{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:16:21Z","timestamp":1790266581299,"version":"4.1.0"},"reference-count":56,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,6,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS) often suffer from poor mental health and low quality\u2010of\u2010life post event, with no current evidence\u2010based treatments available. This study aimed to evaluate the effects of an internet\u2010delivered cognitive behavioral therapy program on stress and anxiety symptoms in patients diagnosed with myocardial infarction with nonobstructive coronary arteries or TS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">A parallel, multicenter, randomized controlled trial with a wait\u2010list control group was conducted. Patients with elevated symptoms of stress or anxiety were included (the 14\u2010item perceived stress scale \u226525 or hospital anxiety and depression scale, anxiety subscale \u22658). The primary outcome was normalized stress and anxiety levels 10 to 12\u2009weeks after randomization. Secondary outcomes included normalized stress and anxiety separately and symptoms as continuous measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      A total of 88 patients were randomized (treatment: 45, control: 43). The treatment group showed a greater, though not statistically significant proportion of normalized patients (odds ratio, 2.37 [95% CI, 0.88\u20136.38],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.09). Secondary analyses indicated treatment effects on anxiety normalization and on symptoms as continuous measures (effect sizes: d=0.44\u20130.67). There was also an interaction between treatment and diagnosis (TS versus non\u2010TS), favoring a treatment effect in TS patients (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">The patient\u2010tailored internet\u2010delivered cognitive behavioral therapy program reduced stress and anxiety symptoms in patients with myocardial infarction with nonobstructive coronary arteries or TS and normalized anxiety symptoms in a greater proportion of treated patients than controls. Exploratory analyses indicated that patients with TS may experience greater benefit from the internet\u2010delivered cognitive behavioral therapy intervention, but this warrants further research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047311","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:12:58Z","timestamp":1781525578000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Randomized Controlled Trial of Internet\u2010Delivered Cognitive Behavioral Therapy After Myocardial Infarction With Nonobstructive Coronary Arteries or Takotsubo Syndrome"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0787-9102","authenticated-orcid":false,"given":"Philip","family":"Leissner","sequence":"first","affiliation":[{"name":"Uppsala University","place":["Uppsala, 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