Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Nov 19, 2021; 11(11): 1147-1166
Published online Nov 19, 2021. doi: 10.5498/wjp.v11.i11.1147
Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: A meta-analysis
Yan-Ni Li, Nicholas Buys, Samantha Ferguson, Zhan-Jiang Li, Jing Sun
Yan-Ni Li, Jing Sun, School of Medicine and Dentistry, Griffith University, Gold Coast Q4222, Queensland, Australia
Nicholas Buys, Jing Sun, Menzies Health Institute Queensland, Griffith University, Gold Coast Q4222, Queensland, Australia
Zhan-Jiang Li, The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing 100088, China
Zhan-Jiang Li, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
Author contributions: Sun J contributed to the paper conceptualization and design; Sun J and Li YN contributed to research design; Sun J and Li YN compiled studies and extracted data; Li YN conducted statistical and meta-analysis, completed table and figure presentation; Sun J and Li YN conducted writing of the paper; Buys N, Ferguson S and Li ZJ edited the draft; Sun J and Li YN revised and proofed the final revised version of the paper.
Conflict-of-interest statement: All authors declare no conflict of interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Sun, PhD, Associate Professor, School of Medicine and Dentistry, Griffith University, G40 8.23, Gold Coast Q4222, Queensland, Australia. j.sun@griffith.edu.au
Received: April 9, 2021
Peer-review started: April 9, 2021
First decision: July 14, 2021
Revised: July 27, 2021
Accepted: October 18, 2021
Article in press: October 18, 2021
Published online: November 19, 2021
Processing time: 221 Days and 20.4 Hours
ARTICLE HIGHLIGHTS
Research background

Coronary heart disease (CHD) is the most common coronary atherosclerotic heart disease, leading to adverse health outcomes for patients with CHD. Cognitive behavioral therapy (CBT) is a short-term psychotherapy, which has been increasingly recognized as an effective intervention approach to reduce psychosocial risk factors in CHD patients. CBT is to change an individual's non-adaptive thought patterns and beliefs, leading to positive behavioral changes. However, no comprehensive systematic review has been conducted to evaluate the efficacy of the CBT-based intervention on health outcomes in patients with CHD.

Research motivation

There is an increasing number of randomized control trials to investigate the efficacy of the CBT-based intervention in CHD patients. However, no comprehensive systematic review has been conducted, and there has been no meta-analysis of the effects of key components of CBT on health outcomes in patients with CHD.

Research objectives

This study aimed to synthesize results from previous randomized controlled trials (RCTs) using a meta-analysis method and explore the therapeutic effect of CBT-based intervention on health outcomes in CHD patients. The secondary aim was to analyze several key components of CBT interventions that explained the effects of CBT intervention.

Research methods

Relevant RCTs published in English were obtained by searching PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Proquest, with the retrieval time from inception to August 2020. Review Manager 5.3 was used to conduct the meta-analysis. We used The Physiotherapy Evidence Database tool to assess the quality of included studies. Mean difference (MD) was used for continuous outcome variables, and standardized MD was used to measure the effect size. The random-effect model was used to estimate outcomes based on the heterogeneity testing. I2 was used for heterogeneity testing, and Egger regression was used to assess the publication bias.

Research results

A total of 22 RCTs were included in the systematic review and meta-analysis. The primary analysis revealed that CBT-based intervention significantly reduced depression, anxiety, stress symptoms, and body mass index (BMI) levels, and improved physical and mental functioning of the quality of life. Additionally, subgroup analysis found that CBT-based interventions were particularly effective in reducing symptoms of depression and anxiety in CHD patients when individual treatment form was used, and when psycho-education, behavioral and cognitive strategies were applied as the core treatment components.

Research conclusions

CBT-based interventions are effective in improving health outcomes in CHD patients, including reducing depression, anxiety, stress symptoms, BMI levels, and improving quality of life. Subgroup analysis further found CBT was more effective in reducing depression and anxiety symptoms in CHD patients when it is an individual treatment method, and when psycho-education, behavioral and cognitive strategies are emphasized as the core intervention strategies.

Research perspectives

Our research findings suggest that CBT is a promising approach in the health promotion of the population with CHD. However, the current practice in CBT-based interventions for CHD is not standardized, therefore, further research to standardize the CBT approach in clinical and community intervention programs in patients with CHD is needed.