Internet-based Cognitive Behavior Therapy After Myocardial Infarction

A Randomized Controlled Study of the Effects of Internet-based Cognitive Behavior Therapy on Depression and Anxiety in Patients With a Previous Myocardial Infarction

The overall aim and primary objective is to evaluate the effects on level of depression and anxiety of an Internet-based CBT-program in depressed and/or anxious patients after a myocardial infarction (MI).

Major or minor depressive disorders and anxiety disorders are present in many patients with cardiovascular disease (CVD) and are associated with adverse cardiovascular outcomes, even after controlling for other risk factors. 500 patients with symptoms of anxiety and/or depression after MI will be randomized either to a 14 week Internet-based CBT-program or to treatment as usual (TAU) which is the control condition. A reference group of 250 participants without depressive or anxiety symptoms will also be studied during TAU. Data will be collected before, after and 7 months after treatment. Anxiety and depression according to ratings on the Hospital Anxiety and Depression Scale (HADS) are the primary outcome measures.

Inclusion Criteria:

• Patients younger than 75 years with a recent acute MI (< 3 months)
• Depression and/or anxiety score of > 7 on one or both of the HADS subscales (concerns only the intervention, not the reference group)

Exclusion Criteria:

• Patients that are scheduled for a coronary artery bypass surgery (CABG)
• Unable or unwilling to use computer or Internet
• Difficulties in reading or understanding Swedish
• A life expectancy of less than a year
• Anticipated poor compliance (multi-disease, substance abuse etc.)
• Highly depressed or suicidal (MADRS-score > 29 or MADRS item 9 > 3)