Experiences of the attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: a qualitative study.

Background: Clinically significant anxiety and depression symptoms are common in patients with coronary heart disease (CHD) and associated with a range of negative outcomes. Preliminary evidence suggests that the attention training technique (ATT), a component of metacognitive therapy (MCT), delivered in a group format, is feasible and potentially effective in reducing symptoms of anxiety and depression in these patients. Patients' experiences of treatment including facilitators and barriers are useful in order to further develop effective intervention. We are not aware of any previous qualitative studies conducted on ATT in patients with CHD. Our study aimed to assess the treatment experiences in these patients.

Methods: Patients (N = 10) with CHD and significant symptoms of anxiety and/or depression, who participated in a randomized controlled trial of the effectiveness of ATT delivered in a group format, were recruited to in-depth, individual interviews three months after treatment completion. The interviews were recorded, transcribed and analysed according to the principles of thematic analysis.

Results: Nine males and one female participated, with a mean age of 54.3 (range 45-63) years. Mean time since cardiac event was 54.2 months. We identified two main themes; non-specific ATT treatment factors and group ATT-specific treatment factors. Furthermore, non-specific ATT treatment factors included subthemes relating to individual and group factors. These subthemes encompassed the (relational aspects such as the) interaction between the group patients, interaction between the patients and the therapist, and the therapist's delivery of the group ATT. Second, specific ATT treatment factors included subthemes concerning understanding and making sense of the technique and treatment, changes in relation to thoughts and thinking, and group format as a facilitator of ATT treatment.

Conclusions: Group ATT was perceived as helpful among outpatients with CHD in terms of symptom relief. Both general and ATT specific factors were regarded important, and the patients seemed to understand ATT in a way that is consistent with the rationale of ATT treatment. All patients emphasized the importance of the group format.

Trial registration: The study was approved by the Regional Committee of Ethics (REK) South East Norway (REK 52002) and by the data protection officer at Drammen Hospital (20/04048-1/005). The study is registered at clinicaltrials.gov (Identifier NCT05621408).