| 1. |
- Westas, Mats, 1972-
(författare)
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Internet-based cognitive behavioural therapy for depression : Effects and experiences among patients with cardiovascular disease
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depressive symptoms are common in patients with cardiovascular disease (CVD). CVD has a negative impact on patients’ prognosis and health-related quality of life (HRQoL). Guidelines for the treatment of CVD recommend treatment of depressive symptoms. However, the detection rate of depressive symptoms in CVD care is low and patients are therefore at risk of not receiving treatment. The reason for the low detection rate in CVD patients has not been fully explored, but may be related to healthcare professionals or the patients themselves. CVD patients’ experience of how depressive symptoms are discussed or managed by healthcare providers has not currently been fully explored. Today, cognitive behavioural therapy (CBT) is the recommended treatment for mild to moderate depressive symptoms and has been found to be effective in CVD patients. One problem with CBT is the low access to the treatment, which is mainly due to a lack of psychotherapists. A solution could be to use the internet to provide CBT (iCBT), since this has been shown to be effective in the treatment of depressive symptoms in non- CVD populations and is as effective as regular CBT. At the time when this thesis was planned there was a lack of iCBT studies on patients with CVD and depressive symptoms, and more research regarding iCBT in CVD has been called for in the literature. AimThe overall aim of this thesis was to generate knowledge which can lead to improvements in the care of patients with CVD and depressive symptoms. This is done by exploring how depressive symptoms are managed in the healthcare setting from the patient’s perspective, and by evaluating the effects and experiences of an iCBT programme for depressive symptoms in patients with CVD. Design and methodsThis thesis represents two quantitative and two qualitative studies that were performed on the same cohort of participants (n=144) recruited to a randomised controlled trial (RCT) aiming to evaluate a nine-week iCBT programme (n=72) adapted for patients with CVD and depressive symptoms. In the RCT, the comparator was a nine-week online discussion forum (n=72). These participants were recruited via an invitation letter sent to patients diagnosed with CVD (i.e. coronary heart disease, atrial fibrillation/atrial flutter or heart failure) who had contacted four hospitals in southeast Sweden during the past year. Study I had a qualitative study design with an inductive semantic approach. The sample (n=20) was recruited from those who had performed iCBT and had completed at least one module of the treatment programme. The interviews were conducted by telephone using a semi-structured interview guide. Study II was designed as an RCT, and compared the effect of a nine-week iCBT programme adapted for CVD (n=72) with nine weeks of ODF (n=72) on depressive symptoms in CVD patients. Data regarding depressive symptoms and HRQoL was collected at baseline and at nine weeks post-intervention. Study III used the same cohort as study I, and had a qualitative study design with an inductive latent approach. Study IV used a quantitative longitudinal and explorative design. Data regarding depressive symptoms was collected at baseline, at nine weeks post-intervention and at six- and twelve-month follow-ups. ResultsThe mean age of the participants in studies II and IV was 63 years, and 61% (n=89) were men. Atrial fibrillation/flutter was found in 56% (n=81), 44% (n=63) had coronary heart disease and 26% (n=38) had heart failure. The mean age of the participants in studies I and III (n=20) was 62 years, and 55% (n=11) were men. The patients experienced how depressive symptoms were addressed and managed in clinical cardiac care encounters under three main themes: “Not being seen as a whole person”; “Denying depressive symptoms”; and “I was provided with help”. The RCT study showed that iCBT after nine weeks was more effective than ODF in terms of decreasing depressive symptoms and improving HRQoL. At six- and twelve-month follow-ups, the improvements in depressive symptoms in the iCBT group were sustained. At the twelve-month follow-up, it was those who had more depressive symptoms at baseline who also experienced more improvements in depressive symptoms through iCBT, whereas those with heart failure were less likely to improve. The experience of participating in the iCBT programme was perceived as: taking control of the disease; not just a walk in the park; and feeling a personal engagement with the iCBT programme. ConclusionsCVD patients experienced that healthcare professionals focused on somatic symptoms and did not address their depressive symptoms. On the other hand, CVD patients did not always understand that they had depressive symptoms – or denied having depressive symptoms – when meeting healthcare professionals. Those who had received treatment had taken the initiative to address this by themselves or through support from family or friends. A nine-week iCBT programme adapted for CVD and guided by nurses with clinical experience of CVD and psychiatry and a brief education in iCBT seems to be useful for decreasing depressive symptoms and improving HRQoL. The effect of iCBT seems to be more beneficial in CVD patients with higher levels depressive symptoms, whereas the effect of iCBT on heart failure patients is less certain. The iCBT programme adapted to CVD seems to provide knowledge, and was experienced by patients as helpful for taking control of their disease. A CVD-adapted iCBT programme including feedback from nurses with clinical experience of CVD and psychiatry was helpful for engaging with and motivating carrying out the iCBT programme. Participating in the iCBT programme can be demanding and emotionally challenging, but is sometimes necessary to achieve improvements in depressive symptoms.
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| 2. |
- Eriksson-Liebon, Magda, et al.
(författare)
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Experience of internet-delivered cognitive behavioural therapy among patients with non-cardiac chest pain
- 2023
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 32:13-14, s. 4060-4069
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Tidskriftsartikel (refereegranskat)abstract
- Aims and Objective To explore the experiences of patients with non-cardiac chest pain and cardiac anxiety regarding participation in an internet-delivered cognitive behavioural therapy program. Background Non-cardiac chest pain is common and leads to cardiac anxiety. Internet-delivered cognitive behavioural therapy may be a possible option to decrease cardiac anxiety in these patients. We have recently evaluated the effect of an internet-delivered cognitive behavioural therapy program on cardiac anxiety. Design An inductive qualitative study using content analysis and the COREQ checklist. Methods Semi-structured interviews with 16 Swedish patients, who had participated in the internet-delivered cognitive behavioural therapy program. Results Three categories were found. The first, Driving factors for participation in the internet-delivered cognitive behavioural therapy program described the impact of pain on their lives and struggle that led them to participating in the program. The second, The program as a catalyst described that the program was helpful, trustworthy and useful and the last category, Learning to live with chest pain described the program as a tool for gaining the strength and skills to live a normal life despite chest pain. Conclusions The program was experienced as an opportunity to return to a normal life. The program was perceived as helpful, trustworthy and useful, which helped the participants challenge their fear of chest pain and death, and gain strength and new insights into their ability to live a normal life. Relevance to Clinical Practice A tailored internet-delivered cognitive behavioural therapy program delivered by a nurse therapist with clinical experience of the patient group is important to improve cardiac anxiety. Patient or Public Contribution Patients or the general public were not involved in the design, analysis or interpretation of the data of this study, but two patients with experience of non-cardiac chest pain were involved in the development of the pilot study. Trial Registration NCT03336112; .
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| 3. |
- Eriksson-Liebon, Magda, 1986-
(författare)
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The effects and experiences of internet-delivered cognitive behavioural therapy : The perspectives of patients with non-cardiac chest pain and healthcare professionals in the emergency and cardiac care
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundNon-cardiac chest pain (NCCP) is a common issue, accounting for roughly half of all emergency department visits related to chest pain. Patients afflicted with NCCP often endure cardiac anxiety, misinterpreting the pain as heart-related and fearing it, despite the absence of any life-threatening cardiac issues. This anxiety often leads to the avoidance of physical activities, negatively impacting their quality of life. Cognitive behavioural therapy (CBT) has been shown to be effective in managing psychological distress such as anxiety and depression. CBT is a structured process that helps patients identify and restructure their negative thoughts, get a corrected and more realistic perception of their symptoms, and learn to manage their thoughts about chest pain. Despite its effectiveness, CBT is resource-intensive, and therefore internet-delivered cognitive behavioural therapy (iCBT) may be an alternative as it increases accessibility and is more cost-effective compared to traditional therapy methods. However, there is a lack of re-search on the effectiveness of this treatment approach for patients with NCCP and cardiac anxiety. Moreover, digital care technologies are still relatively unfamiliar in clinical practice, particularly in emergency departments, and the successful implementation of iCBT relies on healthcare professionals' acceptance and integration of digital care into clinical practice. Aim The overall aim of this dissertation was to evaluate the short- and long-term effects of a nurse-led iCBT program on psychological distress in patients with NCCP, and to explore their experiences participating in the iCBT program. In addition, the study aimed to describe healthcare professionals' perceptions of digital care in the emergency and cardiac care for patients with NCCP. Methods This dissertation comprises two quantitative and two qualitative studies. A randomised clinical trial (RCT) (studies I, II, and III) was conducted to evaluate cardiac anxiety, measured with the Cardiac Anxiety Questionnaire (CAQ); and secondary outcomes such as fear of body sensations, measured with The Body Sensations Questionnaire (BSQ); depressive symptoms, assessed with the Patient Health Questionnaire-9 (PHQ-9); health-related quality of life (HRQoL), measured using the EuroQol Visual Analog Scale (EQ-VAS); and chest pain frequency with a self-developed question. The RCT cohort consisted of 109 patients who had at least two healthcare consultations for NCCP in the past 6 months, experienced cardiac anxiety (CAQ score ≥24), and were randomised into a 5-week iCBT program (n=54) or psychoeducation (n=55). An intention-to-treat analysis was conducted, and linear mixed model analysis was used to assess between-group differences in primary and secondary outcomes. The iCBT program included psychoeducation, mindfulness, and exposure to physical activity, with weekly homework assignments and feedback, while the control (psychoeducation) group received readable psychoeducation program aimed to increase knowledge about their mental health, symptoms, and the strategies that can be used to manage chest pain and improve their well-being. Study I was a short-term follow-up with a three-month duration. Study III was a longitudinal study with a 12-month follow-up. Additionally, factors impacting the treatment effect of iCBT on cardiac anxiety were also explored. Study II was a semi-structured qualitative study utilising an inductive approach with content analysis following Patton (2015). Face-to-face interviews were conducted with 16 participants from the iCBT group. Study IV was a qualitative descriptive study involving individual, digital/face-to-face semi-structured interviews with 17 licensed healthcare professionals (physicians and nurses) working in emergency care or cardiology. Data were analysed using inductive thematic analysis based on Braun and Clarke (2006). Result In Study I, no significant differences were found between the iCBT and control (psychoeducation) groups regarding cardiac anxiety or any of the secondary outcomes in terms of the interaction effect of time and group over the 3-month follow-up. iCBT demonstrated a small effect size on cardiac anxiety (Cohen’s d=0.31). A positive change score (≥11 points on the CAQ) was reported by 16 patients in the iCBT group (36%) compared to 13 patients (27%) in the control (psychoeducation) group, indicating a slightly greater improvement in cardiac anxiety in the iCBT group. However, the difference between the groups was non-significant (p=.213). Within-group analysis showed significant improvement in cardiac anxiety (p=.037) at the 3-month follow-up compared to the 5-week follow-up in the iCBT group, but not in the control (psychoeducation) group. In Study III, there was no statistically significant interaction effect of time and group between the iCBT and control (psychoeducation) groups regarding cardiac anxiety over the 12-month follow-up. However, there was a statistically significant interaction effect of time and group (p=.009) regarding chest pain frequency for the iCBT group and a group effect on health-related quality of life (p=.03) for the iCBT group. Furthermore, the regression analysis showed that higher scores of "avoidance" on the CAQ at baseline were associated with improvement in cardiac anxiety at the 12-month follow-up in both groups. In Study II, participants described their experiences, leading to three main categories: "driving factors for participation in the iCBT program", "the program as a catalyst" and "learning to live with chest pain." Participants described how pain impacted their lives, the struggle that led them to participate in the program, and how they found the program helpful, trustworthy, and viewed it as a tool for gaining the strength and skills they needed to live a normal life despite chest pain. In Study IV, healthcare professionals described their perception of digital care, resulting in four themes: "new ground to walk on”, "a challenge for the current healthcare system", "digital care has its potential" and "prerequisites for use in clinical practice". These themes describe healthcare professionals' knowledge and experience with digital care, the challenges associated with implementing digital care in the current healthcare system, the opportunities it presents, and identify facilitators for the implementation of digital care in clinical practice.ConclusionsIn studies I and III, iCBT was not superior to psychoeducation in reducing cardiac anxiety in patients with NCCP. However, both iCBT and psychoeducation have demonstrated utility as interventions for reducing cardiac anxiety in these patients. Moreover, patients with an increased propensity to avoid activities or situations they believe may trigger cardiac -related symptoms, were found to have reduced cardiac anxiety. Patients generally perceived the iCBT program positively, viewing it as a tailored and effective tool for confronting fears and restoring normalcy in their lives. Healthcare professionals express a mixture of caution and optimism towards digital care, emphasising the importance of clear leadership, education, technical competence, and positive attitudes to ensure successful implementation and maximise benefits for patients with NCCP.
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| 4. |
- Johansson, Peter, 1962-, et al.
(författare)
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An internet-based cognitive behavioral therapy program adapted to patients with cardiovascular disease and depression : Randomized controlled trial
- 2019
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Ingår i: Journal of Medical Internet Research. - Toronto, Canada : Journal of Medical Internet Research. - 1438-8871. ; 21:10, s. 1-14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression.Objective: The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD.Methods: A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire–9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale–self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models. Results: Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=−2.34 [95% CI −3.58 to −1.10], P<.001, Cohen d=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; P<.001, Cohen d=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (P<.001, Cohen d=0.66) and the EQ-VAS (P<.001, Cohen d=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression.Conclusions: Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time.
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| 5. |
- Johansson, Peter, 1962-, et al.
(författare)
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Internet-Based Cognitive Behavioral Therapy and its Association With Self-efficacy, Depressive Symptoms, and Physical Activity : Secondary Analysis of a Randomized Controlled Trial in Patients With Cardiovascular Disease
- 2022
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Ingår i: JMIR Cardio. - Toronto, Canada : JMIR Publications, Inc.. - 2561-1011. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: In patients with cardiovascular disease (CVD), knowledge about the associations among changes in depressivesymptoms, self-efficacy, and self-care activities has been requested. This is because such knowledge can be helpful in the designof behavioral interventions aimed to improve self-efficacy, reduce depressive symptoms, and improve performance of self-careactivities in CVD patients.Objective: We aim to evaluate if internet-based cognitive behavioral therapy (iCBT) improves self-efficacy and explore therelationships among changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT onthese relationships.Methods: This study received funding in January 2015. Participant recruitment took place between January 2017 and February2018, and the main findings were published in 2019. This study is a secondary analysis of data collected in a randomized controlledstudy evaluating the effects of a 9-week iCBT program compared to an online discussion forum (ODF) on depressive symptomsin patients with CVD (N=144). Data were collected at baseline and at the 9-week follow-up. Analysis of covariance was used toevaluate the differences in self-efficacy between the iCBT and ODF groups. Structural equation modeling explored the relationshipsamong changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT on these relationships.Results: At follow-up, a significant difference in the increase in self-efficacy favoring iCBT was found (P=.04, Cohen d=0.27).We found an indirect association between changes in depressive symptoms and physical activity (ß=–.24, P<.01), with the changein self-efficacy acting as a mediator. iCBT had a direct effect on the changes in depressive symptoms, which in turn influencedthe changes in self-efficacy (ß=.23, P<.001) and physical activity (ß=.12, P<.001).Conclusions: Self-efficacy was improved by iCBT. However, the influence of iCBT on self-efficacy and physical activity wasmostly mediated by improvements in depressive symptoms.Trial Registration: ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074
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| 6. |
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| 7. |
- Mourad, Ghassan, 1974-, et al.
(författare)
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Cost-effectiveness of internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms: secondary analysis of an RCT
- 2022
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Ingår i: BMJ Open. - London, United Kingdom : BMJ Publishing Group Ltd. - 2044-6055. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Cost-effectiveness evaluations of psychological interventions, such as internet-delivered cognitive behavioural therapy (iCBT) programmes, in patients with cardiovascular disease (CVD) are rare. We recently reported moderate to large effect sizes on depressive symptoms in CVD outpatients following a 9-week iCBT programme compared with an online discussion forum (ODF), in favour of iCBT. In this paper, we evaluate the cost-effectiveness of this intervention.Methods Cost-effectiveness analysis of a randomised controlled trial. The EQ-5D-3L was used to calculate quality-adjusted life-years (QALYs). Data on healthcare costs were retrieved from healthcare registries.Results At 12-month follow-up, the QALY was significantly higher in iCBT compared with the ODF group (0.713 vs 0.598, p=0.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of 1 year. Incremental cost-effectiveness ratio (ICER) for iCBT versus ODF was euro18 865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared with ODF.Conclusions The ICER of euro18 865 was lower than the cost-effectiveness threshold range of euro23 400-euro35 100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective.
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| 8. |
- Mourad, Ghassan, 1974-, et al.
(författare)
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Depressive symptoms and health care utilization : -a comparison between patients with non-cardiac chest pain and patients with ischemic heart disease
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: More than half of patients admitted to hospital for acute chest pain are diagnosed as having non-cardiac chest pain (NCCP). While there are well established guidelines for diagnosing and treating patients with ischemic heart disease (IHD), an international consensus approach to treat patients with NCCP is lacking. This lack of structured care may possibly cause mental distress in patients and increased health care utilization.Objectives: To compare depressive symptoms and health care utilization in patients admitted for NCCP and patients with acute myocardial infarction (AMI) and angina pectoris (AP) post-hospitalization and at one-year follow-up.Methods: A cross-sectional, descriptive and comparative design was used. In total 131 patients with NCCP, 66 with AMI and 70 with AP completed two depression screening questionnaires 2-3 weeks after the hospital stay and one year later. Data on health care utilization were collected from a population-based diagnose-related database.Results: Depressive symptoms were found in 27% of the participants post-hospitalization and in 26% one year later. At follow-up, 17 patients had recovered from their depressive symptoms, 37 patients had continuous depressive symptoms, and 26 patients had developed depressive symptoms. No difference in depressive symptoms was found between the different diagnose groups neither at baseline nor at follow-up. Patients diagnosed with NCCP visited health care providers in primary care as often as patients diagnosed with AMI, but had fewer hospital admissions. Patients with AP and patients with depressive symptoms utilized most health care services.Conclusion: Persisting depressive symptoms are frequently seen among patients with NCCP as well as in patients with IHD. NCCP patients utilize as much primary care resources as AMI patients. This might imply a need for interventions targeting depressive symptoms in patients with both NCCP and IHD.
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| 9. |
- Mourad, Ghassan, 1974-, et al.
(författare)
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Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior : A Cross-Sectional Study
- 2016
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Ingår i: The patient. - : ADIS INT LTD. - 1178-1653. ; 9:1, s. 69-77
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with non-cardiac chest pain (NCCP) suffer from recurrent chest pain and make substantial use of healthcare resources.OBJECTIVE: To explore the prevalence of depressive symptoms, cardiac anxiety, and fear of body sensations in patients discharged with a NCCP diagnosis; and to describe how depressive symptoms, cardiac anxiety, and fear of body sensations are related to each other and to healthcare-seeking behavior.METHODS: Cross-sectional design. Data were collected between late October 2013 and early January 2014 in 552 patients with NCCP from four hospitals in southeast Sweden, using the Patient Health Questionnaire-9, Cardiac Anxiety Questionnaire, and Body Sensations Questionnaire.RESULTS: About 26 % (n = 141) of the study participants reported at least moderate depressive symptoms, 42 % (n = 229) reported at least moderate cardiac anxiety, and 62 % (n = 337) reported some degree of fear of body sensations. We found strong positive relationships between depressive symptoms and cardiac anxiety (r s = 0.49; P < 0.01), depressive symptoms and fear of body sensations (r s = 0.50; P < 0.01), and cardiac anxiety and fear of body sensations (r s = 0.56; P < 0.01). About 60 % of the participants sought care because of chest pain once, 26 % two or three times, and the rest more than three times. In a multivariable regression analysis, and after adjustment for multimorbidity, cardiac anxiety was the only variable independently associated with healthcare-seeking behavior.CONCLUSION: Patients with NCCP and many healthcare consultations had high levels of depressive symptoms and cardiac anxiety, and moderate levels of fear of body sensations. Cardiac anxiety had the strongest relationship with healthcare-seeking behavior and may therefore be an important target for intervention to alleviate suffering and to reduce healthcare use and costs.
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| 10. |
- Mourad, Ghassan, 1974-, et al.
(författare)
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Guided Internet-delivered cognitive behavioral therapy in patients with non-cardiac chest pain : a pilot randomized controlled study
- 2015
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients with recurrent episodes of non-cardiac chest pain (NCCP) may suffer from cardiac anxiety and avoidance behavior, leading to increased healthcare utilization. These patients might benefit from help and support to evaluate the perception and management of their chest pain.Objective: To test the feasibility of a short guided Internet-delivered CBT intervention and the effects on chest pain, cardiac anxiety, fear of body sensations and depressive symptoms in patients with NCCP compared to usual care.Methods: A pilot randomized controlled study was conducted. Fifteen patients, nine men and six women with a median age of 66 years (range 22-76), were randomly assigned to either intervention (n=7) or control (n=8) group. Patients had recurrent episodes of non-cardiac chest pain and suffered from cardiac anxiety and/or fear of body sensations. The intervention consisted of a four-session guided Internet-delivered CBT program containing psychoeducation, physical activity, and relaxation. The control group received usual care. All patients completed a web-based questionnaire on socio-demographic variables, chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms.Results: Five out of the seven patients in the intervention group completed all sessions as planned and two joined only parts of the program. The program was perceived as userfriendly with understandable language, adequate and varied content, and manageable homework assignments. The patients were engaged in the program for about 60 minutes per day and about 22 minutes’ therapist time was required to guide, support and give feedback to each patient through the program. Participating in the program, particularly being guided and supported, empowered and motivated many of the patients to be active and complete the program. In general, patients in both intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but there were no significant differences between the groups.Conclusions: A short guided Internet-delivered CBT program was feasible. Patients in both intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups. Patients should be followed-up for longer periods to measure the long-term effects of the intervention.
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