PATHWAY VERSION 1 DATE 13/02/2015 (RP-PG-1211-20011)
Research type
Research Study
Full title
PATHWAY: Improving the effectiveness of psychological interventions for depression and anxiety in the cardiac rehabilitation pathway. A single-blind randomised controlled trial with four-month and twelve-month follow-up comparing Group-MCT plus usual CR (intervention) with usual CR (control).
IRAS ID
156862
Contact name
Adrian Wells
Contact email
Duration of Study in the UK
4 years, 10 months, 31 days
Research summary
Cardiac rehabilitation (CR) services aim to improve heart disease patients’ health and quality of life, and reduce the risk of further cardiac events. Approximately 69,000 patients attend CR annually in the UK across 372 CR programmes. Depression, anxiety and distress are common among CR patients: 37% of patients have significant anxiety and/or depressive symptoms. Distressed patients are at greater risk of death, further cardiac events and poorer quality of life than those without distress and they use more healthcare resources, leading to greater NHS costs. Available drug and psychological treatments have only small effects on distress and quality of life, and no effects on physical health. Furthermore, the needs of people with heart disease who have depression and anxiety are not being met by the NHS despite the treatment of emotional distress being emphasised in key NHS policy. Therefore, it is essential that more effective treatments for depression and anxiety are integrated into CR services.
Extensive evidence shows that a particular style of thinking dominated by rumination (dwelling on the past) and worry maintains emotional distress. Research has shown that metacognitive therapy (MCT), a psychological intervention, reduces this style of thinking, alleviating depression and anxiety in mental health settings. The PATHWAY programme integrates a version of MCT into CR services; specifically a Group-MCT intervention. This will provide choice for patients and is consistent with NHS policy which recommends a ‘menu- based’ approach to widen uptake and participation in CR. The programme will lead to better informed and integrated care with the potential to improve psychological and physical well being as well as reduce NHS costs. The intervention will take place at three NHS sites and will consist initially of a pilot trial of a Group-MCT intervention (n=50) followed by full scale randomised control trial (RCT: n=300) of the Group-MCT intervention.
REC name
North West - Preston Research Ethics Committee
REC reference
15/NW/0163
Date of REC Opinion
6 Mar 2015
REC opinion
Favourable Opinion