Online Cognitive Behavioral Therapy Targeting Cardiac Anxiety

Online Cognitive Behavioral Therapy Targeting Cardiac Anxiety Following Myocardial Infarction: A Randomized Controlled Trial

The purpose of the present study is to evaluate an internet-delivered exposure-based cognitive behavioral therapy (CBT) protocol tailored for patients following myocardial infaction (MI) to increase Quality of Life (Qol) and physical activity by reducing cardiac anxiety.

In the present research project, the investigators have tailored a CBT protocol to target the hypothesized mechanisms of how cardiac anxiety affects the clinical course of MI; by using exposure therapy to reduce fear, hypervigilance, and misinterpretations of cardiac symptoms to reduce MI-related avoidance and increasing physical activity.

Participants (estimated N=100) are randomized to internet-delivered CBT for 8 weeks or to a waitlist offered treatment as usual. Patients in the control arm will be crossed over to CBT treatment 3 months after the experimental group has completed treatment. Assessments will be conducted pre-treatment, post-treatment, 3 months (primary endpoint), 1-, 2 - and 5 years after treatment. These measurement points will also include the control group as it is crossed over to CBT after the 3-month follow-up

Inclusion Criteria:

• Inclusion criteria:
• Myocardial infarction ≥ 6 months before assessment (type 1 STEMI/NSTEMI)
• Age 18-80 years;
• Clinically significant cardiac anxiety that leads to severe distress and/or interferes with daily life
• On adequate medical treatment(21); (E) Able to read and write in Swedish.

Exclusion Criteria:

• heart failure with severe systolic dysfunction (ejection fraction ≤ 35%)
• Significant valvular disease
• Planned coronary artery bypass surgery or percutaneous interventions
• Any medical restriction to physical exercise
• Severe medical illness
• Grade 3 hypertension (i.e., blood pressure ≥ 180 systolic and/or 110 diastolic)
• Severe psychiatric disorder or risk of suicide
• Alcohol dependency
• Ongoing psychological treatment.