Published online Nov 19, 2021. doi: 10.5498/wjp.v11.i11.1147
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
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.
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.
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.
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.
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.
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.
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.