title: Internet-based cognitive behavior therapy for patients with heart failure and depressive symptoms: A proof of concept study.
abstract: OBJECTIVE
  The aim was (1) to describe the development of a guided internet-based CBT (ICBT) program adapted to patients with heart failure (HF) and (2) to evaluate the feasibility of the ICBT program in regard to depressive symptoms, the time used by health care providers to give feedback, and participants' perceptions of the ICBT program.
  
  
  METHODS
  A multi-professional team developed the program and seven HF patients with depressive symptoms were recruited to the study. The Patient Health Questionnaire-9 (PHQ-9) and the Montgomery Åsberg Depression Rating-Self-rating scale (MADRS-S) were used to measure depression, and patients were interviewed about their perceptions of the program.
  
  
  RESULTS
  Based on research in HF and CBT, a nine-week program was developed. The median depression score decreased from baseline to the end of the study (PHQ-9: 11-8.5; MADRS-S: 25.5-16.5) and none of the depression scores worsened. Feedback from health care providers required approximately 3h per patient. Facilitating perceptions (e.g. freedom of time) and demanding perceptions (e.g. part of the program demanded a lot of work) were described by the patients.
  
  
  CONCLUSIONS
  The program appears feasible and time-efficient. However, the program needs to be evaluated in a larger randomized study.
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden. Electronic address: johan.lundgren@liu.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Lundgren
authors.affiliation: Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. Electronic address: gerhard.andersson@liu.se.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Electronic address: orjan.dahlstrom@liu.se.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Dahlström
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden. Electronic address: tiny.jaarsma@liu.se.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden. Electronic address: anita.karner@liu.se.
authors.forename: Anita Kärner
authors.initials: AK
authors.lastname: Köhler
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: peter.johansson@aries.vokby.se.
authors.forename: Peter
authors.initials: P
authors.lastname: Johansson
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy; D005240:Feasibility Studies; D005246:Feedback; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016730:Program Development; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome
keywords: Cognitive behavior therapy; Depression; Heart failure; Internet