Digital CBT reduced cardiac-related anxiety and improved disease-specific health status following heart attack
Digital CBT treatment reduced cardiac-related anxiety and improved patients' quality of life and physical function after a heart attack. This is shown in a new randomised study published in Journal of the American College of Cardiology, in which researchers at Karolinska Institutet compared digital CBT with standard care.
Many people who suffer a heart attack develop persistent anxiety related to their heart, such as fear of new cardiac events or avoidance of everyday activities such as physical activity. The study involved 96 people who had had a heart attack at least six months earlier and who experienced significant cardiac-related anxiety.
The participants were randomly assigned to either eight weeks of digital, exposure-based CBT or standard care, i.e. the usual medical follow-up after a heart attack without any psychological treatment.
The psychological treatment consisted of exercises in which the participants gradually approached situations and cardiac-related symptoms that they had previously avoided due to fear. Participants completed self-assessments of their symptoms before and after treatment.
The results show that the group that received digital CBT improved their quality of life and reduced heart-related anxiety more than the control group at the three-month follow-up. The reduction was stable up to one year after treatment.
Physical functioning also increased more in the treatment group. Participants felt less hindered in their daily lives and dared to be more physically active.
"Our method focuses on reducing fear of cardiac-related symptoms. When the fear decreases, many dare to resume activities they had begun to avoid after their heart attack, which has a positive effect on their quality of life,‘ says last author Josefin Särnholm, licensed psychologist and researcher at the Department of Clinical Neuroscience, Karolinska Institutet.
“’It is important to understand that cardiac-related anxiety is common after a heart attack and that it can be treated. Digital therapy can be a way to reach more patients”, continues first author Amanda Johnsson, licensed psychologist and doctoral student at the Department of Clinical Neuroscience, Karolinska Institutet.
The study was conducted in collaboration between researchers in psychology and cardiology at Karolinska Institutet and Karolinska University Hospital. The research was funded by the Swedish Heart-Lung Foundation and the Swedish Research Council. Some of the researchers report compensation for lectures and assignments, which is disclosed in the study.
Publication:
”Digital Cognitive Behavioral Therapy for Cardiac Anxiety After Myocardial Infarction: Effects on Disease-Specific Health Status—Randomized Trial Results”, Amanda Johnsson, Brjánn Ljótsson, Björn E Liliequist, Matthias Lidin, Marie Löf, Linnea Maurex, Eva Ólafsdóttir, Elina Rautio, Johanna Sandborg, Frieder Braunschweig, Linda G Mellbinb, Josefin Särnholm, Journal of the American College of Cardiology, online 25 mars, 2026, doi: 10.1016/j.jacc.2026.02.5068
“Digital Cognitive Behavioral Therapy for Cardiac Anxiety After Myocardial Infarction: Effects on Disease-Specific Health Status—Detailed Methods and Protocol”, Amanda Johnsson, Brjánn Ljótsson, Björn E Liliequist, Matthias Lidin, Marie Löf, Linnea Maurex, Eva Ólafsdóttir, Elina Rautio, Johanna Sandborg, Frieder Braunschweig, Linda G Mellbinb, Josefin Särnholm, Journal of the American College of Cardiology Advances, online 25 mars, 2026, doi: 10.1016/j.jacadv.2026.102669
END
Many people who suffer a heart attack develop persistent anxiety related to their heart, such as fear of new cardiac events or avoidance of everyday activities such as physical activity. The study involved 96 people who had had a heart attack at least six months earlier and who experienced significant cardiac-related anxiety.
The participants were randomly assigned to either eight weeks of digital, exposure-based CBT or standard care, i.e. the usual medical follow-up after a heart attack without any psychological treatment.
The psychological treatment consisted of exercises in which the participants gradually approached situations and cardiac-related symptoms that they had previously avoided due to fear. Participants completed self-assessments of their symptoms before and after treatment.
The results show that the group that received digital CBT improved their quality of life and reduced heart-related anxiety more than the control group at the three-month follow-up. The reduction was stable up to one year after treatment.
Physical functioning also increased more in the treatment group. Participants felt less hindered in their daily lives and dared to be more physically active.
"Our method focuses on reducing fear of cardiac-related symptoms. When the fear decreases, many dare to resume activities they had begun to avoid after their heart attack, which has a positive effect on their quality of life,‘ says last author Josefin Särnholm, licensed psychologist and researcher at the Department of Clinical Neuroscience, Karolinska Institutet.
“’It is important to understand that cardiac-related anxiety is common after a heart attack and that it can be treated. Digital therapy can be a way to reach more patients”, continues first author Amanda Johnsson, licensed psychologist and doctoral student at the Department of Clinical Neuroscience, Karolinska Institutet.
The study was conducted in collaboration between researchers in psychology and cardiology at Karolinska Institutet and Karolinska University Hospital. The research was funded by the Swedish Heart-Lung Foundation and the Swedish Research Council. Some of the researchers report compensation for lectures and assignments, which is disclosed in the study.
Publication:
”Digital Cognitive Behavioral Therapy for Cardiac Anxiety After Myocardial Infarction: Effects on Disease-Specific Health Status—Randomized Trial Results”, Amanda Johnsson, Brjánn Ljótsson, Björn E Liliequist, Matthias Lidin, Marie Löf, Linnea Maurex, Eva Ólafsdóttir, Elina Rautio, Johanna Sandborg, Frieder Braunschweig, Linda G Mellbinb, Josefin Särnholm, Journal of the American College of Cardiology, online 25 mars, 2026, doi: 10.1016/j.jacc.2026.02.5068
“Digital Cognitive Behavioral Therapy for Cardiac Anxiety After Myocardial Infarction: Effects on Disease-Specific Health Status—Detailed Methods and Protocol”, Amanda Johnsson, Brjánn Ljótsson, Björn E Liliequist, Matthias Lidin, Marie Löf, Linnea Maurex, Eva Ólafsdóttir, Elina Rautio, Johanna Sandborg, Frieder Braunschweig, Linda G Mellbinb, Josefin Särnholm, Journal of the American College of Cardiology Advances, online 25 mars, 2026, doi: 10.1016/j.jacadv.2026.102669
END