{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:27:44Z","timestamp":1787027264972,"version":"build-2736575974"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T00:00:00Z","timestamp":1658880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Depression and anxiety symptoms are highly prevalent in coronary heart disease (CHD) patients and associated with poor outcome. Most psychological treatments have shown limited effectiveness on anxiety and depression in these patients. This study evaluates the feasibility of the attention training technique (ATT) in CHD patients with symptoms of anxiety and\/or depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Five consecutive CHD patients with significant depression and anxiety symptoms with Hospital Anxiety and Depression rating scale (HADS) -anxiety or -depression subscale score &amp;gt; 8 received 6 weekly group-sessions of ATT in an open trial. Outcomes included feasibility and symptoms measured by HADS, at baseline, post-treatment and at 6 months follow-up. We also assessed psychiatric diagnoses, type D personality, insomnia, worry, and rumination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The sample comprised five men with a mean age of 59.9 (SD 4.4) years. Four of the patients attended all six sessions, and one patient attended all but one session. Mean HADS-A scores at baseline, post-treatment, and follow-up were 9.4 (SD 3.0), 4.2 (SD 3.0), and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (SD 3.7), and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Statistically significant changes were found from pre- to post-treatment scores for HADS-A and worry, which were maintained at follow-up, and HADS-D scores significantly decreased from pre-treatment to 6-months follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients. An adequately powered randomized controlled trial is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2022.948081","type":"journal-article","created":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T02:05:05Z","timestamp":1658887505000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["The Attention Training Technique Reduces Anxiety and Depression in Patients With Coronary Heart Disease: A Pilot Feasibility Study"],"prefix":"10.3389","volume":"13","author":[{"given":"Toril","family":"Dammen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristoffer","family":"Tunheim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Munkhaugen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costas","family":"Papageorgiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1111\/j.1467-9450.2009.00793.x","article-title":"Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients","volume":"51","author":"Bergvik","year":"2010","journal-title":"Scand. J. Psychol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S0022-3999(01)00296-3","article-title":"The validity of the hospital anxiety and depression scale. An updated literature review","volume":"52","author":"Bjelland","year":"2002","journal-title":"J. Psychosom. Res."},{"key":"B3","volume-title":"Statistical Power Analysis for the Behavioral Sciences, 2nd Edn","author":"Cohen","year":"1988"},{"key":"B4","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.ijcard.2016.04.080","article-title":"Insomnia predicts long-term all-cause mortality after acute myocardial infarction: a prospective cohort study","volume":"215","author":"Cond\u00e9n","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1536\/ihj.54.258","article-title":"Clinical correlates of insomnia in patients with acute coronary syndrome","volume":"54","author":"Coryell","year":"2013","journal-title":"Int. Heart J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"126","DOI":"10.3109\/08039488.2014.936502","article-title":"An open trial of group metacognitive therapy for depression in Norway","volume":"69","author":"Dammen","year":"2014","journal-title":"Nord J. Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"227","DOI":"10.4172\/2167-1044.1000227","article-title":"A two year follow up study of group metacognitive therapy for depression in Norway","volume":"5","author":"Dammen","year":"2016","journal-title":"J. Depress. Anxiety"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000149256.81953.49","article-title":"DS14: standard assessment of negative affectivity, social inhibition, and type D personality","author":"Denollet","year":"2005","journal-title":"Psychosom. Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"l4378","DOI":"10.1136\/bmj.l4378","article-title":"CONSORT 2010 statement: extension to randomised crossover trials","volume":"366","author":"Dwan","year":"2019","journal-title":"BMJ"},{"key":"B10","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1097\/PSY.0b013e318219e64e","article-title":"Major depressive disorder, anxiety disorders, and cardiac biomarkers in subjects at high risk of obstructive sleep apnea","volume":"73","author":"Einvik","year":"2011","journal-title":"Psychosom. Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1016\/j.cbpra.2015.11.001","article-title":"The attention training technique: a review of a neurobehavioural therapy for emotional disorders","volume":"23","author":"Fergus","year":"2016","journal-title":"Cogn. Behav. Pract."},{"key":"B12","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1891\/0889-8391.32.2.140","article-title":"A pilot study of a 4-week ehealth-based protocol of the attention training technique component of metacognitive therapy among patients with anxiety disorders","volume":"32","author":"Fergus","year":"2018","journal-title":"J. Cogn. Psychother."},{"key":"B13","volume-title":"Structured Clinical Interview for DSM-IV Axis I Disorders\u2013Patient Edition (SCID-IP. Version 2.0. 4. 97 Revision): Biometrics Research Department","author":"First","year":"1997"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1093\/sleepadvances\/zpac007","article-title":"Insomnia as a predictor of recurrent cardiovascular events in patients with coronary heart disease","author":"Fr\u00f8jd","year":"2022","journal-title":"Sleep Adv."},{"key":"B15","doi-asserted-by":"publisher","first-page":"931","DOI":"10.5664\/jcsm.9082","article-title":"Insomnia in patients with coronary heart disease: prevalence and correlates","volume":"17","author":"Fr\u00f8jd","year":"2021","journal-title":"J. Clin. Sleep Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1176\/appi.ajp.2009.09040458","article-title":"Last observation carried forward versus mixed models in the analysis of psychiatric clinical trials","volume":"166","author":"Hamer","year":"2009","journal-title":"Am. J. Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1093\/clipsy.9.3.329","article-title":"The psychotherapy dose-response effect and its implications for treatment delivery services","volume":"9","author":"Hansen","year":"2002","journal-title":"Clin. Psychol. Sci. Pract"},{"key":"B18","doi-asserted-by":"publisher","first-page":"827","DOI":"10.3389\/fpsyg.2018.00827","article-title":"A randomized controlled trial comparing the attention training technique and mindful self-compassion for students with symptoms of depression and anxiety","volume":"9","author":"Haukaas","year":"2018","journal-title":"Front. Psychol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.cbpra.2016.06.006","article-title":"Metacognitive therapy in major depression: an open trial of comorbid cases","volume":"24","author":"Hjemdal","year":"2017","journal-title":"Cogn. Behav. Pract."},{"key":"B20","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1001\/archpsyc.62.6.617","article-title":"Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication","volume":"62","author":"Kessler","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1002\/jclp.22312","article-title":"A systematic review of efficacy of the attention training technique in clinical and nonclinical samples","volume":"72","author":"Knowles","year":"2016","journal-title":"J. Clin. Psychol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"547","DOI":"10.4330\/wjc.v8.i9.547","article-title":"Depression risk in patients with coronary heart disease in Germany","volume":"8","author":"Konrad","year":"2016","journal-title":"World J. Cardiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"103693","DOI":"10.1016\/j.brat.2020.103693","article-title":"Effects of attention training technique on brain function in high- and low-cognitive-attentional syndrome individuals: regional dynamics before, during, and after a single session of ATT","volume":"132","author":"Kowalski","year":"2020","journal-title":"Behav. Res. Ther."},{"key":"B24","doi-asserted-by":"publisher","first-page":"307e","DOI":"10.1111\/j.2002.384.doc.x","article-title":"Design and analysis of pilot studies: recommendations for good practice","volume":"10","author":"Lancaster","year":"2004","journal-title":"J. Eval. Clin. Pract."},{"key":"B25","volume-title":"M\u00e5leegenskaper ved den norske versjonen av Hospital Anxiety and Depression Scale (HADS). [Psychometric assessment of the Norwegian version of the Hospital Anxiety and Depression Scale (HADS)]. Rapport 2016.","author":"Leiknes","year":"2016"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e001708","DOI":"10.1136\/openhrt-2021-001708","article-title":"Cardiac rehabilitation patients experiences and understanding of group metacognitive therapy: a qualitative study","volume":"8","author":"McPhillips","year":"2021","journal-title":"Open Heart"},{"key":"B27","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/0005-7967(90)90135-6","article-title":"Development and validation of the Penn state worry questionnaire","volume":"28","author":"Meyer","year":"1990","journal-title":"Behav. Res. Ther."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1498","DOI":"10.1016\/S0140-6736(96)07492-2","article-title":"Alternative projections of mortality and disability by cause 1990-2020: global burden of disease study","volume":"349","author":"Murray","year":"1997","journal-title":"Lancet"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.3389\/fpsyg.2019.01532","article-title":"Can the attention training technique reduce stress in students? A controlled study of stress appraisals and meta-worry","volume":"10","author":"Myhr","year":"2019","journal-title":"Front. Psychol."},{"key":"B30","unstructured":"Depression in Adults With a Chronic Physical Health Problem: Recognition and Management. NICE Guideline 91. National Institute for Health and Care Excellence2009"},{"key":"B31","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1037\/0022-3514.61.1.115","article-title":"A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta earthquake","volume":"61","author":"Nolen-Hoeksema","year":"1991","journal-title":"J. Pers. Soc. Psychol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e0158163","DOI":"10.1371\/journal.pone.0158163","article-title":"A single, one-off measure of depression and anxiety predicts future symptoms, higher healthcare costs, and lower quality of life in coronary heart disease patients: analysis from a multi-wave, primary care cohort study","volume":"11","author":"Palacios","year":"2016","journal-title":"PLoS ONE"},{"key":"B33","doi-asserted-by":"publisher","first-page":"691","DOI":"10.2466\/pms.107.3.691-706","article-title":"A new scale for measuring insomnia: the Bergen insomnia scale","volume":"107","author":"Pallesen","year":"2008","journal-title":"Percept. Mot. Skills"},{"key":"B34","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/j.1467-9450.2006.00518.x","article-title":"A Norwegian adaptation of the Penn state worry questionnaire: factor structure, reliability, validity and norms","volume":"47","author":"Pallesen","year":"2006","journal-title":"Scand. J. Psychol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/S1077-7229(00)80051-6","article-title":"Treatment of recurrent major depression with attention training","volume":"7","author":"Papageorgiou","year":"2000","journal-title":"Cogn. Behav. Pract."},{"key":"B36","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1177\/1403494816688375","article-title":"Reproducibility of an extensive self-report questionnaire used in secondary coronary prevention","volume":"45","author":"Peersen","year":"2017","journal-title":"Scand. J. Public Health"},{"key":"B37","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1007\/s12529-021-09992-y","article-title":"The influence of personality type D on cardiovascular prognosis in patients after coronary artery bypass grafting: data from a 5-year-follow-up study","volume":"29","author":"Raykh","year":"2022","journal-title":"Int. J. Behav. Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"e73459","DOI":"10.1371\/journal.pone.0073459","article-title":"Psychological interventions for patients with coronary heart disease and their partners: a systematic review","volume":"8","author":"Reid","year":"2013","journal-title":"PLoS ONE"},{"key":"B39","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1177\/2047487317739978","article-title":"Psychological interventions for coronary heart disease: cochrane systematic review and meta-analysis","volume":"25","author":"Richards","year":"2018","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1002\/jclp.22567","article-title":"Efficacy of metacognitive therapy in improving mental health: a meta-analysis of single-case studies","volume":"74","author":"Rochat","year":"2018","journal-title":"J. Clin. Psychol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.genhosppsych.2009.10.001","article-title":"Early detection of patients at risk for anxiety, depression and apathy after stroke","volume":"32","author":"Sagen","year":"2010","journal-title":"Gen. Hosp. Psychiatry"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e010859","DOI":"10.1161\/JAHA.118.010859","article-title":"Sex- and gender-stratified risks of psychological factors for incident ischemic heart disease: systematic review and meta-analysis","volume":"8","author":"Smaardijk","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"B43","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1093\/occmed\/kqu024","article-title":"The hospital anxiety and depression scale","volume":"64","author":"Stern","year":"2014","journal-title":"Occup. Med."},{"key":"B44","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1080\/14017431.2020.1852308","article-title":"Challenges in coronary heart disease prevention - experiences from a long-term follow-up study in Norway","volume":"55","author":"Sverre","year":"2021","journal-title":"Scand. Cardiovasc. J."},{"key":"B45","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1097\/01.psy.0000146294.82810.9c","article-title":"Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis","volume":"66","author":"van Melle","year":"2004","journal-title":"Psychosom. Med."},{"key":"B46","doi-asserted-by":"publisher","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"B47","doi-asserted-by":"publisher","first-page":"e000068","DOI":"10.1161\/JAHA.112.000068","article-title":"Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease","volume":"2","author":"Watkins","year":"2013","journal-title":"J. Am. Heart Assoc."},{"key":"B48","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S0005-7894(05)80330-2","article-title":"Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment","volume":"21","author":"Wells","year":"1990","journal-title":"Behav. Ther"},{"key":"B49","volume-title":"Metacognitive Therapy for Anxiety and Depression","author":"Wells","year":"2009"},{"key":"B50","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/S0005-7967(96)00050-2","article-title":"Modelling cognition in emotional disorder: the S-REF model","volume":"34","author":"Wells","year":"1996","journal-title":"Behav. Res. Ther."},{"key":"B51","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1161\/CIRCULATIONAHA.120.052428","article-title":"Improving the effectiveness of psychological interventions for depression and anxiety in cardiac rehabilitation: PATHWAY-A single-blind, parallel, randomized, controlled trial of group metacognitive therapy","volume":"144","author":"Wells","year":"2021","journal-title":"Circulation"},{"key":"B52","doi-asserted-by":"publisher","first-page":"582","DOI":"10.3389\/fpsyt.2020.00582","article-title":"Establishing the feasibility of group metacognitive therapy for anxiety and depression in cardiac rehabilitation: a single-blind randomized pilot study","volume":"11","author":"Wells","year":"2020","journal-title":"Front. Psychiatry"},{"key":"B53","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.948081\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T02:05:18Z","timestamp":1658887518000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.948081\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,27]]},"references-count":53,"alternative-id":["10.3389\/fpsyg.2022.948081"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2022.948081","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,27]]},"article-number":"948081"}}