GMMH's Research & Innovation department and the ADePT Research Unit are delighted to announce the launch of the MCT-PATHWAY Mechanism study, further deepening our knowledge of how to combat anxiety and depression for people with cardiovascular disease (CVD).
This new ‘Mechanism’ study – funded by the National Institute of Health and Social Care Research (NIHR) – delves deeper into the research data from the team’s previous PATHWAY studies to track exactly how and why Metacognitive Therapy (MCT), a ground-breaking talking therapy approach, can aid recovery after a heart event.
Over 7.6 million people in the UK have cardiovascular disease, and 89,573 people access cardiac rehabilitation every year.1 Mental health is extremely important to manage CVD, both in order for patients to access cardiac rehabilitation services, as well as to ensure they have the confidence and ability to make lifestyle changes necessary to reduce their risk of a cardiac event. Whilst cardiac rehab includes lifestyle interventions such as exercise and education, it does not routinely include talking therapies.
However, more than one in three people with CVD (37%) report experiencing symptoms of anxiety or depression.2 These symptoms can reduce their quality of life, impair functioning, increase the risk of death and further cardiac events and increase the need for use of healthcare services.
This is where MCT-PATHWAY came in - which aims to improve mental health in patients living with heart disease. Funded by the National Institute for Health & Social Care Research (NIHR), the team wanted to find ways to ensure that more patients with anxiety and depression could access and benefit from their rehabilitation experience.
Specifically, researchers wanted to see if Metacognitive Therapy (MCT) would be helpful. MCT was developed by Professor Adrian Wells, Professor of Clinical and Experimental Psychopathology at the University of Manchester and Consultant Clinical Psychologist at GMMH. MCT directly reduces worry, rumination and unhelpful thinking styles and modifies the specific beliefs behind them, discovering new and more helpful ways to react to distressing thoughts result in a positive effect on anxiety and mood. Whilst some therapies address the content of a person’s thoughts, MCT looks at the way we think about our thoughts.
The PATHWAY team wanted to deliver MCT alongside conventional cardiac rehabilitation in the UK, and worked with members of the public who have personal experience living with the condition (either directly, or as a loved one or family member) to plan a research study.
Between 2014 and 2021, two large-scale research studies were undertaken to see how effective MCT is – either as a self-help tool or in a group setting of three to ten service users – at reducing distress. A course of six one-hour sessions were delivered by a trained health professional from cardiac rehabilitation services, including nurses, physiotherapists, and occupational therapists.
A further programme, PATHAY Beacons, is looking at how best to train healthcare staff and roll out MCT into cardiac rehab services.
These previous studies found that adding talking-based therapy to cardiac rehab significantly reduced distress in service users. So much so that the MCT-PATHWAY and PATHWAY Beacons teams have been shortlisted for Mental Health Innovation of the Year at the Health Service Journal (HSJ) Awards, in recognition of their outstanding contribution to healthcare.
Professor Adrian Wells, PATHWAY Chief Investigator, commented:
“It’s not surprising that people living with or recovering from serious heart problems experience symptoms of anxiety, depression and trauma.
"They are often recovering from potentially life-limiting conditions and uncertainty which understandably causes distress. What’s important is that we recognise this and provide patients with effective, evidence-based treatment options.
"The results of our trial have shown that MCT can help cardiac patients discover new and more helpful ways to process their distressing thoughts, whether they are undergoing treatment at home or at a clinic.”
Following these successful studies, the PATHWAY team now wants to understand more about why MCT works, who it works best for and which of the MCT techniques are most successful.
Working again with the Patient Participation Group who collaborated on the previous studies over the past ten years, the team has refined the study aims and is focussing on how to make the results of this new study accessible and easy to understand.
Using the data collected from the previous studies, which included 572 service user participants, the research team will compare the levels of distress and types of beliefs (mechanisms) over the course of the rehab treatment they received. This might have been standard cardiac rehab treatment (a control group), MCT in a group setting, or a self-help form of MCT.
The researchers will then look to see if there is a link between any mechanisms and the level of distress after cardiac rehab. By doing this, we will gain a better understanding of why treatment might not work for some people, which techniques need to be improved and which should be changed. The aim is to better understand how to support those living with CVD in managing distress, improving quality of life, and provide more cost-effective approaches for the NHS.
GMMH looks forward to following the progress of PATHWAY Beacons and PATHWAY Mechanism over the coming months.
You can find out more about the ADePT Research Unit and their research on anxiety and depression, including MCT-PATHWAY, by visiting their website here .
If you are interested in finding out more about the Patient Participation and Involvement (PPI) Group and how to get involved in shaping our research, visit ADePT’s User Involvement page here .
GMMH wishes the best of luck to our colleagues in the MCT-PATHWAY team at the HSJ awards ceremony on 16 November!
1 British HeartFoundation: UK Fact Sheet April 2023. BHF UK CVD Factsheet British Heart Foundation: The National Audit of Cardiac Rehabilitation: Quality and Outcomes Report 2019. nacr-quality-and-outcomes-report-2019.pdf (bhf.org.uk)
2 British Heart Foundation: National Audit of Cardiac Rehabilitation. Annual Report 2012. In. York, UK: University of York; 2012.