Introduction
death, heart disease, anxiety, CVD, depression
CVD, DISORDERS, CARDIOVASCULAR DISEASE, HEART DISEASE
Cardiovascular disease (CVD) is the leading cause of death globally [While CR improves anxiety and depression, the effects are small, limiting the benefits that CR alone might have on improving psychological health. This is important because anxiety and depression are common among heart disease patients [While CR services offer home and centre-based CR programmes that are exercise and lifestyle based, less emphasis has been placed on offering effective home-based/self-help psychological support for CR patients. When home-based psychological therapies are offered, cognitive behavioural therapy (CBT) techniques are used but the effectiveness is limited [A candidate treatment approach is metacognitive therapy (MCT [The present study is to our knowledge, the first large-scale trial of a self-help, home-based MCT in patients with CVD. We evaluated if the addition of home-MCT to usual cardiac rehabilitation improved anxiety and depression. The trial tested the primary hypothesis that the addition of home-MCT to usual CR is more effective than CR alone in alleviating symptoms of anxiety and depression in patients with CVD between baseline and 4-month follow-up. We set a minimal inclusion criterion as presence of mild symptoms of anxiety, depression, or both, based on HADS scores, which could include individuals with current or previous psychological disorders.