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Effectiveness of Cognitive Behavioral Therapy for Depression and Anxiety in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis
Open accessAbstract
OBJECTIVE: Depression and anxiety are highly prevalent in patients with cardiovascular disease (CVD) and influence their mental well-being and CVD prognosis. The primary objective was to assess the effectiveness of cognitive behavioral therapy (CBT) for depression and anxiety in patients with CVD. Secondary objectives were to assess the impact of CBT on cardiovascular mortality, cardiovascular events, patient satisfaction, and quality of life. METHODS: MEDLINE, PsycINFO, CINAHL, CENTRAL, and alternative sources were searched for randomized controlled trials and observational studies with a control. Studies were required to assess CBT in coronary heart disease, acute coronary syndrome, atrial fibrillation, or postmyocardial infarction patients, with anxiety and/or depression. Studies were independently screened by two reviewers and critically appraised using the Cochrane Risk of Bias tool. The random-effects model was used to pool standardized mean differences (SMD). RESULTS: Twelve randomized controlled trials were included. At follow-up, depression (SMD = -0.35, 95% confidence interval [CI] = -0.52 to -0.17, p < .001, I = 59%) and anxiety (SMD = -0.34, 95% CI = -0.65 to -0.03, p = .03, I = 71%) scores were significantly lower in CBT patients compared with controls. Change in mental health quality of life (SF-12) was also significantly greater for CBT patients, compared with controls (mean difference = 3.62, 95% CI = 0.22 to 7.02, p = .04, I = 0%). No differences in patient satisfaction or cardiovascular events were evident between CBT and control groups. Among the study reports included in this meta-analysis, data specific to cardiovascular mortality were not reported. CONCLUSIONS: Cognitive behavioral therapy seems to be an effective treatment for reducing depression and anxiety in patients with CVD and should be considered in standard clinical care.
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“Psychological treatment of anxiety and depression has small to moderate efficacy in this group and is not commonly based on a model of causal mechanisms.”
From Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review (2020) · cites this paper as [18]
In the citing paper
“Whilst CBT significantly decreased symptoms, the effect sizes were small for depression (Cohen’s d = 0.35) and anxiety (Cohen’s d = 0.34) [18].”
From Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review (2020) · cites this paper as [18]
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“It’s important to note that [45], which is inconsistent with our results.”
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The effects of cognitive behavioral therapy in women with polycystic ovary syndrome: A meta-analysis
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“CBT has been successful in the treatment of various illnesses including obesity, depression, anxiety, eating disorders, insomnia, and other chronic disorders (Grilo et al., 2011; Reavell et al., 2018; Zweerde et al., 2019).”
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“CBT is an empirically validated psychotherapy that is efficacious for targeting depression, anxiety, and PTSD in women and men [105–108].”
Health Psychology and Behavioral Medicine
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“scored between ‘none of the days’ (0) to ‘often, 5–7 days’ (3).”
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“However, considering a previous review focusing on face-to-face CBT that showed comprehensive and significant improvements in depression as well as anxiety and HRQoL among patients with CVDs [52], patient concerns or diagnoses and preferences must be considered.”
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“…improvements in depression and anxiety exhibited by real-world LTC patients in the pre-sent study thus builds upon existing research where prior studies and trials have shown the effectiveness of CBT-based interventions for treating comorbid depression and anxiety across a variety of LTCs [36–39].”
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“A systematic review and meta-analysis by Reavell et al [51] showed a significant reduction in anxiety in long CBT interventions but not in short-to medium-term interventions compared with controls.”
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“A literature review showed RCTs on the effects of CBT on physiological and psychological symptoms in patients receiving hemodialysis and those with numerous chronic diseases, such as HF, cancer, and MS (Menzies et al., 2018; Reavell et al., 2018).”
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“16 17 It is evident that more effective psychological interventions and higher-quality trials are needed.”
Ai, A. L., & Carretta, H. J. (2020) · International Journal of Behavioral Medicine · doi:10.1007/s12529-020-09915-3 · Cited by 13
Faija, C., Reeves, D., Heal, C., Capobianco, L., Anderson, R., & Adrian Wells, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02109 · Cited by 13
“A recent meta-analysis including 12 randomized controlled trials of CBT in cardiac patients showed small to moderate effects in improving anxiety (d = 0.34) and depression (d = 0.35) compared mainly to usual care (Reavell et al., 2018).”
ResultInfluentialGuo, X., Guo, X., Wang, R., & Zhang, Y. (2022) · Computational and Mathematical Methods in Medicine · doi:10.1155/2022/8304405 · Cited by 11
“At present, cognitive behavioral therapy has been widely used in the treatment of psychological diseases [3, 4].”
MethodValidation of Two Screening Tools for Anxiety in Hemodialysis Patients
Nadort, E., van Geenen, N. J. K., Schouten, R. W., Boeschoten, R. E., Shaw, P. C., Vleming, L. J., Schouten, M., Farhat, K., Dekker, F. W., van Oppen, P., et al. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12071077 · Cited by 11
Xie, M., Yang, Y., & Zhang, J. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1297841 · Cited by 13
Susinski, S., Bouchard, K., Stragapede, E., Dozois, S., Sterling, E., & Tulloch, H. E. (2024) · Canadian Journal of Physiology and Pharmacology · doi:10.1139/cjpp-2023-0416 · Cited by 10
Kwek, S. Q., Yeo, T. M., Teo, J. Y. C., Seah, A. C. W., Kai Ning, J. P., & Wang, W. (2025) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvaf084 · Cited by 13
El-Malahi, O., Mohajeri, D., Bäuerle, A., Mincu, R. I., Rammos, C., Jansen, C., Teufel, M., Rassaf, T., & Lortz, J. (2025) · Journal of Medical Internet Research · doi:10.2196/67118 · Cited by 13
“Our meta-analysis finding that internet-based CBT has no significant effect on the SF-12 Physical Health score is consistent with the findings of a previous meta-analysis that investigated the impact of CBT in patients with CVD [49].”
Augsburg, J. B., Dar, M. I., Wood, K., Rasmussen, T. B., & Risom, S. S. (2022) · Mental Health & Prevention · doi:10.1016/j.mhp.2022.200245 · Cited by 10
Mourad, G., Lundgren, J., Andersson, G., Husberg, M., & Johansson, P. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059939 · Cited by 9
Westas, M., Mourad, G., Andersson, G., Neher, M., Lundgren, J., & Johansson, P. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03939-7 · Cited by 10
“Although a recognized method in the treatment of depression in cardiovascular patients [8, 9], CBT brings another challenge.”
MethodFu, Y. H. H., Lin, Q., Xiang, Q., Wen, X., & Liu, L. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1027253 · Cited by 9
“This phenomenon has been found not only in Japanese hospitals but also in European ones (Suzuki et al., 2011; Celano et al., 2016; Matsuda et al., 2017; Aguirre-Camacho and Moreno-Jiménez, 2018; Norlund et al., 2018; Reavell et al., 2018).”
BackgroundAn Integrated Perspective for Understanding the Psychosocial Impact of Acute Cardiovascular Events
Jackson, A. C., Rogerson, M. C., & Murphy, B. M. (2023) · Heart and Mind · doi:10.4103/hm.hm-d-23-00029 · Cited by 9
Gostoli, S., Subach, R., Guolo, F., Buzzichelli, S., Daga, G. A., de Figueiredo, J. M., & Rafanelli, C. (2024) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2024.100444 · Cited by 9
“Such a form of active control — unlike in previous trials that have used treatment as usual (Reavell et al., 2018) — allows discrimination of specific and nonspecific ingredients of the psychotherapeutic approach.”
ResultWestas, M., Mourad, G., Andersson, G., Lundgren, J., & Johansson, P. (2024) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvad097 · Cited by 8
“15 Cognitive behavioural therapy (CBT) could be one way to decrease anxiety in patients with CVD. 16 Access to CBT is limited due to a lack of therapists, leading to a large treatment-demand gap; i.e. many patients will not have access to CBT in spite of need.”
BackgroundInfluentialNetwork analysis of anxiety and depressive symptoms among patients with cardiovascular disease
Zhao, Q., Zhang, Y., Ji, L., & Pan, Z. (2025) · BMC Public Health · doi:10.1186/s12889-025-22269-3 · Cited by 8
“Previous studies have explored the influencing factors [25] and intervention strategies [26] of anxiety and depression in patients with CVD.”
Beyond the Heart: The Significance of Depression in Cardiac Surgery
Stenman, M., Jackson, V., Särnholm, J., Falk, A. S., Nielsen, S. J., & Sartipy, U. (2025) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezaf277 · Cited by 8
“…intervention for improving psychological outcomes, such as depression and anxiety, in patients with CHD and other cardiovascular conditions 72,73 Additionally, CBT has been shown to have a positive impact on physical health outcomes, including enhanced cardiac function and reduced…”
Schmidt, T., Kok, R., Andersen, C. M., Skovbakke, S. J., Ahm, R., Wiil, U. K., Frostholm, L., & Pedersen, S. S. (2021) · Informatics for Health and Social Care · doi:10.1080/17538157.2021.1878185 · Cited by 8
“However, due to the heterogeneity of the different study results found in the meta-analysis on the effect of CBT on anxiety in patients with CVD, no clear conclusion can be made on CBT’s effect on anxiety.(15) Furthermore, the results of online cognitive behavioral therapy (iCBT) administered for IHD patients and como…”
BackgroundBerg, S. K., Herning, M., Schjødt, I., Thorup, C. B., Juul, C., Svendsen, J. H., Jørgensen, M. B., Risom, S. S., Christensen, S. W., Thygesen, L. C., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-057085 · Cited by 8
VanVoorhis, R. W., Miller, K. L., & Miller, S. M. (2023) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02622-z · Cited by 10
“A cognitive-behavioral therapy (CBT) model guided development of session content as CBT has been shown to be robust and effective for treating a variety of psychological disorders including anxiety, stress, depression, phobias, and autism (Reavell et al., 2018).”
BackgroundIschemic Heart Disease as an Important Risk Factor for Depression—A Case Report
Bondar, L. I., Osser, B., Osser, G., Mariș, M. A., Piroș, E. L., Almășan, R., & Popescu, M. I. (2024) · Applied Sciences · doi:10.3390/app14051969 · Cited by 8
Psychological distress in patients with cardiovascular disease: time to do something about it?
Johansson, P., Andersson, G., Jaarsma, T., Lundgren, J., Westas, M., & Mourad, G. (2021) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvab007 · Cited by 8
“European Journal of Cardiovascular Nursing (2021) 20, 293–294 EDITORIAL doi:10.1093/eurjcn/zvab007 D ow nloaded from https://academ ic.oup.com /eurjcn/article/20/4/293/6220444 by guest on 01 Septem ber 2021 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .…”
BackgroundInfluentialVest, B. M., Quigley, B. M., Lillvis, D. F., Horrigan-Maurer, C., Firth, R. S., Curtis, A. B., & Lackner, J. M. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-021-07303-5 · Cited by 7
Fi, B., Sumin, A. N., Garganeeva, N. P., Ларева, Н. В., Петрова, М. М., Петрунько, О. В., Попонина, Т. М., Repin, A. N., & Собенников, В. С. (2024) · Complex Issues of Cardiovascular Diseases · doi:10.17802/2306-1278-2024-13-3s-222-253 · Cited by 8
Was ist gesichert in der Therapie depressiver Komorbidität?
Albus, C., & Geiser, F. (2019) · Der Internist · doi:10.1007/s00108-019-00694-y · Cited by 7
Holdgaard, A., Eckhardt-Hansen, C., Lund, T., Lassen, C. F., Sibilitz, K. L., Høfsten, D. E., Prescott, E., & Rasmusen, H. K. (2021) · Trials · doi:10.1186/s13063-021-05405-3 · Cited by 7
Ski, C. F., Taylor, R. S., McGuigan, K., Lambert, J. D., Richards, S. H., & Thompson, D. R. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013508 · Cited by 7
“…prevention guidelines internationally (e.g. BACPR 2017; NICE 2018; Piepoli 2016), although there is a move toward different sorts of targeting of psychological interventions, for example, mood states (Reavell 2018), and adherence to lifestyle change (Khanji 2018), and medicines (Bosworth 2018).”
BackgroundHan, X., Wang, Q., Wang, H., Jia, D., Cheng, J., Wang, R., Zhang, C., Kong, J., & Zhang, Z. (2025) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580251344165 · Cited by 6
Metadata
- Authors
- Reavell, J., Hopkinson, M., Clarkesmith, D., & Lane, D. A.
- Affiliations
- Sandwell & West Birmingham Hospitals NHS Trust (GB)
- Corresponding author
- Lane, Deirdre A.
- Venue
- Psychosomatic Medicine
- Published
- 2018-10
- Volume
- 80
- Issue
- 8
- Pages
- 742-753
- ISSN
- 0033-3174 (ISSN-L)
- 1534-7796
- OpenAlex
- W2883745162
- Cited by
- 189
- References
- 34
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 28 · 2023: 24 · 2022: 36 · 2021: 34 · 2020: 23 · 2019: 12
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Open access
- green
- vbn.aau.dk
- Licence
- other-oa
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion, other-oa)
- Funders
- Bristol-Myers Squibb
- Pfizer
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, depression, anxiety, cardiovascular disease, coronary artery disease, acute coronary syndrome, atrial fibrillation, post-myocardial infarction, quality of life, cardiovascular mortality, cardiovascular events, patient satisfaction
- MeSH terms
- Anxiety Disorders, Cardiovascular Diseases, Depressive Disorder, Humans, Comorbidity, Cognitive Behavioral Therapy, Outcome Assessment, Health Care
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