EFFICACY OF COGNITIVE BEHAVIORAL THERAPY AND POSITIVE PSYCHOLOGY ON PSYCHOLOGICAL OUTCOMES IN PATIENTS WITH CORONARY ARTERY DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Cognitive behavioral therapy (CBT) and positive psychology (PP) are two psychological interventions (PIs) that may have a positive impact in patients with cardiovascular disease. We systematically evaluated the efficacy of these PIs on psychological outcomes in patients with coronary artery disease (CAD). Methods: We searched randomized controlled trials (RCTs) up to March 2018 in PsycINFO, Web of Science, PubMed, and Scopus evaluating CBT or PP in CAD patients. Primary outcomes were depression, stress, anxiety, anger, and positive and negative affect. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as standardized mean difference (SMD) or mean differences (MD) along with their 95% Confidence Intervals (CIs). Subgroup analyses were performed by pre-specified variables that defined heterogeneity across RCTs. Risk of bias was assessed using the Cochrane tool. Results: Nineteen trials were included (n=1846); fourteen evaluated the effects of multi-component CBT (n=1291), two uni-component CBT (n=331), and three PP (n=224). Overall and compared to control groups, depression (SMD -2.08; 95% CI -3.22 to -0.94; 6 studies), stress (SMD -3.72; -5.91 to -1.52; 3 studies), and anxiety (SMD -1.33; -2.38 to -0.29; 5 studies) were significantly reduced with PIs at long-term follow-up. Anger (SMD -0.07; -0.29 to 0.14; 3 studies) and negative affect (SMD -0.34; -0.71 to 0.03; 2 studies) were non-significantly reduced at post-treatment; positive affect was not improved at post-treatment (SMD 0.24, -0.13 to 0.61, 2 studies). Effects of PIs were non-significant on secondary outcomes although outcome data was scarce. Overall, CBT had greater efficacy than PP. Heterogeneity was high across RCTs. Subgroup analyses were consistent with overall analyses, and did not reduce heterogeneity of effects for most of outcomes. Conclusion Multi- and uni-component CBT methods improve psychological outcomes in patients with CAD. New RCTs evaluating PP may be needed to assess its role in CAD populations.