A feasibility study of the Attention Training Technique in a group format for anxiety and depression in outpatients with coronary heart disease
Authors: Dammen T , Tunheim K , Sverre E , Munkhaugen J , Papageorgiou C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Significant symptoms of anxiety and depression are prevalent (30-40%) in coronary heart disease (CHD) patients and these are associated with a greater risk of death, recurrent cardiovascular events, poorer quality of life, and more frequent use of healthcare services compared to those without this heart condition. To date, only a few psychological treatments have shown limited effectiveness on symptoms of anxiety and depression in CHD patients. Therefore, it is essential to develop and evaluate more effective treatments for depression and anxiety in CHD patients.
Metacognitive therapy (MCT) is effective in reducing significant symptoms of anxiety and depression. A key component of MCT is the attention training technique (ATT), which is based on the self-regulatory executive function model. According to the MCT treatment manual, ATT is brief and does not require extensive training to be delivered by health care personnel in routine care. A review of the empirical evidence shows that ATT can be as effective as full MCT in alleviating anxiety and depressive symptoms. However, ATT has not yet been used as a stand-alone intervention in treating symptoms of anxiety and depression in CHD patients.

Purpose
To evaluate the feasibility of implementing group ATT in CHD patients with significant symptoms of anxiety and depression and describe changes in these symptoms.

Methods
Five consecutively referred CHD patients with significant anxiety and depressive symptoms, as assessed by the Hospital Anxiety and Depression Scale (HADS)-Anxiety or Depression subscale score &gt; 8, were included in the study. They received six weekly group sessions of ATT in an open trial. Outcomes included symptoms measured by HADS at baseline, post-treatment and at six months follow-up. We also assessed psychiatric diagnoses and specific psychological factors (type D personality, insomnia, worry and rumination) as secondary measures.

Results
The sample comprised of five men between 52 and 65 years of age, with a mean age of 59.9 years. Four of the patients attended all six sessions, and one patient attended all but one session. The mean HADS-A scores at baseline, post-treatment, and follow up were 9.4 (SD 3.0), 4.2 (SD 3.0) and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (3.7) and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Wilcoxon Signed Rank Tests revealed a signiﬁcant change in outcome from pre- to post-treatment for HADS-A and worry, which was maintained at 6-months follow-up, and HADS-D significantly decreased from pre-treatment to 6-months follow up.

Conclusions
ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients with significant symptoms of anxiety or depression. Based on these preliminary results, we believe that an adequately powered randomised controlled trial is now warranted.