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Published on: June 6, 2025

Randomized Controlled Trial of Internet-Delivered Cognitive Behavioral Therapy After Myocardial Infarction With

Philip Leissner1, Runa Sundelin2, Elisabet Rondung3

  • 1Department of Women's and Children's Health Uppsala University Uppsala Sweden.

Journal of the American Heart Association
|June 15, 2026
PubMed

Insights

An internet-delivered cognitive behavioral therapy program helped reduce stress and anxiety in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS). The intervention showed particular promise for improving outcomes in TS patients.

Area of Science:

  • Cardiology
  • Psychiatry
  • Digital Health

Background:

  • Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and Takotsubo syndrome (TS) experience significant mental health challenges and reduced quality of life.
  • Currently, no evidence-based treatments are established for these post-event psychological sequelae.

Purpose of the Study:

  • To assess the efficacy of an internet-delivered cognitive behavioral therapy (iCBT) program.
  • To evaluate iCBT's impact on stress and anxiety symptoms in MINOCA and TS patients.

Main Methods:

  • A multicenter, randomized controlled trial with 88 participants (45 treatment, 43 wait-list control).
  • Inclusion criteria: elevated stress (Perceived Stress Scale ≥25) or anxiety (Hospital Anxiety and Depression Scale ≥8).
  • Primary outcome: normalized stress and anxiety levels at 10-12 weeks post-randomization; secondary outcomes included separate normalization and continuous symptom measures.

Main Results:

  • The iCBT group showed a higher proportion of normalized patients, though not statistically significant (OR 2.37, P=0.09).
  • Significant treatment effects were observed for anxiety normalization and continuous symptom measures (d=0.44-0.67).
  • An interaction effect indicated greater treatment benefit for Takotsubo syndrome patients (P=0.016).

Conclusions:

  • Patient-tailored iCBT effectively reduced stress and anxiety symptoms in MINOCA and TS patients, normalizing anxiety in a greater proportion compared to controls.
  • Exploratory findings suggest Takotsubo syndrome patients may benefit more from iCBT, warranting further investigation.
Abstract

Keywords:
MINOCARCTTakotsubo syndromeanxietyiCBTstress

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