Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Dec 28, 2021)
Date Submitted: Nov 26, 2020
Open Peer Review Period: Nov 26, 2020 - Jan 21, 2021
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Patients with cardiovascular disease and depression and their experiences of how a tailored internet-based cognitive behavioral therapy influences their emotions, thoughts, and behaviors.
ABSTRACT
Background:
Depression in cardiovascular disease (CVD) is associated with poor quality of life and a worse prognosis. There is also a treatment gap for depression in people living with CVD. Internet-based cognitive behavioral therapy (iCBT) has been suggested as a solution. In a recent study we found that an iCBT treatment tailored for patients with CVD led to reduced levels of depression. However, we still have little knowledge about how patients with CVD and depression experience the changes they go through during iCBT for depressive symptoms.
Objective:
The aim of this qualitative interview study was to explore how an iCBT program tailored for patients with CVD and depressive symptoms influenced their emotions, thoughts, and behaviors.
Methods:
Design A qualitative interview study. Data were analyzed using inductive thematic analysis. Settings 20 patients with CVD from southeast Sweden who had participated in a nine-week iCBT program for depression were included.
Results:
Three main themes emerged: (1) Taking control of the disease, (2) Not just a walk in the park, and (3) Feeling a personal engagement with the iCBT program. The contents of the first theme included comments that the tailored content of the program gave the patients a feeling of being active in the treatment process, and helped them achieve changes in thoughts and behaviors necessary to take control of their cardiovascular disease. In contrast, the second theme showed that patients also experienced the program as demanding and emotionally challenging. However, it was viewed as helpful to challenge negative thinking about living with CVD and to change depressive thoughts. In the third theme patients reported that the structure inherent in the program, in the form of organizing their own health and the scheduled feedback from the therapist, was appreciated and conveyed a feeling of being seen as an individual. The patients described how the feeling of being acknowledged as a person made it easier to continuously work with the changes necessary to improve their health.
Conclusions:
An iCBT program tailored for patients with CVD and depression was found to influence patients’ emotions, thoughts, and behaviors. This was achieved by learning to take control of their CVD and by feeling acknowledged as a person, including having support. The patients considered working with the iCBT program demanding and emotionally challenging, but necessary to achieve change in emotions, thoughts, and behaviors. Clinical Trial: The trial is registered at ClinicalTrials.gov, NCT02778074
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