Cognitive behavioral therapy for cardiac anxiety after heart attack

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Created On: 18/06/2025

Cardiac anxiety, a common yet under-addressed issue after myocardial infarction (MI), involves fear and avoidance of heart-related symptoms and is linked to poorer cardiovascular outcomes.

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Key take away

Anxiety after a heart attack isn’t just common—it’s treatable. Exposure-based cognitive behavioral therapy is a practical and well-tolerated intervention to alleviate cardiac anxiety and boost quality of life after myocardial infarction.

Background

Cardiac anxiety, a common yet under-addressed issue after myocardial infarction (MI), involves fear and avoidance of heart-related symptoms and is linked to poorer cardiovascular outcomes.

The goal of two pilot studies was to explore the feasibility, acceptability, and preliminary effectiveness of a tailored cognitive behavioral therapy (MI-CBT) program specifically designed to address cardiac anxiety and improve health-related quality of life after MI.

Method

Two consecutive, non-randomized pilot studies were carried out. In the first (number of patients = 15), therapy sessions were conducted through face-to-face videoconferencing, while the second (number of patients = 23) was delivered through an online platform. Participants had a confirmed MI at least 6 months prior and met the criteria for elevated cardiac anxiety through clinical assessment.

Guided by a therapist, the intervention lasted 8 weeks, incorporating exposure exercises intended to reduce avoidance of heart-related symptoms. A 12-item Short Form Health Survey (SF-12) and self-reported, 18-item Cardiac Anxiety Questionnaire (CAQ) were completed by the study participants at the beginning, end, and after 6 months.

Result

Both studies displayed strong participant engagement and high satisfaction. Noteworthy reductions in cardiac anxiety (CAQ scores, p < 0.001) and improvements in health-related quality of life (SF-12 scores, p < 0.001) were observed.

Conclusion

MI-CBT is a practical and well-received intervention with potential benefits for reducing cardiac-related psychological distress and improving quality of life post-MI. Further randomized trials are warranted to assess its full efficacy.