Metacognitive therapy self-help for anxiety-depression: single-blind randomized feasibility trial in cardiovascular disease
Open accessAbstract
BACKGROUND: One in three cardiovascular disease (CVD) patients experience significant anxiety and depression. Current psychological interventions have limited efficacy in reducing such symptoms and are offered as a face-to-face intervention that may be a barrier to accessing treatment. We evaluated the feasibility and acceptability of delivering assisted home-based self-help metacognitive therapy (home-MCT) to cardiac rehabilitation (CR) patients experiencing anxiety and depression. METHOD: One hundred eight CR patients with elevated anxiety and/or depression were recruited to a single-blind randomized feasibility trial across two United Kingdom National Health Service Trusts and were randomized to usual CR or usual CR plus home-MCT. The feasibility and acceptability of adding home-MCT to CR was based on credibility or expectancy ratings, recruitment rate, drop-outs, number of CR and home-MCT modules completed, and ability of outcome measures to discriminate between patients. The study was used to refine the sample size estimate for a full-scale trial. The quality of telephone support calls delivered by CR staff trained in MCT was assessed. RESULTS: Home-MCT was found to be feasible and acceptable for the current CR patients with anxiety and depression. Recruitment and retention of participants was high, and attendance at CR was similar for both groups. Completion of home-MCT was high, but the quality of telephone support calls delivered was lower than expected. CONCLUSIONS: Home-MCT was acceptable and feasible to deliver to CR patients experiencing anxiety and depression, and the feasibility of conducting a full-scale trial of the intervention was established. Home-MCT may provide additional treatment options for cardiac patients experiencing psychological distress. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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In the PATHWAY program, half of the patients indicated that they did not need the telephone calls and even rated them negatively.
“In evaluating the program, however, half of the patients indicated that they did not need the calls and even rated them negatively (26).”
From Improving mental well-being in psychocardiology—a feasibility trial for a non-blended web application as a brief metacognitive-based intervention in cardiovascular disease patients (2023) · cites this paper as [26]
The Results (Acceptability; page not provided) say 40% of respondents did not need the calls, while 40% said they did; the Discussion describes patients as evenly split. The claim that patients rated the calls negatively is not supported: the poor delivery-quality ratings in the Results (Home-MCT Telephone Support Calls Quality Ratings) came from independent raters, not patients. (LLM, conf=0.90)
Experimental — accuracy not yet measuredMCT has been shown to be an encouraging approach for brief internet interventions.
“Recently, MCT has been also shown to be an encouraging approach for brief internet interventions (26, 27).”
From Improving mental well-being in psychocardiology—a feasibility trial for a non-blended web application as a brief metacognitive-based intervention in cardiovascular disease patients (2023) · cites this paper as [26]
The Discussion reports that home-based MCT appeared feasible and acceptable for cardiac rehabilitation patients, supporting the description of MCT as encouraging. But the Method > Treatment specifies a six-module paper manual with telephone support, not an internet intervention; the paper does not establish its promise for brief internet delivery. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWells et al. showed a completion rate of 50-70% of at least four modules while being guided.
“Wells et al. (26) showed a completion rate of 50–70% of at least four modules while being guided.”
From Improving mental well-being in psychocardiology—a feasibility trial for a non-blended web application as a brief metacognitive-based intervention in cardiovascular disease patients (2023) · cites this paper as [26]
The Results (Home-MCT Adherence) report that 24 patients completed at least four modules: 45.3% of eligible Home-MCT patients, or 72.7% of those who returned the credibility questionnaire. The Discussion describes 50–70% as an assumed completion range, not a single observed rate. The Method (Statistical Analysis) confirms that patients received supportive telephone calls. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- Wells, A., Reeves, D., Heal, C., Fisher, P., Doherty, P., Davies, L., Heagerty, A., & Capobianco, L.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- University of Liverpool (GB)
- University of York (GB)
- University of Manchester (GB)
- Manchester Royal Infirmary (GB)
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- ORCID
- Venue
- Health Psychology
- Published
- 2022-05
- Volume
- 41
- Issue
- 5
- Pages
- 366-377
- ISSN
- 0278-6133 (ISSN-L)
- 1930-7810
- PMC
- PMC9037049
- OpenAlex
- W4224942355
- Cited by
- 11
- References
- 54
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 1
- FWCI
- 1.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Health Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Funders
- National Institute for Health Research (RP-PG-1211-20011)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- metacognitive therapy, anxiety, depression, cardiovascular disease, cardiac rehabilitation, telephone-delivered intervention, feasibility, acceptability, psychological distress, psychological intervention
- MeSH terms
- Anxiety, Cardiovascular Diseases, Depression, Feasibility Studies, Humans, State Medicine, Single-Blind Method
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