Internet-based Behavioral Intervention Following ACS

NCT ID: NCT06298864

Last Updated: 2025-09-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

176 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-03-07

Study Completion Date

2027-10-31

Brief Summary

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The aim of this study is to evaluate if an online Cognitive Behavioral Therapy (CBT) protocol customized for patients following Acute Coronary Syndrome (ACS), reduce cardiac anxiety, enhance Quality of Life (QoL), and promote increased physical activity while controlling for caregiver attention, utilizing an active control group receiving internet-based cardiac lifestyle intervention.

Detailed Description

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ACS is a leading global cause of mortality and health-related losses. Following ACS, many individuals exhibit symptoms of anxiety and depression, recognized risk factors for recurrent cardiovascular events. Specifically, anxiety related to cardiac symptoms and avoidance behavior, known as cardiac anxiety, has been shown to increase the long-term risk of adverse cardiac events.

The purpose of the present interdisciplinary research project is to develop and evaluate an online CBT protocol tailored for ACS patients. This project comprises a series of clinical studies aimed at accumulating knowledge about the most effective ways to treat ACS patients with CBT over the internet.

The aim of this study is to assess whether internet-based CBT, following ACS, reduces cardiac anxiety and improves QoL, while controlling for caregiver attention and expectancy of improvement using an active control group.

Method: A randomized controlled trial is conducted where participants are randomly assigned to either internet-based CBT (N= 88) or internet-based cardiac lifestyle intervention (internet-CL) (N= 88). The active control group receives internet-CL, focusing on lifestyle modification and health-promoting behaviors. Weekly therapist support through online written communication is provided to participants in both groups. Both treatment are conducted over 8-weeks and are comparable in terms of the number of treatment modules, intensity, and attention from the treating psychologist.

Conditions

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Acute Coronary Syndrome Online CBT Targeting Cardiac Anxiety

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Internet-based Cognitive Behavioral Therapy (Internet-CBT)

Internet-CBT following ACS is exposure-based, centering on exposure to cardiac related symptoms and situations. The CBT is therapist-guided and lasts for 8 weeks.

Group Type EXPERIMENTAL

Internet-CBT

Intervention Type BEHAVIORAL

* Common reactions following ACS. The role of cardiac anxiety and avoidance behavior on quality of life and physical health. Brief training in self-observation, i.e., labeling. General lifestyle advice on e.g., physical activity, diet.
* Identifying life areas impaired by ACS-related disability or symptom fear. Set health behavioral goals i.e., increased physical activity and gradually take steps towards them.
* Gradual exposure to physical sensations (e.g., palpitations due to physical activity) to reduce fear of these symptoms.
* Gradual exposure to avoided situations, activities and increase in physical activity.
* Prevention of relapse into avoidance behaviors by identifying risk situations and conduct a plan forward on maintaining a healthy physically and active lifestyle.

Internet-based Cardiac Lifestyle intervention (Internet-CL)

Internet-CL is based on strategies for behavioral change and guidelines on health promoting lifestyle modifications following ACS. The Internet-CL is therapist-guided and lasts for 8 weeks.

Group Type ACTIVE_COMPARATOR

Internet-CL

Intervention Type BEHAVIORAL

* Education on ACS, risk factors, its treatments and medication.
* Education and advice promoting healthy habits regarding diet, alcohol and tobacco.
* Education and advice regarding physical activity and the beneficial effects on health.
* Education regarding common emotional reactions following ACS.
* Prevention of relapse and plan forward to maintain a healthy lifestyle.

Interventions

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Internet-CBT

* Common reactions following ACS. The role of cardiac anxiety and avoidance behavior on quality of life and physical health. Brief training in self-observation, i.e., labeling. General lifestyle advice on e.g., physical activity, diet.
* Identifying life areas impaired by ACS-related disability or symptom fear. Set health behavioral goals i.e., increased physical activity and gradually take steps towards them.
* Gradual exposure to physical sensations (e.g., palpitations due to physical activity) to reduce fear of these symptoms.
* Gradual exposure to avoided situations, activities and increase in physical activity.
* Prevention of relapse into avoidance behaviors by identifying risk situations and conduct a plan forward on maintaining a healthy physically and active lifestyle.

Intervention Type BEHAVIORAL

Internet-CL

* Education on ACS, risk factors, its treatments and medication.
* Education and advice promoting healthy habits regarding diet, alcohol and tobacco.
* Education and advice regarding physical activity and the beneficial effects on health.
* Education regarding common emotional reactions following ACS.
* Prevention of relapse and plan forward to maintain a healthy lifestyle.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* ACS ≥ 6 months before assessment (type 1 MI STEMI/NSTEMI or unstable angina \[UA\])
* Age 18 and older
* Clinically significant cardiac anxiety that leads to distress and/or interferes with daily life (Cardiac Anxiety Questionnaire; CAQ: ≥18
* Able to read and write in Swedish

Exclusion Criteria

* Heart failure New York heart Association class IV or ejection fraction ≤ 30%
* Significant valvular disease
* Planned coronary artery bypass surgery or percutaneous interventions
* Any medical restriction to physical exercise
* Severe medical illness or an acute health threatening disease (e.g., cancer)
* Grade 3 hypertension (i.e., blood pressure ≥ 180 systolic and/or 110 diastolic)
* Severe mental illness requiring urgent psychiatric hospitalization or intervention, or risk of suicide
* Alcohol or substance use disorder that would impede ability to complete study protocol
* Ongoing psychological treatment
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Karolinska University Hospital

OTHER

Sponsor Role collaborator

Karolinska Institutet

OTHER

Sponsor Role lead

Responsible Party

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Josefin Särnholm

PhD, Lic. Psychologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Karolinska University Hospital

Stockholm, , Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Josefin Särnholm, Lic psychologist, PhD

Role: CONTACT

+ 46 852483258

Facility Contacts

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Josefin Särnholm, PhD

Role: primary

References

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Johnsson A, Ljotsson B, Braunschweig F, Mellbin LG, Sarnholm J. Digital cognitive behavioural therapy for cardiac anxiety following acute coronary syndrome: protocol for a randomised controlled trial comparing CBT to a digital lifestyle intervention. BMJ Open. 2025 Oct 28;15(10):e106473. doi: 10.1136/bmjopen-2025-106473.

Reference Type DERIVED
PMID: 41151962 (View on PubMed)

Other Identifiers

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ASC-RCT 2

Identifier Type: -

Identifier Source: org_study_id

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