.489 ± 0.960, p = 0.139) and PHQ-9 scores (8.419 ± 0.713 vs. 10.409 ± 0.741, p = 0.794) manifested no significant difference between the two groups.

CONCLUSION

The findings suggest that CBT is effective in improving HRQoL and reducing psychological distress among patients with AF at 6 month follow-up. This highlights the potential benefits of integrating CBT into the therapeutic regimen for AF patients.

TRIAL REGISTRATION

Retrospectively registered with ClinicalTrials.gov (NCT05716828). The date of registration : 5 June 2023.

Preoperative depression and anxiety as predictors of postoperative C-reactive protein levels in patients undergoing cardiac surgery: a prospective observational study

AIM OF THE STUDY

In patients undergoing cardiac surgery, preoperative depressive and anxiety symptoms and increased postoperative C-reactive protein (CRP) levels have been associated with adverse outcomes. We tested the hypothesis that preoperative depressive and anxiety symptoms predict elevated in-hospital CRP levels after cardiac surgery.

METHODS

The study participants were 96 consecutive patients (mean age [SD], 67.6 [10.3] years, 78.1% men) from a single cardiac surgery centre who underwent either isolated coronary artery bypass grafting (CABG) (n = 34), isolated valve surgery (n = 29), combined procedures (including different combinations of CABG, valve surgery, aortic surgery, and others) (n = 30), or other cardiac surgical procedures (n = 3). Participants self-rated depressive and anxiety symptoms using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) questionnaire before undergoing elective surgery. CRP levels were measured every 24 h up to 10 days post-surgery. Linear mixed (random effects) regression analysis examined the association between preoperative depressive and anxiety symptoms and CRP levels over time, adjusting for pre-surgery CRP levels, demographics, cardiovascular risk factors, medications, and surgery-related variables.

RESULTS

Before surgery, 32.2% of patients had clinically relevant depressive symptoms (PHQ-9 score ≥5) and 32.2% of patients had clinically relevant anxiety symptoms (GAD-7 score ≥5). More severe depressive symptoms (estimate [95% CI]: 0.081 [0.023, 0.139], p = 0.007) and more severe anxiety symptoms (0.059 [0.005, 0.113], p = 0.032) predicted CRP levels over 10 days, independent of covariates. Furthermore, CRP levels were higher in patients with than in those without clinically relevant depressive symptoms (0.697 [0.204, 1.191], p = 0.006) and were predicted by both more severe somatic (0.132 [0.035, 0.229], p = 0.008) and cognitive (0.128 [0.014, 0.242], p = 0.029) depressive symptoms.

CONCLUSIONS

Preoperative depressive and anxiety symptoms were independent predictors of elevated CRP levels up to 10 days post-surgery. Such a mechanism may help explain the increased morbidity and mortality risk in patients with depression and anxiety who undergo cardiac surgery.