Pathway Mechanisms

Pathway Mechanisms

Professor Adrian Wells

Chief Investigator

2-year project

study name

Pathway Mechanisms

Study participants were heart disease patients with comorbid anxiety/depression symptoms referred to CR services at seven NHS Trusts in the North West and took part in the MCT-PATHWAY study. 

Study Participants

  • The study is a mechanistic study using data from the NIHR-funded PGfAR PATHWAY study. 
  • PATHWAY was completed in August 2021 and included two RCTs. 
  • The first RCT (WS2) was a multicentre, two-arm, single-blind RCT with four-month and twelve-month follow-ups comparing Group-MCT plus usual CR with usual CR alone. 
  • The second RCT (WS3) was a multicentre, two-arm, single-blind RCT with a four-month follow-up comparing home-based MCT plus usual CR with usual CR alone. 

Pathway Mechanisms Info

  • Depression and anxiety (distress) affect at least I in 3 patients attending cardiac rehabilitation (CR). 
  • Talking-based therapies are not routinely offered and when available, have limited effects. 
  • This is concerning because distressed patients are at greater risk of death, further cardiac events, poorer quality of life, and use more healthcare services. 
  • Our previous studies found that adding a talking-based therapy called metacognitive therapy (MCT for short) to CR significantly reduced distress. 
  • We need to understand more about why MCT works, who it works best for, and which of the MCT techniques are most successful. 
  • This will allow us to understand why treatment might fail for some people, which techniques need to be improved and which shouldn’t be changed. 

Project Timeline

Stage 1

Months 1-3 will be for study initiation including the creation of databases. 

Stage 2

Months 3-19 will be for data cleaning and data analyses. 

Stage 3

Months 19-24 will be for report writing and dissemination. 

Pathway Mechanisms FAQs

YoMeta Study FAQ
What is the purpose of the study?
  • To determine how and why metacognitive therapy (MCT) reduces anxiety and low mood in cardiac rehabilitation (CR) patients. 
  • This will allow us to understand why treatment might fail for some people, which techniques need to be improved and which shouldn’t be changed. 
What does the study involve?
What is Patient and Public Involvement (PPI)?