Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Nov 19, 2021; 11(11): 1147-1166
Published online Nov 19, 2021. doi: 10.5498/wjp.v11.i11.1147
Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: A meta-analysis
Yan-Ni Li, Nicholas Buys, Samantha Ferguson, Zhan-Jiang Li, Jing Sun
Yan-Ni Li, Jing Sun, School of Medicine and Dentistry, Griffith University, Gold Coast Q4222, Queensland, Australia
Nicholas Buys, Jing Sun, Menzies Health Institute Queensland, Griffith University, Gold Coast Q4222, Queensland, Australia
Zhan-Jiang Li, The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing 100088, China
Zhan-Jiang Li, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
Author contributions: Sun J contributed to the paper conceptualization and design; Sun J and Li YN contributed to research design; Sun J and Li YN compiled studies and extracted data; Li YN conducted statistical and meta-analysis, completed table and figure presentation; Sun J and Li YN conducted writing of the paper; Buys N, Ferguson S and Li ZJ edited the draft; Sun J and Li YN revised and proofed the final revised version of the paper.
Conflict-of-interest statement: All authors declare no conflict of interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jing Sun, PhD, Associate Professor, School of Medicine and Dentistry, Griffith University, G40 8.23, Gold Coast Q4222, Queensland, Australia.
Received: April 9, 2021
Peer-review started: April 9, 2021
First decision: July 14, 2021
Revised: July 27, 2021
Accepted: October 18, 2021
Article in press: October 18, 2021
Published online: November 19, 2021

Recently, the efficacy of cognitive behavioral therapy (CBT)-based intervention on health outcomes in patients with coronary heart disease (CHD) has been recognized in randomized controlled trials (RCTs), but no comprehensive systematic review has been conducted. To address this research gap, our study aimed to evaluate whether comprehensive CBT-based interventions positively affect health outcomes in CHD patients. It was hypothesized that CBT-based interventions are effective in: (1) Reducing depression, anxiety, and stress symptoms; (2) Reducing body mass index, blood pressure, and lipid levels; and (3) Improving quality of life, and exercise endurance.


To verify the effectiveness of CBT-based interventions on CHD patients through a meta-analysis of previous publications.


Relevant RCTs published in English were obtained by searching electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Proquest, with the retrieval time from inception to August 2020. The primary outcomes were psychological factors (depression, anxiety, and stress symptoms), physiological factors (body mass index, blood pressure, blood lipids). The secondary outcomes included quality of life and exercise endurance. We used Review Manager 5.3 to conduct the meta-analysis and used the Physiotherapy Evidence Database tool to evaluate the quality of studies.


A total of 22 RCTs comprising 4991 patients with CHD were included in the systematic review and meta-analysis. The main analysis revealed that CBT-based intervention can reduce depression symptoms: -2.00 [95% confidence interval (CI): -2.83 to -1.16, P < 0.001]; anxiety symptoms: -2.07 (95%CI: -3.39 to -0.75, P = 0.002); stress symptoms: -3.33 (95%CI: -4.23 to -2.44, P < 0.001); body mass index: -0.47 (95%CI: -0.81 to -0.13, P = 0.006); and improve physical functioning: 3.36 (95%CI: 1.63 to 5.10, P = 0.000) and mental functioning: 6.91 (95%CI: 4.10 to 9.73, P < 0.001). Moreover, subgroup analysis results showed that CBT-based interventions were more effective for symptoms of depression and anxiety in CHD patients when individual, as opposed to group treatment, and psycho-education, behavioral and cognitive strategies were applied as the core treatment approaches.


CBT-based interventions are effective treatment strategies for CHD patients, significantly improving their symptoms of depression, anxiety and stress, body mass index, and health-related quality of life.

Keywords: Coronary heart disease, Cognitive behavioral therapy, Physiological factors, Psychological factors, Quality of life

Core Tip: This is the first comprehensive meta-analysis examining the effects of critical components of cognitive behavioral therapy (CBT) on improving health outcomes in coronary heart disease (CHD) patients. Our findings suggest that CBT-based interventions were effective in reducing depression, anxiety, stress symptoms, and body mass index levels, and improving physical and mental functioning of the quality of life. In addition, the intervention was more effective when it was delivered as an individual-based treatment, when there was no CHD-specific manual, and when psycho-education, behavioral, and cognitive strategies were applied as the key components of the CBT approach.