Introduction: Randomized controlled trials (RCT) of psychotherapeutic interventions have addressed depression and demoralization associated with acute coronary syndromes (ACS). The present trial introduces psychological well-being, an increasingly recognized factor in cardiovascular health, as a therapeutic target. Objective: This study was designed to determine whether the sequential combination of cognitive-behavioral therapy (CBT) and well-being therapy (WBT) may yield more favorable outcomes than an active control group (clinical management; CM) and to identify subgroups of patients at greater risk for cardiac negative outcomes. Methods: This multicenter RCT comparedCBT/WBT sequential combination versus CM, with up to 30 months of follow-up. One hundred consecutive depressed and/or demoralized patients (out of 740 initially screened by cardiologists after a first episode of ACS) were randomized to CBT/WBT associated with lifestyle suggestions (n = 50) and CM (n = 50). The main outcome measures included: severity of depressive symptoms according to the Clinical Interview for Depression, changes in subclinical psychological distress, well-being, and biomarkers, and medical complications and events. Results: CBT/WBT sequential combination was associated with a significant improvement in depressive symptoms compared to CM. In both groups, the benefits persisted at follow-up, even though the differences faded. Treatment was also related to a significant amelioration of biomarkers (platelet count, HDL, and D-dimer), whereas the 2 groups showed similar frequencies of adverse cardiac events. Conclusions: Addressing psychological well-being in the psychotherapeutic approach to ACS patients with depressive symptoms was found to entail important clinical benefits. It is argued that lifestyle changes geared toward cardiovascular health may be facilitated by a personalized approach that targets well-being.
Psychother Psychosom

中文翻译：

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急性冠脉综合征抑郁患者的认知行为治疗和幸福感治疗的序贯组合：一项随机对照试验（TREATED-ACS 研究）。

简介：心理治疗干预的随机对照试验 (RCT) 已经解决了与急性冠脉综合征 (ACS) 相关的抑郁和士气低落问题。本试验将心理健康作为治疗目标，这是心血管健康中越来越被认可的因素。目的：本研究旨在确定认知行为疗法 (CBT) 和幸福感疗法 (WBT) 的序贯组合是否比积极的对照组（临床管理；CM）产生更有利的结果，并确定患者亚组心脏不良结果的风险更大。方法：该多中心 RCT 比较CBT/WBT 序贯组合对比 CM，随访时间长达 30 个月。100 名连续抑郁和/或士气低落的患者（在 ACS 首次发作后最初由心脏病专家筛查的 740 名患者中）随机接受与生活方式建议相关的 CBT/WBT（n = 50）和 CM（n = 50）。主要结果测量包括：根据抑郁症临床访谈的抑郁症状严重程度、亚临床心理困扰、幸福感和生物标志物的变化，以及医疗并发症和事件。结果：与 CM 相比，CBT/WBT 序贯组合与抑郁症状的显着改善相关。在两组中，尽管差异逐渐消失，但随访时获益仍然存在。治疗还与生物标志物（血小板计数、HDL 和 D-二聚体）的显着改善有关，而两组显示出相似的心脏不良事件频率。结论：发现在对有抑郁症状的 ACS 患者的心理治疗方法中解决心理健康问题具有重要的临床益处。有人认为，以健康为目标的个性化方法可能会促进针对心血管健康的生活方式改变。
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