{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:31:31Z","timestamp":1790443891804,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T00:00:00Z","timestamp":1625529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2021,7,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Depression and anxiety in cardiovascular disease are significant, contributing to poor prognosis. Unfortunately, current psychological treatments offer mixed, usually small improvements in these symptoms. The present trial tested for the first time the effects of group metacognitive therapy (MCT; 6 sessions) on anxiety and depressive symptoms when delivered alongside cardiac rehabilitation (CR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 332 CR patients recruited from 5 National Health Service Trusts across the North-West of England were randomly allocated to MCT+CR (n=163, 49.1%) or usual CR alone (n=169, 50.9%). Randomization was 1:1 via minimization balancing arms on sex and Hospital Anxiety and Depression Scale scores within hospital site. The primary outcome was Hospital Anxiety and Depression Scale total after treatment (4-month follow-up). Secondary outcomes were individual Hospital Anxiety and Depression Scales, traumatic stress symptoms, and psychological mechanisms including metacognitive beliefs and repetitive negative thinking. Analysis was intention to treat.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The adjusted group difference on the primary outcome, Hospital Anxiety and Depression Scale total score at 4 months, significantly favored the MCT+CR arm (\u20133.24 [95% CI, \u20134.67 to \u20131.81],\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001; standardized effect size, 0.52 [95% CI, 0.291 to 0.750]). The significant difference was maintained at 12 months (\u20132.19 [95% CI, \u20133.72 to \u20130.66],\n                      <jats:italic>P<\/jats:italic>\n                      =0.005; standardized effect size, 0.33 [95% CI, 0.101 to 0.568]). The intervention improved outcomes significantly for both depression and anxiety symptoms when assessed separately compared with usual care. Sensitivity analysis using multiple imputation of missing values supported these findings. Most secondary outcomes favored MCT+CR, with medium to high effect sizes for psychological mechanisms of metacognitive beliefs and repetitive negative thinking. No adverse treatment-related events were reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Group MCT+CR significantly improved depression and anxiety compared with usual care and led to greater reductions in unhelpful metacognitions and repetitive negative thinking. Most gains remained significant at 12 months. Study strengths include a large sample, a theory-based intervention, use of longer-term follow-up, broad inclusion criteria, and involvement of a trials unit. Limitations include no control for additional contact as part of MCT to estimate nonspecific effects, and the trial was not intended to assess cardiac outcomes. Nonetheless, results demonstrated that addition of the MCT intervention had broad and significant beneficial effects on mental health symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: ISRCTN74643496.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.120.052428","type":"journal-article","created":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T05:00:10Z","timestamp":1624251610000},"page":"23-33","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":94,"title":["Improving the Effectiveness of Psychological Interventions for Depression and Anxiety in Cardiac Rehabilitation: PATHWAY\u2014A Single-Blind, Parallel, Randomized, Controlled Trial of Group Metacognitive Therapy"],"prefix":"10.1161","volume":"144","clinical-trial-number":[{"clinical-trial-number":"isrctn74643496","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7713-1592","authenticated-orcid":true,"given":"Adrian","family":"Wells","sequence":"first","affiliation":[{"name":"School of Psychologcial Science, Faculty of Biology Medicine and Health, The University of Manchester, United Kingdom (A.W.)."},{"name":"Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, National Health Service Foundation, United Kingdom (A.W., L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Reeves","sequence":"additional","affiliation":[{"name":"National Institute for Health Research School for Primary Catre Research, Manchester Academic Health Sciences Centre, The University of Manchester, United Kingdom (D.R.)."},{"name":"Centre for Biostatistics, School for Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester (D.R., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6877-8650","authenticated-orcid":true,"given":"Lora","family":"Capobianco","sequence":"additional","affiliation":[{"name":"Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, National Health Service Foundation, United Kingdom (A.W., L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin","family":"Heal","sequence":"additional","affiliation":[{"name":"Centre for Biostatistics, School for Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester (D.R., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Davies","sequence":"additional","affiliation":[{"name":"Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Heagerty","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, Core Technology Facility, The University of Manchester (A.H.)."},{"name":"Manchester Royal Infirmary, Manchester University NHS Foundation Trust, United Kingdom (A.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Doherty","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, United Kingdom (P.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7388-720X","authenticated-orcid":true,"given":"Peter","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Liverpool, United Kingdom (P.F.)."},{"name":"Royal Liverpool and Broadgreen University Hospital NHS Trust, United Kingdom (P.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","unstructured":"World Health Organization (WHO). WHO Global NCD Action Plan 2013\u20132020. 2013. WHO. Accessed June 10 2020. https:\/\/www.who.int\/nmh\/events\/ncd_action_plan\/en\/."},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2011.02.007"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2017.10.015"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.4.367"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000133362.75075.a6"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002902.pub4"},{"key":"e_1_3_5_8_2","volume-title":"Metacognitive Therapy for Anxiety and Depression","author":"Wells A","year":"2009","unstructured":"Wells, A. Metacognitive Therapy for Anxiety and Depression. Guilford Press;2009."},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2018.02288"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2018.54"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-64577-1"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2018.02211"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001800.pub3"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-314206"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-018-2593-8"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"},{"key":"e_1_3_5_17_2","unstructured":"National Audit of Cardiac Rehabilitation (NACR). Annual report. British Heart Foundation University of York; 2019. https:\/\/www.bhf.org.uk\/informationsupport\/publications\/statistics\/national-audit-of-cardiac-rehabilitation-quality-and-outcomes-report-2019"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0022-3999(01)00296-3"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0197-2456(02)00242-8"},{"key":"e_1_3_5_20_2","volume-title":"The BACPR standards and core components for cardiovascular disease prevention and rehabilitation","author":"British Association of Cardiovascular Prevention and Rehabilitation (BACPR)","year":"2017","unstructured":"British Association of Cardiovascular Prevention and Rehabilitation (BACPR)The BACPR standards and core components for cardiovascular disease prevention and rehabilitation.2017.3rd edhttp:\/\/www.bacpr.com\/resources\/AC6_BACPRStandards&CoreComponents2017.pdf","edition":"3"},{"key":"e_1_3_5_21_2","volume-title":"Mind Over Mood: A Cognitive Therapy Treatment Manual for Clients","author":"Greenberger D","year":"1995","unstructured":"Greenberger, D, Padesky, C. Mind Over Mood: A Cognitive Therapy Treatment Manual for Clients. Guilford Press; 1995."},{"key":"e_1_3_5_22_2","first-page":"399","volume-title":"In: Assessing Psychological Trauma and PTSD","author":"Weiss DS","year":"1997","unstructured":"Weiss, DS, Marmar, CR. The Impact of Event Scale\u2014Revised. Wilson, JP, Leane, TM, eds. In: Assessing Psychological Trauma and PTSD. Guildford Press; 1997:399\u2013411."},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7967(03)00147-5"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-011-9903-x"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2012.02.008"},{"key":"e_1_3_5_26_2","unstructured":"National Institute for Health and Care Excellence. Position statement on use of the EQ-5D-5L valuation set. Updated October 2019 https:\/\/www.nice.org.uk\/Media\/Default\/About\/what-we-do\/NICE-guidance\/NICE-technology-appraisal-guidance\/eq5d5l_nice_position_statement.pdf. Accessed June 5 2020."},{"key":"e_1_3_5_27_2","volume-title":"Cognitive Attentional Syndrome Scale 1 Revised (CAS-1R)","author":"Wells A","year":"2015","unstructured":"Wells, A. Cognitive Attentional Syndrome Scale 1 Revised (CAS-1R). University of Manchester2015."},{"key":"e_1_3_5_28_2","first-page":"CD008012","article-title":"Psychological and pharmacological interventions for depression in patients with coronary artery disease.","volume":"9","author":"Baumeister H","year":"2011","unstructured":"Baumeister, H, Hutter, N, Bengel, J. Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database Syst Rev. 2011;9:CD008012. do:10.1002\/14651858.CD008012.pub3","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00582"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0258(20000715)19:13<1793::aid-sim482>3.0.co;2-q"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.329"},{"key":"e_1_3_5_32_2","volume-title":"In: Cochrane Handbook for Systematic Reviews of Interventions Version 6.0. Updated July 2019","author":"Higgins JPT","year":"2019","unstructured":"Higgins, JPT, Li, T, Deeks, JJChapter 6: choosing effect measures and computing estimates of effect. Higgins, JPT, Thomas, J, Chandler, J, Cumpston, M, Li, T, Page, MJ, Welch, VA, eds. In: Cochrane Handbook for Systematic Reviews of Interventions Version 6.0. Updated July 2019. Cochrane; 2019. https:\/\/www.training.cochrane.org\/handbook"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1037\/\/0022-006x.59.1.12"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.739"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.915"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.02621"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2018-000973"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.018926"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.120.052428","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T04:09:48Z","timestamp":1715573388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.120.052428"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,6]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,7,6]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.120.052428"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.120.052428","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,6]]},"assertion":[{"value":"2020-11-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}