Effectiveness of Cognitive Behavioral Therapy on Psychological Distress among Myocardial Infarction Survivors: A Systematic Review
DOI:
https://doi.org/10.64960/srimedj.v41i1.270266Keywords:
cognitive behavioral therapy, myocardial infarction, psychological distress, survivorAbstract
Cognitive behavioral therapy (CBT) is effective in reducing depression, anxiety, and stress among individuals with cardiovascular disease; however, empirical evidence in myocardial infarction (MI) survivors remains limited. Furthermore, the design features of CBT that alleviate psychological distress require further investigation. This systematic review aimed to evaluate the effectiveness of CBT in reducing psychological distress among myocardial infarction (MI) survivors and to identify the design features that support emotional recovery. A systematic review was conducted using six databases with 13 randomized controlled trials (RCTs) published between 2014 and 2023 that met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute, and the data were synthesized narrative style. Metanalysis was not feasible. Thirteen RCTs involving 1,586 participants were included. CBT or CBT-based approaches—delivered face-to-face or through technology-assisted formats—were shown to significantly reduce depression, anxiety, and stress compared with standard care, and both combined and internet-based CBT programs showed comparable effectiveness. Additionally, several studies reported improved sleep quality and cardiac biomarkers. CBT is effective in the alleviation of psychological distress among MI survivors. Thus, integrating face-to-face or technology-assisted CBT into psychosocial nursing practice can enhance their emotional well-being and recovery outcomes.
References
Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation 2024;149(8):e347–e913. doi:10.1161/CIR.0000000000001209.
Quashie NT, D’Este C, Agrawal S, Naidoo N, Kowal P. Prevalence of angina and co-morbid conditions among older adults in six low- and middle-income countries: evidence from SAGE Wave 1. Int J Cardiol 2019; 285(6):140-146. doi:10.1016/j.ijcard.2019.02.068.
Murat B, Murat S. Comparison of clinical profiles, angiographic features and outcomes of young and elderly patients with ST-segment elevation myocardial infarction. Acta Medica 2022;53(1):44–52. doi:10.32552/2022.ActaMedica.670.
Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi S, AlKatheeri R, et al. Global epidemiology of ischemic heart disease: results from the Global Burden of Disease Study. Cureus 2020;12(7):e9349. doi:10.7759/cureus.9349.
Salari N, Morddarvanjoghi F, Abdolmaleki A, Rasoulpoor S, Khaleghi AA, Hezarkhani LA, et al. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023;23(1):206. doi:10.1186/s12872-023-03231-w.
Du R, Wang P, Ma L, Larcher LM, Wang T, Chen C. Health-related quality of life and associated factors in patients with myocardial infarction after returning to work: a cross-sectional study. Health Qual Life Outcomes 2020;18(1):190. doi:10.1186/s12955-020-01447-4.
Kivimäki M, Steptoe A. Effects of stress on the development and progression of cardiovascular disease. Nat Rev Cardiol 2018;15(4):215–29. doi:10.1038/nrcardio.2017.189.
Narendrula A, Ajani K, Lang J, Brinza E, Longenecker CT. Psychological distress and health perception in patients with a previous myocardial infarction or stroke: a national cross-sectional study. BMC Cardiovasc Disord 2023;23(1):430. doi:10.1186/s12872-023-03422-5.
Levine GN, Carney RM, Cohen BE, Dunn SL, Gaffey AE, Kronish IM, et al. Post–Myocardial Infarction Psychological Distress: A Scientific Statement From the American Heart Association. Circulation 2025;152(16):e298-e310. doi:10.1161/CIR.0000000000001381.
Moazzami K, Garcia M, Sullivan S, Lewis TT, Bremner JD, Razavi AC, et al. Association between symptoms of chronic psychological distress and myocardial ischemia induced by mental stress in patients with coronary artery disease. J Am Heart Assoc 2023;12(21):e030305. doi:10.1161/JAHA.123.030305.
Vaccarino V, Almuwaqqat Z, Kim JH, Hammadah M, Shah AJ, Ko YA, et al. Association of mental stress–induced myocardial ischemia with cardiovascular events in patients with coronary heart disease. JAMA 2021;326(18):1818–28. doi:10.1001/jama.2021.17649.
Arri SS, Ryan M, Redwood SR, Marber MS. Mental stress-induced myocardial ischaemia. Heart 2016;102(6):472–80. doi:10.1136/heartjnl-2014-307306.
Sara JDS, Toya T, Ahmad A, Clark MM, Gilliam WP, Lerman LO, et al. Mental stress and its effects on vascular health. Mayo Clin Proc 2022;97(5):951–90. doi:10.1016/j.mayocp.2022.02.004.
Jacquet-Smailovic M, Tarquinio C, Alla F, Denis I, Kirche A, Tarquinio C, et al. Posttraumatic stress disorder following myocardial infarction: a systematic review. J Trauma Stress 2021;34(1):190–9. doi:10.1002/jts.22591.
Särnholm J, Skúladóttir H, Rück C, Axelsson E, Bonnert M, Bragesjö M, et al. Cognitive behavioral therapy improves quality of life in patients with symptomatic paroxysmal atrial fibrillation. J Am Coll Cardiol 2023;82(1):46–56. doi:10.1016/j.jacc.2023.04.044.
Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B. Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther 2014;58:10-23. doi:10.1016/j.brat.2014.04.006.
Ski CF, Taylor RS, McGuigan K, Long L, Lambert JD, Richards SH, et al. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation. Cochrane Database Syst Rev 2024;4(4):CD013508. doi:10.1002/14651858.CD013508.pub3
Chew TR, Yeo TM, Teo JYC, Seah CWA, Soh CSQ, Meng J, et al. Effectiveness of psychological interventions in reducing post-traumatic stress among post-myocardial infarction patients: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2025;24(3):375–86. doi:10.1093/eurjcn/zvae179
Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. Adelaide: JBI; 2024 [cited Dec 19, 2025]. Available from: https://synthesismanual.jbi.global. doi.org/10.46658/JBIMES-24-01 ISBN: 978-0-6488488-2-0.
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021;372:n160. doi:10.1136/bmj.n160.
Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ 2020;368:l6890. doi:10.1136/bmj.l6890.
Aghababaei S, Yazdannik AR, Keshvari M. The impact of guided mental imagery on the sleep quality of the elderly after having heart attack. Ann Trop Med Public Health 2017;10(5):1328–32. doi:10.4103/ATMPH.ATMPH_204_17.
Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, et al. Enhancing cardiac rehabilitation with stress management training: a randomized, clinical efficacy trial. Circulation 2016;133(14):1341–50. doi:10.1161/circulationaha.115.018926.
Humphries SM, Wallert J, Norlund F, Wallin E, Burell G, von Essen L, et al. Internet-based cognitive behavioral therapy for patients reporting symptoms of anxiety and depression after myocardial infarction: U-CARE Heart randomized controlled trial twelve-month follow-up. J Med Internet Res 2021;23(5):e25465. doi:10.2196/25465.
Javaheri S, Reid M, Drerup M, Mehra R, Redline S. Reducing coronary heart disease risk through treatment of insomnia using web-based cognitive behavioral therapy for insomnia: a methodological approach. Behav Sleep Med 2020;18(3):334–44. doi:10.1080/15402002.2019.1584896.
Norlund F, Olsson EMG, Pingel R, Held C, Svärdsudd K, Gulliksson M, et al. Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: a sub-analysis from the SUPRIM trial. Eur J Prev Cardiol 2017;24(9):917–25. doi:10.1177/2047487317693131.
Norlund F, Wallin E, Gustafsson EM, Wallert J, Burell G, von Essen L, et al. Internet-based cognitive behavioral therapy for symptoms of depression and anxiety among patients with a recent myocardial infarction: the U-CARE Heart randomized controlled trial. J Med Internet Res 2018;20(3):e88. doi:10.2196/jmir.9710
O’Neil A, Taylor B, Sanderson K, Cyril S, Chan B, Hawkes AL, et al. Efficacy and feasibility of a tele-health intervention for acute coronary syndrome patients with depression: results of the MoodCare randomized controlled trial. Ann Behav Med 2014;48(2):163–74. doi:10.1007/s12160-014-9592-0.
O’Neil A, Taylor B, Hare DL, Sanderson K, Cyril S, Venugopal K, et al. Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial. Eur J Prev Cardiol 2015;22(9):1111–20. doi:10.1177/2047487314547655.
Rafanelli C, Gostoli S, Buzzichelli S, Guidi J, Sirri L, Gallo P, et al. Sequential combination of cognitive-behavioral treatment and well-being therapy in depressed patients with acute coronary syndromes: a randomized controlled trial (TREATED-ACS study). Psychother Psychosom 2020;89(6):345–56. doi:10.1159/000510006.
Rakowska JM. Brief strategic therapy in first myocardial infarction patients with increased levels of stress: a randomized clinical trial. Anxiety Stress Coping 2015;28(6):687–705. doi:10.1080/10615806.2015.1004323.
Schmidt KES, De Quadros AS, Eibel B, Aires AM, Gottschall CAM, Moura MRS, et al. The influence of cognitive behavioral intervention for anger management on endothelial function in patients with recent myocardial infarction: a randomized clinical trial. Psychosom Med 2022;84(2):224–30. doi:10.1097/PSY.0000000000001039.
Schneider LH, Hadjistavropoulos HD, Dear BF, Titov N. Efficacy of internet-delivered cognitive behavioural therapy following an acute coronary event: a randomized controlled trial. Internet Interv 2020;21:100329. doi:10.1016/j.invent.2020.100324.
Wu K, Wan M, Zhou H, Li C, Zhou X, Li E, et al. Mindfulness-based stress reduction combined with early cardiac rehabilitation improves negative mood states and cardiac function in patients with acute myocardial infarction assisted with an intra-aortic balloon pump: a randomized controlled trial. Front Cardiovasc Med 2023;10:1123456. doi:10.3389/fcvm.2023.1166157.
Li YN, Buys N, Ferguson S, Li ZJ, Sun J. Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: a meta-analysis. World J Psychiatry 2021;11(11):1147–66. doi:10.5498/wjp.v11.i11.1147.
Wang S, Gao L, Wang C, Bai J, Shen M, Zhao X, et al. Effects of internet-based cognitive behavioral therapy on anxiety and depressive symptoms among patients with cardiovascular and cerebrovascular diseases: a systematic review and meta-analysis. Front Psychiatry 2024;15:1433558. doi:10.3389/fpsyt.2024.1433558.
Savin KL, Clark TL, Perez-Ramirez P, Allen TS, Tristão Parra M, Gallo LC. The effect of cognitive behavioral therapy for insomnia (CBT-I) on cardiometabolic health biomarkers: a systematic review of randomized controlled trials. Behav Sleep Med 2023;21(6):671–94. doi:10.1080/15402002.2022.2154213.
Karyotaki E, Efthimiou O, Miguel C, Bermpohl FMG, Furukawa TA, Cuijpers P, et al. Internet-based cognitive behavioral therapy for depression: a systematic review and individual patient data network meta-analysis. JAMA Psychiatry 2021;78(4):361–71. doi:10.1001/jamapsychiatry.2020.4364.
Westas M, Lundgren J, Andersson G, Mourad G, Johansson P. Effects of internet-delivered cognitive behavioural therapy adapted for patients with cardiovascular disease and depression: a long-term follow-up of a randomized controlled trial at 6 and 12 months posttreatment. Eur J Cardiovasc Nurs 2022;21(6):559–67. doi:10.1093/eurjcn/zvab131.
Johansson P, Westas M, Andersson G, Alehagen U, Broström A, Jaarsma T, et al. An internet-based cognitive behavioral therapy program adapted to patients with cardiovascular disease and depression: randomized controlled trial. JMIR Ment Health 2019;6(10):e14648. doi:10.2196/14648.
Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther 2018;47(1):1–18. doi:10.1080/16506073.2017.1401115.
Cuijpers P, Noma H, Karyotaki E, Vinkers CH, Cipriani A, Furukawa TA. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry 2020;19(1):92–107. doi:10.1002/wps.207.
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