Therapy delivered remotely can help ease mental illness symptoms

Metacognitive therapy (MCT), which helps people have better control over negative thoughts, can help reduce depression, anxiety and post-traumatic stress (PTS) symptoms in patients with heart disease even when it is delivered remotely, a new study has found.

The study, published in the journal Plos Medicine, was conducted by Greater Manchester Mental Health NHS Foundation Trust and the University of Manchester. It recruited 240 cardiac rehabilitation (CR) patients from five trusts in the North West of England, randomly assigned to two groups. The first group of 118 patients were given home-based MCT plus standard CR treatment, while the other 122 patients received only CR.

Researchers decided to carry out the study because one-third of cardiovascular disease (CVD) patients suffer anxiety and depression symptoms, but current psychological support in cardiac rehabilitation (CR) is limited and produces small effects. It is important, they write in the paper, to treat anxiety and depression because they are associated with worse health outcomes and impair quality of life. An earlier study of MCT had been found to improve anxiety and depression when delivered by cardiac staff, so the researchers wanted to find out if it could also be effective if delivered to patients in their own homes.

‘Significant’ reductions in anxiety

The patients receiving MCT were given a self-help manual to supplement the therapy, as well as phone calls from trained professionals to support their learning and give them opportunities for reflection.

This group reported significant reductions in anxiety, depression, and PTS symptoms compared to the group receiving CR care alone. Researchers say that the results show that MCT is effective in both therapist-led sessions and at home.

The study’s chief investigator, Professor Adrian Wells, said: “It’s not surprising that people living with or recovering from serious heart problems experience symptoms of anxiety, depression and trauma. They are often recovering from potentially life-limiting conditions and uncertainty which understandably causes distress.

“What’s important is that we recognise this and provide patients with effective, evidence-based treatment options. The results of our trial have shown that home-based MCT can help cardiac patients discover new and more helpful ways to process their distressing thoughts, whether they are undergoing treatment at home or at a clinic.”

Joanne Varker, a cardiac rehabilitation specialist nurse at Royal Bolton Hospital, one of the NHS sites involved in the study, said that being involved in the study had been “of great benefit” to 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.”