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Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial

BACKGROUND: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlled trial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heart disease. The project was successful in reducing the risk of fatal or non-f...

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Autores principales: Norlund, Fredrika, Olsson, Erik MG, Pingel, Ronnie, Held, Claes, Svärdsudd, Kurt, Gulliksson, Mats, Burell, Gunilla
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5431359/
https://www.ncbi.nlm.nih.gov/pubmed/28195501
http://dx.doi.org/10.1177/2047487317693131
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author Norlund, Fredrika
Olsson, Erik MG
Pingel, Ronnie
Held, Claes
Svärdsudd, Kurt
Gulliksson, Mats
Burell, Gunilla
author_facet Norlund, Fredrika
Olsson, Erik MG
Pingel, Ronnie
Held, Claes
Svärdsudd, Kurt
Gulliksson, Mats
Burell, Gunilla
author_sort Norlund, Fredrika
collection PubMed
description BACKGROUND: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlled trial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heart disease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aim of this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vital exhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events. METHODS: A total of 362 patients were randomly assigned to intervention or usual care groups. The psychological outcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of the outcomes were analysed using joint modelling of the longitudinal and time to event data. RESULTS: The intervention had a positive effect on somatic anxiety (p < 0.05), reflecting a beneficial development over time compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time. Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events. CONCLUSIONS: The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustion or depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardiovascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, the mechanisms between the intervention and the protective cardiovascular outcome remain to be identified.
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spelling pubmed-54313592017-05-23 Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial Norlund, Fredrika Olsson, Erik MG Pingel, Ronnie Held, Claes Svärdsudd, Kurt Gulliksson, Mats Burell, Gunilla Eur J Prev Cardiol Cardiac Rehabilitation BACKGROUND: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlled trial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heart disease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aim of this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vital exhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events. METHODS: A total of 362 patients were randomly assigned to intervention or usual care groups. The psychological outcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of the outcomes were analysed using joint modelling of the longitudinal and time to event data. RESULTS: The intervention had a positive effect on somatic anxiety (p < 0.05), reflecting a beneficial development over time compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time. Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events. CONCLUSIONS: The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustion or depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardiovascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, the mechanisms between the intervention and the protective cardiovascular outcome remain to be identified. SAGE Publications 2017-01-01 2017-06 /pmc/articles/PMC5431359/ /pubmed/28195501 http://dx.doi.org/10.1177/2047487317693131 Text en © The European Society of Cardiology 2017 http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Cardiac Rehabilitation
Norlund, Fredrika
Olsson, Erik MG
Pingel, Ronnie
Held, Claes
Svärdsudd, Kurt
Gulliksson, Mats
Burell, Gunilla
Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
title Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
title_full Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
title_fullStr Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
title_full_unstemmed Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
title_short Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
title_sort psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: a sub-analysis from the suprim trial
topic Cardiac Rehabilitation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5431359/
https://www.ncbi.nlm.nih.gov/pubmed/28195501
http://dx.doi.org/10.1177/2047487317693131
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