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Cited by 104Digital Mental Health InterventionsCardiac Health and Mental HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The Effect of Guided Web-Based Cognitive Behavioral Therapy on Patients With Depressive Symptoms and Heart Failure: A Pilot Randomized Controlled Trial

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Lundgren, Johan Gustav, Dahlström, Örjan, Andersson, Gerhard, Jaarsma, Tiny, Kärner Köhler, Anita, Johansson, Peter·2016·Journal of Medical Internet Research
DOI 10.2196/jmir.5556PMC PMC5070581
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Abstract

BACKGROUND: Depressive symptoms, and the associated coexistence of symptoms of anxiety and decreased quality of life (QoL), are common in patients with heart failure (HF). However, treatment strategies for depressive symptoms in patients with HF still remain to be established. Internet-based cognitive behavioral therapy (ICBT), as guided self-help CBT programs, has shown good effects in the treatment of depression. Until now, ICBT has not been evaluated in patients with HF with depressive symptoms. OBJECTIVE: The aims of this study were to (1) evaluate the effect of a 9-week guided ICBT program on depressive symptoms in patients with HF; (2) investigate the effect of the ICBT program on cardiac anxiety and QoL; and (3) assess factors associated with the change in depressive symptoms. METHODS: Fifty participants were randomized into 2 treatment arms: ICBT or a Web-based moderated discussion forum (DF). The Patient Health Questionnaire-9 was used to measure depressive symptoms, the Cardiac Anxiety Questionnaire (CAQ) was used to measure cardiac-related anxiety, and the Minnesota Living with Heart Failure questionnaire was used to measure QoL. Data were collected at baseline and at follow-up at the end of the 9-week intervention. Intention-to-treat analysis was used, and missing data were imputed by the Expectation-Maximization method. Between-group differences were determined by analysis of covariance with control for baseline score and regression to the mean. RESULTS: No significant difference in depressive symptoms between the ICBT and the DF group at the follow-up was found, [F(1,47)=1.63, P=.21] and Cohen´s d=0.26. Secondary within-group analysis of depressive symptoms showed that such symptoms decreased significantly in the ICBT group from baseline to the follow-up (baseline M=10.8, standard deviation [SD]=5.7 vs follow-up M=8.6, SD=4.6, t(24)=2.6, P=.02, Cohen´s d=0.43), whereas in the DF group, there was no significant change (baseline M=10.6, SD=5.0, vs follow-up M=9.8, SD=4.3, t(24)=0.93, P=.36. Cohen´s d=0.18). With regard to CAQ and QoL no significant differences were found between the groups (CAQ [d(1,47)=0.5, P=.48] and QoL [F(1,47)=2.87, P=.09]). In the ICBT group in the CAQ subscale of fear, a significant within-group decrease was shown (baseline M=1.55 vs follow-up M=1.35, P=.04). In the ICBT group, the number of logins to the Web portal correlated significantly with improvement in depressive symptoms (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in depressive symptoms. This study is underpowered because of difficulties in the recruitment of patients. CONCLUSIONS: Guided ICBT adapted for persons with HF and depressive symptoms was not statistically superior to participation in a Web-based DF. However, within the ICBT group, a statically significant improvement of depressive symptoms was detected. CLINICALTRIAL: Clinicaltrials.gov NCT01681771; https://clinicaltrials.gov/ct2/show/NCT01681771 (Archived by WebCite at http://www.webcitation.org/6ikzbcuLN).

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  • Researchers in this field often start by conducting a randomized controlled trial, sometimes referred to as a 'pilot RCT', but not necessarily having smaller samples than older psychotherapy trials, which were often underpowered.

    “Researchers in this field often start by conducting a ran domized controlled trial (RCT), sometimes referred to as a”

    From Internet-delivered psychological treatments: from innovation to implementation (2019) · cites this paper as [43]

    The Methods (Recruitment Procedure and Inclusion; page unavailable) describe randomizing 50 patients, and the paper identifies itself as a pilot randomized controlled trial. The paper does not establish that researchers often begin with pilot RCTs or compare their sample sizes with older psychotherapy trials. The Discussion (Principal Findings; page unavailable) calls this study itself underpowered, not older trials generally. (LLM, conf=0.84)

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  • The intervention structure and content build up on prior CBT- and ACT-inspired interventions developed by the Department of Behavioural Sciences and Learning at Linköping University, targeting other populations.

    “The intervention structure and content build up on prior CBT- and ACT-inspired interventions developed by the Department of Behavioural Sciences and Learning at Linköping University, targeting other populations [41-45].”

    From Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study (2022) · cites this paper as [45]

    The Methods (Intervention Procedure; page unavailable) describe a guided CBT intervention for patients with heart failure and depressive symptoms, so this paper can serve as an example of a prior CBT intervention targeting another population. Our copy does not establish that the citing paper’s intervention built on this program, that it was ACT-inspired, or that it was developed by the named department. (LLM, conf=0.79)

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  • Before being used in the RCT, the iCBT programme had been developed together with a patient representing a cardiac patient organization and evaluated in proof of concept and pilot studies.

    “Before being used in the RCT, the programme had been developed together with a patient representing a cardiac patient organization and evaluated in proof of concept and pilot studies. 25,26”

    From The effects of internet-based cognitive behaviour therapy for depression in cardiovascular disease on symptoms of anxiety: a secondary analysis of a randomized trial. (2024) · cites this paper as [25]

    The Methods (Intervention Procedure; page unavailable) say the programme had been tested in a proof-of-concept study before this trial and was modified in response to participants’ feedback. Our copy does not say it was developed with a patient representing a cardiac patient organization or evaluated in a separate pilot study before this RCT. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 1

  1. [34]American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorder, 5th edition 2013 Arlington, VA American Psychiatric Association

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Authors
Lundgren, J. G., Dahlström, Ö., Andersson, G., Jaarsma, T., Kärner Köhler, A., & Johansson, P.
Affiliations
Linköping University (SE)
Corresponding author
Lundgren, Johan Gustav
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2016-08-03
Volume
18
Issue
8
Pages
e194
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.5556
PMC
PMC5070581
OpenAlex
W2494997758
Cited by
104
References
54
Citations by year
2026: 2 · 2025: 7 · 2024: 4 · 2023: 26 · 2022: 18 · 2021: 13 · 2020: 11 · 2019: 10 · 2018: 7 · 2017: 3 · 2016: 3
FWCI
11.81
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion, cc-by)
  • DiVA (Linkoping University) (submittedVersion, other-oa)
Funders
  • Forskningsrådet i Sydöstra Sverige
  • Region Östergötland
  • Riksförbundet HjärtLung
  • Medical Research Council (FORSS-470121, LIO-470271)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • 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
Keywords
internet-based cognitive behavioral therapy, depressive symptoms, heart failure, cardiac anxiety, quality of life, guided self-help, anxiety comorbidity, predictors of treatment response, medication adherence, patient engagement
MeSH terms
Adult, Depression, Female, Heart Failure, Humans, Male, Middle Aged, Pilot Projects, Quality of Life, Surveys and Questionnaires, Therapy, Computer-Assisted, Health Behavior, Cognitive Behavioral Therapy, Telemedicine, Internet

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