Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: A meta-analysis

Table 1 Characteristics of randomized controlled trials included in this meta-analysis

Ref.	Country	Sample size (I/C)	Gender: female, n (%)	Age (mean ± SD)	CHD diagnosis	Intervention	Format	Manual	Control group	Outcome	Measurement	Drop-out rate (%)	Quality of article
Barth et al[29], 2005	Germany	59 (27/32)	I: 5 (18.50) C: 9 (28.10)	I: 60.81 ± 11.06 C: 55.62 ± 10.05	MI; CABG; PTCA; Unstable Angina Pectoris	CBT based intervention	Individual	Yes	UC	(2)	BDI; HADS	I: 0.00 C: 12.50	7 (moderate)
Beresnevaitė et al[24], 2016	Lithuania	150 (79/71)	I: 13 (30.20) C: 14 (30.40)	I: 56.70 ± 10.20 C: 59.10 ± 11.10	CABG; valve replacement; valve repair surgery	CBT	Individual	Yes	UC	(3), (5)	SF36	I: 45.57 C: 35.21	4 (moderate)
Berkman et al[14], 2003	United States	2481 (1238/1243)	I: 532 (43.00) C: 552 (44.00)	I: 61.00 ± 12.60 C: 61.00 ± 12.50	MI	CBT	Individual + group	No	UC	(2)	BDI	I: 7.51 C: NR	7 (moderate)
Blumenthal et al[30], 2016	United States	151 (76/75)	I: 31 (41.00) C: 24 (32.00)	I: 61.80 ± 10.80 C: 60.40 ± 10.60	ACS; stable angina; coronary revascularization	CR + SMT	Group	No	CR	(2), (3)	BDI-II; STAI; PSS; GHQ	I: 3.95 C: 4.00	7 (moderate)
Claesson et al[31], 2006	Sweden	198 (101/97)	I: 101 (100.00) C: 97 (100.00)	I: 59.40 ± 9.30 C: 62.20 ± 7.70	AMI; CABG; coronary angioplasty; angina pectoris	CBT based intervention	Group	No	UC	(1), (2), (3), (5)	ELSS; CPRS-S-A	I: 23.76 C: 15.46	6 (moderate)
Dao et al[32], 2011	United States	100 (50/50)	I: 11 (22.90) C: 10 (20.40)	I: 62.80 ± 11.80 C: 64.20 ± 11.90	A CAD diagnosis and were scheduled to undergo a first-time CABG	CBT	Individual	No	UC	(2), (3)	BDI-II; STAI SF12	I: 4.00 C: 4.00	6 (moderate)
Freedland et al[33], 2009	United States	123 (41/42/40)1	I: 23 (56.00) C1: 21 (50.00) C2: 17 (43.00)	I: 62.00 ± 11.00 C1: 59.00 ± 10.00 C2: 61.00 ± 9.00	CABG	CBT + UC	Individual	Yes	SSM+ UC; UC	(2), (3)	BDI; BAI PSS; SF36	I: 2.44 C1: 11.90 C2: 7.50	7 (moderate)
Javaheri et al[34], 2020	United States	34 (18/16)	I: 7 (38.89) C: 2 (12.50)	I: 70.30 ± 10.00 C: 72.90 ± 9.20	MI; coronary artery revascularization; angiographically documented stenosis of a major coronary artery	General sleep education + web-based CBT	Individual	No	Wait-list	(1), (2), (3)	PHQ-8; Duke Health Profile	I: 16.67 C: 11.11	5 (moderate)
Koertge et al[38], 2008	Sweden	247 (119/128)	I: 119 (100.00) C: 128 (100.00)	I: 61.36 ± 9.10 C: 62.73 ± 8.72	AMI; PCI; CABG	CBT based intervention	Group	No	UC	(2)	BDI	I: 17.65 C: 20.31	7 (moderate)
Lv et al[25], 2016	China	75 (38/37)	I: 12 (31.58) C: 10 (27.03)	I: 52.40 ± 6.30 C: 52.00 ± 6.20	PCI	CBT + UC	Individual	No	UC	(2), (3)	HAM-D HAM-A CROQ-PTCA-POST	I: 0.00 C: 0.00	6 (moderate)
Merswolken et al[36], 2011	Germany	62 (30/32)	I: 6 (24.00) C: l8 (30.00)	I: 62.50 ± 8.30 C: 59.80 ± 7.50	MI; angiographically documented CHD	CBT based intervention	Group	No	Blank control	(2)	HADS	I: 16.67 C:15.63	5(moderate)
Murphy et al[37], 2013	Australia	275 (139/136)	I: 15 (10.79) C: 22 (16.18)	I: 58.02 ± 8.87 C: 59.92 ± 9.27	MI; CABG; PCI	CBT	Group	Yes	UC	(1), (4), (5)	6MWT	I: 14.39 C: 16.91	7 (moderate)
Nehra et al[26], 2012	India	50 (25/25)	NR	NR	MI; AP	CBT	Individual	No	UC	(2)	PSS	I: 0.00 C: 0.00	5 (moderate)
Nejati et al[27], 2020	Iran	51 (17/17/17)2	I: 7 (41.18) C1: 4 (23.53) C2: 5 (29.41)	I: 59.00 ± 10.48 C1: 57.00 ± 9.17 C2: 58.00 ± 9.77	CABG; coronary angiography	CBTG	Group	No	CTG; UC	(2)	BDI-II; DASS-21	I: 0.00 C: 0.00	6 (moderate)
Norlund et al[38], 2018	Sweden	239 (117/122)	I: 44 (37.60) C: 36 (29.50)	I: 58.40 ± 9.00 C: 60.80 ± 7.80	MI	iCBT	Individual	No	UC	(2)	HADS	I: 17.95 C: 5.74	7 (moderate)
O’Neil et al[39], 2014	Australia	121 (61/60)	I: 16 (26.20) C:14 (23.30)	I: 61.00 ± 10.20 C: 58.90 ± 10.70	ACS; unstable angina	CBT based intervention(telephone)	Individual	No	UC	(2), (3)	PHQ-9;SF-12	I: 13.11 C: 11.67	9 (high)
Rafanelli et al[16], 2020	Italy	100 (50/50)	I: 19 (38.00) C: 12 (24.00)	I: 57.64 ± 9.99 C: 60.02 ± 10.94	MI; unstable angina	CBT + WBT	Individual	No	CM	(1), (2), (5)	SQ	I: 16.00 C: 20.00	7 (moderate)
Schneider et al[40], 2020	Canada	53 (25/28)	I: 12 (48.00) C: 19 (67.90)	I: 56.72 ± 11.90 C: 59.29 ± 6.93	MI; unstable angina	iCBT	Individual	No	Wait-list	(2), (3)	PHQ-9;GAD-7; DASS-21;SF-12	I: 12.00 C: 7.14	7 (moderate)
Turner et al[18], 2013	Australia	57 (25/32)	I: 6 (24.00) C: 5 (28.13)	I: 61.00 ± 11.00 C: 62.00 ± 9.00	ACS; PCI; CABG	CBT	Group	Yes	BI	(2)	BDI-II;HADS-A	I: 16.00 C: 3.13	7 (moderate)
Turner et al[41], 2014	Australia	42 (21/21)	I: 3 (14.29) C: 6 (28.57)	I: 55.60 ± 8.80 C: 57.00 ± 11.20	AMI; CABG; PCI	iCBT	Group	Yes	UC	(1), (2), (4)	BDI-II; HADS-A 6MWT	I: 28.57 C: 23.81	5 (moderate)
Zeighami et al[28], 2018	Iran	90 (30/30/30)3	I: 10 (33.33) C1: 9 (29.90) C2: 12 (40.10)	47.62 ± 8.93	MI	CBT	Nr	No	EMDR	(2)	BAI	NR	4 (moderate)
Zetta et al[42], 2011	United Kingdom	233 (116/117)	I: 31 (28.00) C: 38 (35.00)	I: 64.80 ± 10.04 C: 65.94 ± 9.96	Angina	CBT based intervention	Individual	No	UC	(1), (2), (3)	HADS; SF-36	I: 6.03 C: 6.84	7 (moderate)

¹I = Cognitive behavioral therapy (CBT) + usual care (UC); C1 = Supportive stress management (SSM) + UC; C2 = UC.

²I = Cognitive-behavioral group intervention; C1 = Cognitive therapy in groups; C2 = UC.

³I = CBT; C1 = Eye movement desensitization reprocessing; C2 = control group.

Outcome: (1) Physiological factors (BMI, blood pressure, blood lipid profile: LDL-C, HDL-C, TG, TC); (2) Psychological factors (depression, anxiety, and stress symptoms); (3) QOL; (4) Exercise endurance; and (5) Cardiac rehabilitation. UC: Usual care; SSM: Supportive stress management; EMDR: Eye movement desensitization reprocessing; CBTG: Cognitive-behavioral group intervention; MI: Myocardial infarction; AMI: Acute myocardial infarction; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass grafting; ACS: Acute coronary syndrome; PTCA: Percutaneous transluminal coronary angioplasty; AP: Angina pectoris; iCBT: Internet-cognitive behavioral therapy; CR: Cardiac rehabilitation; SMT: Stress management training; WBT: Well-being therapy; CM: Clinical management; BI: No further intervention; NR: No report; BDI: Beck Depression Inventory; HADS: Hospital Anxiety and Depression Scale; SF-36: 36-Item Short Form Health Survey; BDI-II: Beck Depression Inventory II; STAI: State-Trait Anxiety Inventory; PSS: Perceived Stress Scale; GHQ: General Health Questionnaire; ELSS: The Everyday Life Stress Scale; CPRS-S-A: Comprehensive Psychopathological Rating Scale Self-Affective; SF-12: Short Form-12 Health Survey; BAI: Beck Anxiety Inventory; PHQ-8: Patient Health Questionnaire-8; HAM-D: Hamilton Depression Rating Scale; HAM-A: Hamilton Anxiety Scale; CROQ-PTCA-POST: Coronary Revascularization Outcome Questionnaire; 6MWT: 6-Minite Walk Distance Test; DASS-21: Depression Anxiety, Stress Scales; PHQ-9: Patient Health Questionnaire-9; SQ: Symptom Questionnaire; GAD-7: General Anxiety Disorder 7-Item.