Abstract
Abstract Nearly half of patients with non-cardiac chest pain (NCCP) experience significant complaints after a negative cardiac evaluation, at considerable costs for society. Due to the lack of treatment capacity and low interest for psychological treatment among patients with somatic complaints, only a minority receive effective treatment. The aim of this study was to assess the feasibility and usefulness of internet-assisted cognitive behavioural therapy (I-CBT), including encouragement of physical activity for this condition. Ten patients with NCCP received a six-session I-CBT intervention with minimal support from a therapist. Questionnaires assessing cardiac anxiety, fear of bodily sensations, depression, interpretation of symptoms, frequency of chest pain and impact of chest pain symptoms were collected at baseline, post-treatment and at 3-month follow-up. Semi-structured interviews employing a phenomenological hermeneutic approach assessed the participants’ experience of the intervention. Quantitative results showed clear improvements in several measures both at end of treatment and at 3-month follow-up. The retention rate was 100% and client satisfaction was high. The intervention was feasible to implement in a cardiac setting. This setting made it easier for patients to accept a psychological approach. Qualitative interviews revealed that the participants felt respected and taken care of, and they obtained a better understanding of their chest pain and how to cope with it. This pilot study yielded promising results regarding feasibility, clinical effect and patient satisfaction from a brief I-CBT intervention for NCCP in a cardiac setting. These results indicate that a randomized controlled trial with a larger sample size is warranted. Key learning aims (1) Feasibility of internet-assisted cognitive behavioural therapy (I-CBT) for non-cardiac chest pain (NCCP). (2) How NCCP patients experience I-CBT. (3) Possible effects of I-CBT. (4) How I-CBT can be delivered at the Cardiac Department.
Highlights
Chest pain is a common symptom, with a lifetime prevalence of 20–40% in the general population (Chambers et al, 2015; Ruigomez et al, 2006)
Webster et al (2015) found that non-cardiac chest pain (NCCP) patients often are accepting of psychological explanations of their pain, but it is a challenge to convey an understanding of the connection
Some NCCP patients attribute their symptoms to psychological causes, many remain concerned that they have heart problems even after health professionals inform them that their heart is healthy (Eifert et al, 1996; Jonsbu et al, 2010)
Summary
Chest pain is a common symptom, with a lifetime prevalence of 20–40% in the general population (Chambers et al, 2015; Ruigomez et al, 2006). Despite a negative cardiac evaluation, almost half experience sustained significant complaints, including recurring chest pain; cardiac anxiety; avoidance of physical activity; moderate functional impairments in work, family and social domains; and declines in overall quality of life (Goodacre et al, 2001; Jonsbu et al, 2010; Mourad et al, 2013). Webster et al (2015) found that NCCP patients often are accepting of psychological explanations of their pain, but it is a challenge to convey an understanding of the connection. Avoidance of physical activity is problematic in this group, because exercise often reduces anxiety and improves low mood (Martinsen, 2008; McDowell et al, 2019), which are both common among patients with NCCP (Jonsbu et al, 2009). In keeping with this argument, a recent study found that a 12-week exercise training programme for individuals with NCCP yielded a range of important benefits (e.g. feeling more capable, feeling stronger, faster and less restricted (Roysland et al, 2017))
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