{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:54:57Z","timestamp":1787018097595,"version":"build-2736575974"},"reference-count":65,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,6,4]]},"abstract":"\n Background<\/jats:title>\n \n Psychological distress is prevalent among patients with cardiovascular disease and is linked to increased risk of future cardiac events. Cardiac rehabilitation (\n CR<\/jats:styled-content>\n ) is widely recommended for treating psychological distress but has been of limited benefit. This study aims to understand how distressed cardiac patients describe their emotional needs and the response of\n CR<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n A qualitative descriptive study was conducted with 46 patients who screened positively for anxiety and\/or depression. Semi\u2010structured interviews were held, and data were analyzed using a constant comparative approach. Patients described low mood and diverse concerns, including threat of another cardiac event, restrictions on their lives, and problems unrelated to their health. Patients described worrying constantly about these concerns, worrying about their worry, and feeling that worry was uncontrollable and harmful. Patients wanted to \u201cget back to normal\u201d but lacked any sense of how to achieve this and were reluctant to discuss their worries with\n CR<\/jats:styled-content>\n staff. They hoped to recover over time, meanwhile seeking reassurance that they were responding \u201cnormally.\u201d Patients were mostly dismissive of psychological techniques used in\n CR<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n These findings expose a conundrum. Distressed\n CR<\/jats:styled-content>\n patients have diverse worries but do not generally want to discuss them, so they invest hopes for feeling better in time passing and reassurance. An intervention acceptable to\n CR<\/jats:styled-content>\n patients would allow them to address diverse worries but without having to share the content of worries, would have \u201cface validity,\u201d and would address patients\u2019 worry about worry. Metacognitive therapy is an intervention that might be suitable.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 02420431.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.011117","type":"journal-article","created":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T05:02:06Z","timestamp":1559365326000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Cardiac Rehabilitation Patients\u2019 Accounts of Their Emotional Distress and Psychological Needs: A Qualitative Study"],"prefix":"10.1161","volume":"8","author":[{"given":"Rebecca","family":"McPhillips","sequence":"first","affiliation":[{"name":"School of Psychological Sciences Faculty of Biology, Medicine and Health Manchester Academic Health Science Centre University of Manchester United Kingdom"},{"name":"Department of Research and Innovation Greater Manchester Mental Health Trust Manchester Academic Health Science Centre Manchester United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Salmon","sequence":"additional","affiliation":[{"name":"Division of Clinical Psychology Psychological Sciences University of Liverpool United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Wells","sequence":"additional","affiliation":[{"name":"School of Psychological Sciences Faculty of Biology, Medicine and Health Manchester Academic Health Science Centre University of Manchester United Kingdom"},{"name":"Department of Research and Innovation Greater Manchester Mental Health Trust Manchester Academic Health Science Centre Manchester United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Clinical Psychology Psychological Sciences University of Liverpool United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.04.052"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2005.00269.x"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-3223(03)00111-2"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-016-0800-3"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.181"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1474515111430928"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2017.10.015"},{"key":"e_1_3_2_9_2","unstructured":"American Heart Association . 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