CBT can help after a broken heart

Men are over-represented when it comes to heart disease, but there are certain conditions that mainly affect women, such as ‘broken-heart syndrome’. Stress and anxiety are common in this group. A new study led by researchers at Uppsala University and Karolinska Institutet shows that internet-based CBT can reduce symptoms and help patients manage their emotions better.

Some patients who have clear symptoms of a heart attack, such as chest pain and shortness of breath, are without any obvious narrowing of the coronary arteries. This patient group includes people suffering from broken-heart syndrome, or takotsubo syndrome – a condition that is often triggered by extreme stress and causes heart attack symptoms.

Although people affected by these types of heart disease may experience stress and anxiety both before and after the event, there are currently no treatment guidelines for psychological support. In a new study, researchers have investigated whether internet-based cognitive behavioural therapy (CBT) can help patients manage their emotions more effectively.

“We can see that our treatment, which consists of an internet-based CBT programme designed to manage stress and anxiety, reduces the symptoms. The reduction is significant and is in line with the results typically seen in psychological treatments. Furthermore, very few people dropped out, which suggests that the treatment was appreciated,” says Philip Leissner, a psychologist and the study’s first author.

Women over-represented in the study

The study included a total of 88 people with symptoms of a heart attack. They had either takotsubo syndrome or a heart attack without any obvious narrowing of the coronary arteries – a condition known in healthcare as MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries). The patients were recruited shortly after the onset of the heart disease from hospitals in Stockholm, Örebro and Östersund. There are more women in this patient group than among those who suffer from a normal heart attack. Women are also more likely to participate in psychological treatment. As a result, 91 per cent of the participants were women. They were divided into two groups: one half served as a control group, while the other half were offered online CBT and two brief telephone consultations with a psychologist.

The CBT that the patients underwent had been developed by the researchers in collaboration with patients who had personal experience of these diagnoses. The therapy lasted between seven and nine weeks, tailored to the patients’ needs. After the treatment, the researchers assessed the patients’ ability to cope with anxiety and stress using three different questionnaires.

“Both symptoms of stress and anxiety decreased as a result of the treatment. What we observed, above all, was that patients reacted less negatively to stress, rather than that they felt able to manage stressful situations in their daily lives. We interpret this to mean that there are factors in their daily lives that they cannot do very much about, such as the fact that they have developed this illness. But at least they got better at dealing with the emotions that arise,” says Leissner.

Most effective for takotsubo syndrome

Among the 52 patients diagnosed with takotsubo syndrome, CBT proved more effective than standard care to a much greater extent than among the 36 patients with diagnoses other than takotsubo (the MINOCA group).

“These patients benefited greatly from the treatment. One explanation could be that there were more patients with takotsubo syndrome in the group that designed the treatment. But it could also be because these individuals have a greater need of psychological treatment – that they may have been suffering from stress and poor health for some time and really need help.”

In the current study, patients reported that their illness had been triggered by events such as a death in the family, shocking events or conflicts at work. As the aim of the treatment is for patients to learn how to manage stress and anxiety, they will hopefully also become better at dealing with situations like this in the future.

“This is a group that has gone largely unnoticed, as men are over-represented in the standard statistics on heart disease. But women are also affected, albeit in different ways. That is why we must develop new treatment methods for this group as well.”

The researchers will now continue to develop the model and assess exactly what it was that helped in this particular treatment.

Facts

MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) is a collective term for heart attacks in which no obvious narrowing of the coronary arteries can be detected. Up to 10 per cent of all heart attacks are of this type. Around 60 per cent of those affected by MINOCA are women.

Takotsubo syndrome has historically been a subcategory of MINOCA, but has later been excluded because it is not classified as an ischaemic disease, i.e. it is not caused by a lack of oxygen in the myocardium. Takotsubo can cause symptoms identical to those of a heart attack, such as chest pain and shortness of breath. Ninety per cent of those affected are post-menopausal women. The condition is often caused by mental or physical stress and results in the left ventricle of the heart taking on a characteristic shape. The condition was first identified in Japan and its name comes from the resemblance between the left ventricle of the heart and an octopus trap, or ‘takotsubo’.

Contact

Philip Leissner, affiliated researcher at the Department of Women’s and Children’s Health, Uppsala University
Phone: +46 76-848 84 18
E-mail: philip.leissner@uu.se

Article

Leissner P et al. Randomized Controlled Trial of Internet‐Delivered Cognitive Behavioral Therapy After Myocardial Infarction With Nonobstructive Coronary Arteries or Takotsubo Syndrome. Journal of the American Heart Association. 2025 DOI: 10.1161/JAHA.125.047311