Effectiveness of therapist-supported internet-based cognitive behavioural therapy interventions on depression, anxiety and quality of life among patients with cardiovascular disease: A systematic review and meta-analysis

Shi Qi Kwek; Tin Mei Yeo; Jun Yi Claire Teo; Chuen Wei Alvin Seah; Kai Ning Joylyn Por; Wenru Wang

doi:10.1093/eurjcn/zvaf084

Effectiveness of therapist-supported internet-based cognitive behavioural therapy interventions on depression, anxiety and quality of life among patients with cardiovascular disease: A systematic review and meta-analysis

Eur J Cardiovasc Nurs. 2025 May 6:zvaf084. doi: 10.1093/eurjcn/zvaf084. Online ahead of print.

Authors

Shi Qi Kwek¹, Tin Mei Yeo¹, Jun Yi Claire Teo¹, Chuen Wei Alvin Seah¹, Kai Ning Joylyn Por¹, Wenru Wang^{1

2}

Affiliations

¹ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
² Cardiovascular Metabolic Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore.

PMID: 40327559
DOI: 10.1093/eurjcn/zvaf084

Abstract

Aims: Psychological distress is prevalent among patients with cardiovascular disease (CVD), driven by physiological mechanisms, complex treatment regimens, lifestyle changes and death anxiety. Depression and anxiety significantly impact their quality of life (QoL), highlighting the need for accessible psychological support. Internet-based cognitive behavioural therapy (iCBT) offers a promising approach to address these mental health challenges, however, its effectiveness in patients with CVD has yet to be systematically synthesized. This review evaluates the effectiveness of therapist-assisted iCBT on depression, anxiety and QoL in patients with CVD.

Methods: Ten databases (CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, Scopus and Web of Science, Opengray, Clinicaltrials.gov, Proquest Dissertations) were searched from inception until June 2024. Randomized controlled trials published in English, involving CVD patients receiving therapist-assisted iCBT were included. Study quality was evaluated using Cochrane Risk of Bias. Meta-analysis was undertaken with RevMan Web, and narrative synthesis was performed when meta-analysis was not feasible.

Results: A total of 1690 records were identified and eight studies (ten reports) met the inclusion criteria. Meta-anaysis demonstrated that therapist-assisted iCBT had small to medium effects on depression (SMD=-0.31,95%CI:-0.55 to -0.08,p=0.009) and medium effects on QoL (SMD=0.64, 95%CI:0.31 to 0.98,p=0.0002). Narrative synthesis on anxiety showed mixed effects.

Conclusion: Therapist-assisted iCBT offers a promising, accessible intervention for patients with CVD, particularly for depression and QoL. However, its long-term effectiveness remains unclear due to imited studies. Future research should focus on identifying strategies in enhancing adherence and long-term effectiveness of iCBT interventions, and its impact on anxiety in patients with CVD.

Registration: PROSPERO CRD42024535797.

Keywords: cardiovascular disease; internet-based cognitive behavioural therapy; meta-analysis; nursing.