Home-MCT alongside usual CR (intervention group)
Home-MCT [Patients also received 3 brief scripted telephone support calls delivered by CR staff who had received basic training in delivering the calls. There were 7 support staff, 3 from Bolton and 4 from Liverpool. The support staff were predominantly CR nurses, with 1 site including a physiotherapist. They completed a workshop delivered by the developer of MCT (AW). Training included didactic teaching, role play, discussion, and studying the treatment manual to facilitate an understanding of the MCT approach and the purpose of the techniques in the manual. In addition, they piloted home-MCT support calls with 5 volunteers each (total of 1.5 hours of practise), after which an additional 1-day workshop was delivered, which focused on enhancing support skills.The first scripted call was 10 to 15 minutes and introduced the structure of the manual and helped users think of a timetable for completing the modules. The second and third calls (approximately 30 minutes each) reviewed the modules completed to date and helped participants consolidate what they had learned from the exercises, encouraging widening of practise of techniques, reviewing unhelpful coping behaviours, and increasing motivation to change them. The support calls did not consist of actively delivering MCT intervention techniques (e.g., practising exercises) but patients were asked questions to help them reflect on changing beliefs about worrying (e.g., “Do you believe worrying is uncontrollable?”) and changing behaviours.