Skip to main content
Log in

Can Cognitive Behaviour Therapy Be Beneficial for Heart Failure Patients?

  • Self-Care and Health Outcomes (T Jaarsma, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

This review aims to summarize the theory of cognitive behavioural therapy (CBT) as well as the current evidence for whether CBT can be beneficial for patients with heart failure (HF). Depression and/or anxiety are common in HF patients. However, participation in disease management programmes does not seem to be beneficial for these problems. CBT, which focuses on the identification and changing of dysfunctional beliefs and thoughts and on behaviour therapy, is a possible treatment option. The number of CBT studies on HF is small and they are often not designed as randomized controlled trials. However, the studies on HF indicate that CBT can decrease depression as well as anxiety and suggest that relaxation exercises with elements of CBT may decrease symptom burden. Before implementation in clinical practice, more knowledge is needed about how CBT programmes should be designed, where CBT should be delivered and who should deliver CBT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Michaud CM, Murray CJ, Bloom BR. Burden of disease—implications for future research. JAMA. 2001;285(5):535–9.

    Article  CAS  PubMed  Google Scholar 

  2. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Atherosclerosis. 2007;194(1):1–45. doi:10.1016/j.atherosclerosis.2007.08.024.

    Article  CAS  PubMed  Google Scholar 

  3. Stewart S, MacIntyre K, Hole DJ, Capewell S, McMurray JJ. More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail. 2001;3(3):315–22.

    Article  CAS  PubMed  Google Scholar 

  4. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847. doi:10.1093/eurheartj/ehs104.

    Article  PubMed  Google Scholar 

  5. Johansson P, Dahlstrom U, Brostrom A. Factors and interventions influencing health-related quality of life in patients with heart failure: a review of the literature. Eur J Cardiovasc Nurs. 2006;5(1):5–15.

    Article  PubMed  Google Scholar 

  6. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the heart failure association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail. 2008;10(10):933–89.

    Article  PubMed  Google Scholar 

  7. Pattenden JF, Roberts H, Lewin RJ. Living with heart failure; patient and carer perspectives. Eur J Cardiovasc Nurs. 2007;6(4):273–9. doi:10.1016/j.ejcnurse.2007.01.097.

    Article  CAS  PubMed  Google Scholar 

  8. Muzzarelli S, Leibundgut G, Maeder MT, Rickli H, Handschin R, Gutmann M, et al. Predictors of early readmission or death in elderly patients with heart failure. Am Heart J. 2010;160(2):308–14. doi:10.1016/j.ahj.2010.05.007.

    Article  PubMed  Google Scholar 

  9. Kheirbek RE, Alemi F, Citron BA, Afaq MA, Wu H, Fletcher RD. Trajectory of illness for patients with congestive heart failure. J Palliat Med. 2013;16(5):478–84. doi:10.1089/jpm.2012.0510.

    Article  PubMed  Google Scholar 

  10. Welstand J, Carson A, Rutherford P. Living with heart failure: an integrative review. Int J Nurs Stud. 2009;46(10):1374–85. doi:10.1016/j.ijnurstu.2009.03.009.

    Article  PubMed  Google Scholar 

  11. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48(8):1527–37.

    Article  PubMed  Google Scholar 

  12. Dekker RL, Lennie TA, Doering LV, Chung ML, Wu JR, Moser DK. Coexisting anxiety and depressive symptoms in patients with heart failure. Eur J Cardiovasc Nurs. 2014;13(2):168–76. doi:10.1177/1474515113519520.

    Article  PubMed  Google Scholar 

  13. Johansson P, Brostrom A. Insomnia is associated to depressive symptoms in patients with chronic heart failure. Open J Nurs. 2013;3:33–41. doi:10.4236/ojn.2013.31005.

    Article  Google Scholar 

  14. Muller-Tasch T, Peters-Klimm F, Schellberg D, Holzapfel N, Barth A, Junger J, et al. Depression is a major determinant of quality of life in patients with chronic systolic heart failure in general practice. J Card Fail. 2007;13(10):818–24.

    Article  PubMed  Google Scholar 

  15. Johansson P, Lesman-Leegte I, Lundgren J, Hillege HL, Hoes A, Sanderman R, et al. Time-course of depressive symptoms in patients with heart failure. J Psychosom Res. 2013;74(3):238–43. doi:10.1016/j.jpsychores.2012.09.019.

    Article  PubMed  Google Scholar 

  16. Fulop G, Strain JJ, Stettin G. Congestive heart failure and depression in older adults: clinical course and health services use 6 months after hospitalization. Psychosomatics. 2003;44(5):367–73.

    Article  PubMed  Google Scholar 

  17. O'Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, et al. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol. 2010;56(9):692–9. doi:10.1016/j.jacc.2010.03.068. This is the largest study that have evaluated the effect of SSRI on depression in patients with heart failure.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Cuijpers P, Berking M, Andersson G, Quigley L, Kleiboer A, Dobson KS. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Une méta-analyse de la thérapie cognitivo-comportementale pour la dépression adulte, seule et en comparaison avec d'autres traitements. 2013;58(7):376–85.

  19. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69(4):621–32.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Montgomery P, Dennis J. Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database Syst Rev. 2003;1, CD003161. doi:10.1002/14651858.CD003161.

    PubMed  Google Scholar 

  21. Tallis F. Changing minds the history of psychotherapy as an answer to human suffering. 1998.

  22. Beck AT, Young JE. Cognitive therapy of depression. Guilford clinical psychology and psychotherapy series. New York: Guilford Press; 1979.

    Google Scholar 

  23. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res. 2012;36(5):427–40. doi:10.1007/s10608-012-9476-1.

    Article  Google Scholar 

  24. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014;69(2):153–66. doi:10.1037/a0035747.

    Article  PubMed  Google Scholar 

  25. Tolin DF. Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clin Psychol Rev. 2010;30(6):710–20. doi:10.1016/j.cpr.2010.05.003.

    Article  PubMed  Google Scholar 

  26. Andersson G. The Internet and CBT: a clinical guide. CRC Press. Taylor and Francis Group; 2014.

  27. Gary RA, Dunbar SB, Higgins MK, Musselman DL, Smith AL. Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure. J Psychosom Res. 2010;69(2):119–31. doi:10.1016/j.jpsychores.2010.01.013. This study evaluated the combined effect of CBT and physical exercise on depression in patients with heart failure.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Dekker RL, Moser DK, Peden AR, Lennie TA. Cognitive therapy improves three-month outcomes in hospitalized patients with heart failure. J Card Fail. 2012;18(1):10–20. doi:10.1016/j.cardfail.2011.09.008.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Cully JA, Stanley MA, Deswal A, Hanania NA, Phillips LL, Kunik ME. Cognitive-behavioral therapy for chronic cardiopulmonary conditions: preliminary outcomes from an open trial. Prim Care Companion J Clin Psychiatry. 2010;12(4). doi:10.4088/PCC.09m00896blu.

  30. Tully PJ, Selkow T, Bengel J, Rafanelli C. A dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: the discrete effects of cognitive behavioral therapy, exercise, and psychotropic medication. Disability and Rehabilitation. 0(0):1–8. doi:10.3109/09638288.2014.935493. In this study CBT for anxiety as well as depression was used on heart failure patients with depression and general anxiety disorder.

  31. Mohr DC, Ho J, Duffecy J, et al. Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial. JAMA. 2012;307(21):2278–85. doi:10.1001/jama.2012.5588.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010;5(10):e13196. doi:10.1371/journal.pone.0013196.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Johansson R, Andersson G. Internet-based psychological treatments for depression. Expert Rev Neurother. 2012;12(7):861–9. doi:10.1586/ern.12.63. quiz 70.

    Article  CAS  PubMed  Google Scholar 

  34. Montgomery EC, Kunik ME, Wilson N, Stanley MA, Weiss B. Can paraprofessionals deliver cognitive-behavioral therapy to treat anxiety and depressive symptoms? Bull Menn Clin. 2010;74(1):45–62. doi:10.1521/bumc.2010.74.1.45.

    Article  Google Scholar 

  35. Beattie A, Shaw A, Kaur S, Kessler D. Primary-care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study. Health Expect: Int J Publ Particip Health Care Health Policy. 2009;12(1):45–59. doi:10.1111/j.1369-7625.2008.00531.x.

    Article  Google Scholar 

  36. Lundgren J, Andersson G, Kärner-Köhler A, Jaarsma T, Johansson P. Internet cognitive behavioural therapy—a new tool for depressed heart failure patients. A developmental and feasibility study. Abstract Swedish Cardiovascular Spring Meeting; Malmö 2014.

  37. Silveira H, Moraes H, Oliveira N, Coutinho ES, Laks J, Deslandes A. Physical exercise and clinically depressed patients: a systematic review and meta-analysis. Neuropsychobiology. 2013;67(2):61–8. doi:10.1159/000345160.

    Article  PubMed  Google Scholar 

  38. Turvey CL, Klein DM, Pies CJ. Depression, physical impairment, and treatment of depression in chronic heart failure. J Cardiovasc Nurs. 2006;21(3):178–85.

    Article  PubMed  Google Scholar 

  39. Hind D, O’Cathain A, Cooper CL, Parry GD, Isaac CL, Rose A, et al. The acceptability of computerised cognitive behavioural therapy for the treatment of depression in people with chronic physical disease: a qualitative study of people with multiple sclerosis. Psychol Health. 2010;25(6):699–712. doi:10.1080/08870440902842739.

    Article  PubMed  Google Scholar 

  40. Dekker RL, Lennie TA, Doering LV, Chung ML, Wu J-R, Moser DK. Coexisting anxiety and depressive symptoms in patients with heart failure. Eur J Cardiovasc Nurs. 2014;13(2):168–76. doi:10.1177/1474515113519520.

    Article  PubMed  Google Scholar 

  41. Cockayne S, Pattenden J, Worthy G, Richardson G, Lewin R. Nurse facilitated Self-management support for people with heart failure and their family carers (SEMAPHFOR): a randomised controlled trial. Int J Nurs Stud. 2014;51(9):1207–13. doi:10.1016/j.ijnurstu.2014.01.010.

    Article  PubMed  Google Scholar 

  42. Luskin F, Reitz M, Newell K, Quinn TG, Haskell W. A controlled pilot study of stress management training of elderly patients with congestive heart failure. Prev Cardiol. 2002;5(4):168–72.

    Article  PubMed  Google Scholar 

  43. Sullivan MJ, Wood L, Terry J, Brantley J, Charles A, McGee V, et al. The support, education, and research in chronic heart failure study (SEARCH): a mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure. Am Heart J. 2009;157(1):84–90. The largest study evaluating a Mindfulness intervention on patients with heart failure.

    Article  PubMed  Google Scholar 

  44. Jaarsma T, Lesman-Leegte I, Hillege HL, Veeger NJ, Sanderman R, van Veldhuisen DJ. Depression and the usefulness of a disease management program in heart failure: insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study. J Am Coll Cardiol. 2010;55(17):1837–43. doi:10.1016/j.jacc.2009.11.082.

    Article  PubMed  Google Scholar 

  45. Woltz PC, Chapa DW, Friedmann E, Son H, Akintade B, Thomas SA. Effects of interventions on depression in heart failure: a systematic review. Heart Lung. 2012;41(5):469–83. doi:10.1016/j.hrtlng.2012.06.002.

    Article  PubMed  Google Scholar 

  46. Ljotsson B, Falk L, Vesterlund AW, Hedman E, Lindfors P, Ruck C, et al. Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome—a randomized controlled trial. Behav Res Ther. 2010;48(6):531–9. doi:10.1016/j.brat.2010.03.003.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Johan Lundgren, Gerhard Andersson and Peter Johansson declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter Johansson.

Additional information

This article is part of the Topical Collection on Self-Care and Health Outcomes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lundgren, J., Andersson, G. & Johansson, P. Can Cognitive Behaviour Therapy Be Beneficial for Heart Failure Patients?. Curr Heart Fail Rep 12, 166–172 (2015). https://doi.org/10.1007/s11897-014-0244-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-014-0244-2

Keywords

Navigation