Cognitive-Behavioral Therapy for Insomnia Tailored to Patients With Cardiovascular Disease: A Pre-Post Study.

Objective: There is little research assessing the use of cognitive-behavioral therapy for insomnia (CBT-I) among patients with cardiovascular disease (CVD), even less on the effects of CBT-I on CVD risk factors such as anxiety and depression, and to our knowledge, only limited studies of the efficacy of CBT-I protocols with cardiac disease-specific modifications. The objective of this study is to evaluate a group-based CBT-I intervention tailored to patients with CVD on sleep quality, duration, and mental health. Participants: A sample of 47 participants (25 men) diagnosed with primary insomnia were included in this study. Methods: This study used a pre-post design comparing outcomes before and after a group intervention. Clinicians in a cardiac center referred CVD patients with self-reported sleep disturbance to the intervention group. Following screening and confirmation of insomnia disorder, participants completed a six-week CBT-I group-based intervention tailored for patients with CVD. Participants completed sleep diaries and questionnaires, including the Insomnia Severity Index, Beck Depression Inventory-II, and Beck Anxiety Inventory, pre- and postintervention. Results: Participants' sleep outcomes (sleep duration, maintenance, efficiency, latency, and quality) were significantly improved and patients reported significantly fewer symptoms of anxiety, depression, and insomnia following the CBT-I intervention (p values < .05). Conclusions: After participating in a CBT-I group intervention tailored for cardiac patients, patients reported improved sleep and significantly lower levels of anxiety and depression. Randomized trials of this intervention are warranted.

Establishing the Minimal Clinically Important Difference for the Hospital Anxiety and Depression Scale in Patients With Cardiovascular Disease.

PURPOSE: The Hospital Anxiety and Depression Scale (HADS) is frequently used by clinicians to assess anxiety and depression in patients with cardiovascular disease; yet, its minimal clinically important difference (MCID) has not been established. The purpose of this study was to establish an MCID for the HADS in patients with cardiovascular disease. METHODS: A sample of 591 patients (74% male; ethnicity = 89% white; mean ± standard deviation [SD]: age = 63 ± 10 yr; and body mass index = 29.1 ± 5.6 kg/m) with cardiovascular disease enrolled in a 3-mo cardiac rehabilitation program were included in this study. The MCID for the HADS was estimated using distribution-based methods (ie, standard deviation, effect size, standard error of measurement, and minimal detectable change), anchor-based methods (ie, health transition question, correlation and linear regression, and receiver operating characteristic curve), and Delphi methodology (ie, clinical consensus). RESULTS: A total of 18 MCID values were calculated ranging from 0.81 to 5.21 (Anxiety subscale) and 0.5 to 5.57 (Depression subscale). The final MCID for the HADS, triangulated from the distribution-based, anchor-based, and Delphi-based findings, was 1.7 points. CONCLUSIONS: Our work provides the first estimates of an MCID by triangulating multiple methodologies for the HADS in patients with cardiovascular disease. This MCID may serve as an indicator of treatment success for clinicians and researchers and guide future interventions to improve the mental health of patients with cardiovascular disease.