Magán Inés, Casado Laura, Jurado-Barba Rosa, Barnum Haley, Redondo Marta M, Hernandez Adrian V, Bueno Héctor
Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain.
Instituto de Investigación Biomédica del Hospital 12 de Octubre (Imas12), Madrid, Spain.
Psychol Med. 2021 Aug;51(11):1846-1860. doi: 10.1017/S0033291720000598. Epub 2020 Apr 6.
The benefits of cognitive-behavioral treatment (CBT) and positive psychology therapy (PPT) in patients with cardiovascular disease are still not well defined. We assessed the efficacy of CBT and PPT on psychological outcomes in coronary artery disease (CAD) patients.
Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2018 were systematically analyzed. Primary outcomes were depression, stress, anxiety, anger, happiness, and vital satisfaction. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as standardized mean difference (SMD) or mean differences (MD) with their 95% confidence intervals (CIs); risk of bias was assessed with the Cochrane tool.
Nineteen trials were included (n = 1956); sixteen evaluated CBT (n = 1732), and three PPT (n = 224). Compared with control groups, depressive symptoms (13 trials; SMD -0.80; 95% CI -1.33 to -0.26), and anxiety (11 trials; SMD -1.26; 95% CI -2.11 to -0.41) improved after the PI, and depression (6 trials; SMD -2.08; 95% CI -3.22 to -0.94), anxiety (5 trials; SMD -1.33; 95% CI -2.38 to -0.29), and stress (3 trials; SMD -3.72; 95% CI -5.91 to -1.52) improved at the end of follow-up. Vital satisfaction was significantly increased at follow-up (MD 1.30, 0.27, 2.33). Non-significant effects on secondary outcomes were found. Subgroup analyses were consistent with overall analyses.
CBT and PPT improve several psychological outcomes in CAD patients. Depression and anxiety improved immediately after the intervention while stress and vital satisfaction improve in the mid-term. Future research should assess the individual role of CBT and PPT in CAD populations.
认知行为疗法（CBT）和积极心理疗法（PPT）对心血管疾病患者的益处仍未明确界定。我们评估了CBT和PPT对冠状动脉疾病（CAD）患者心理结局的疗效。
系统分析了截至2018年5月发表的评估CAD患者CBT或PPT的随机对照试验。主要结局为抑郁、压力、焦虑、愤怒、幸福感和生活满意度。采用逆方差法进行随机效应荟萃分析。效应以标准化均数差（SMD）或均数差（MD）及其95%置信区间（CI）表示；使用Cochrane工具评估偏倚风险。
纳入19项试验（n = 1956）；16项评估CBT（n = 1732），3项评估PPT（n = 224）。与对照组相比，干预后抑郁症状（13项试验；SMD -0.80；95% CI -1.33至-0.26）和焦虑（11项试验；SMD -1.26；95% CI -2.11至-0.41）有所改善，随访结束时抑郁（6项试验；SMD -2.08；95% CI -3.22至-0.94）、焦虑（5项试验；SMD -1.33；95% CI -2.38至-0.29）和压力（3项试验；SMD -3.72；95% CI -5.91至-1.52）有所改善。随访时生活满意度显著提高（MD 1.30、0.27、2.33）。未发现对次要结局有显著影响。亚组分析与总体分析一致。
CBT和PPT可改善CAD患者的多种心理结局。干预后抑郁和焦虑立即改善，而压力和生活满意度在中期改善。未来研究应评估CBT和PPT在CAD人群中的个体作用。
