Objectives: This thesis aims to explore evidence for the effectiveness of cognitive
behavioural therapy (CBT) for non-cardiac chest pain (NCCP).
Design: The systematic review aimed to evaluate evidence for CBT as an effective
intervention for anxiety in the NCCP population. Study one describes the chest pain
characteristics, illness beliefs and prevalence of anxiety in a NCCP sample in a
cross-sectional design. Study two explores the acceptability and clinical effectiveness
of a CBT-based self-help intervention for NCCP patients, using a between subjects,
repeated measures design.
Methods: A systematic review was completed via a comprehensive literature search
for comparative studies examining CBT-based interventions for NCCP including a
measure of anxiety. In the empirical study, participants completed measures of
anxiety, illness beliefs and indices of chest pain (self-reported frequency, severity
and impact on activities) at baseline. Comparisons between illness beliefs and
anxiety were undertaken using descriptive statistics and Pearson correlations.
Participants were randomised to receive a CBT-based self-help intervention booklet
or treatment as usual, with questionnaires re-administered at three-month follow-up.
ANOVAs were used to evaluate whether the intervention led to improvements in
anxiety levels, or increased belief in participants’ personal control of symptoms.
Results: Ten studies met inclusion criteria for the systematic review, with four
studies showing evidence regarding the effectiveness of CBT for anxiety.
Approximately two thirds of the thesis research sample reported on-going pain
following clinic attendance, for the majority this was ‘very mild’ or ‘mild’ pain.
Almost half (47%) reported experiencing clinically significant anxiety. Stress was
the most common causal attribution advocated by the sample to explain their chest
pain. Anxiety scores were significantly associated with psychological attribution
scores, but not with personal control or illness coherence beliefs. In study two, 87
participants completed the study and ITT analyses were completed on 119. There
were no significant differences between the groups in terms of reduced anxiety or
self-reported belief in personal control of symptoms. The intervention booklet was
evaluated largely positively by those who reported reading it.
Conclusions: CBT-based self-help appears an acceptable intervention for those
diagnosed with NCCP. Further research is needed to identify those who are most
likely to benefit from such self-help intervention
