New home-based self-help psychological therapy reduces anxiety and depression in people with heart disease

A collaboration between the Greater Manchester Mental Health NHS Foundation Trust (GMMH) and The University of Manchester (UoM), funded by the National Institute for Health and Care Research (NIHR), has discovered that Metacognitive Therapy (MCT) can effectively reduce depression, anxiety, and post-traumatic stress symptoms in heart disease patients when delivered through a self-help format.


Heart disease patients and those who have experienced severe heart problems, such as heart attacks or open-heart surgery, often struggle with stress and anxiety related to their medical condition. They are often referred to a cardiac rehabilitation (CR) program, either in a clinic or remotely, to aid in their recovery. However, the mental health treatment offered as part of these programs can vary greatly and is often limited. Treating anxiety and depression is critical, as research demonstrates that this type of distress can decrease quality of life and increase the risk of further heart problems and even death.


The findings from the MCT-PATHWAY study, published in PLOS Medicine, expands upon earlier research that found group-based MCT to be effective in reducing anxiety and depression symptoms in cardiac patients. This study shows that MCT can be delivered both in a group setting and through a self-help manual, offering patients greater flexibility in their choice for mental health support within cardiac rehabilitation services.


In the study, 118 cardiac patients were randomly assigned to receive Home-MCT plus standard cardiac rehabilitation treatment, while 122 patients were assigned to standard CR only. The Home-MCT patients were given a self-help manual, which they worked through at their own pace, including modules on reducing worry and rumination and developing new ways to cope with negative thoughts. Additionally, Home-MCT patients received support phone calls from trained staff to encourage reflection and to reinforce their learning.


Patients who received home-based MCT showed significant reductions in anxiety, depression, and post-traumatic stress symptoms compared to those who received only standard CR. The results indicate that Metacognitive Therapy can be effective when delivered by a therapist in a group setting and when accessed remotely from home, giving healthcare providers the ability to offer patients greater choice in accessing the psychological components of CR programs.


Harriet Dawson was 22 years old when she had open heart surgery following the discovery of a hole in her heart. She then took part in the MCT-PATHWAY study.

She commented:
“It was very self-guided. You had check-in calls every couple of weeks and I liked that…. I preferred that it was home-based because I didn’t have to compare and contrast my answer. A lot of it was about managing your stress, managing your worry, and how much of it us under your control.”


Professor Adrian Wells, PATHWAY Chief Investigator commented:
“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.”