A controlled trial of cognitive behavioural therapy for non-cardiac chest pain.
BACKGROUND
The majority of patients presenting to cardiac clinics with chest pain who are reassured they do not have heart disease or other serious physical disorder continue to experience symptoms, worry about heart disease and restrict their activities. This randomized trial investigated the effectiveness of psychological treatment within routine cardiac care.


METHODS
Consecutive patients presenting with chest pain and reassured by a cardiologist they do not have heart disease were reassessed 6 weeks later. Those with persistent limiting symptoms were offered the opportunity to participate in a trial of cognitive behavioural therapy.


RESULTS
Thirty-seven subjects agreed to take part. A number of subjects were unenthusiastic about psychological intervention or, following explanation of the study, regarded further treatment as not being necessary. At 3 months there were significant differences between the treatment group and the control group on key outcome measures of symptoms, mood and activity. At 6 months there were fewer differences but significant advantages of treatment in terms of limitation of activities and worry about physical symptoms.


CONCLUSIONS
We conclude that there is a need for 'stepped' further care following reassurance in the cardiac clinic and that cognitive behavioural treatment is effective with those with persistent disabling symptoms.
Mayou
R A
RA
University Department of Psychiatry, Warneford Hospital, Oxford.
Bryant
B M
BM
Sanders
D
D
Bass
C
C
Klimes
I
I
Forfar
C
C
D000328:Adult; D000704:Analysis of Variance; D001294:Attitude to Health; D002637:Chest Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D016009:Chi-Square Distribution; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000628:therapy*; D013315:Stress, Psychological / Q000628:therapy; D016896:Treatment Outcome