Cognitive change following cognitive behavioural therapy for non-cardiac chest pain

Background: Seventeen to 43% of patients with non-cardiac chest pain suffer from anxiety/panic disorders. Cognitive behavioural therapy (CBT) is effec tive in reducing non-cardiac chest pain. However, no data are available ind icating that pain reduction following CBT may be cognitively mediated or wh ether success of CBT is dependent on the presence of panic. The aim of the study was threefold: (1) does CBT have a differential effect on cognitive m easures; (2) does a relationship exist between improvement in non-cardiac c hest pain and changes in cognitive measures, and (3) can panic be establish ed as a moderator of the effect of treatment? Methods: Sixty-five patients with non-cardiac chest pain completed a randomised trial comparing study CB T with 'care as usual'. Dependent measures were: frequency of chest pain, a nxiety, the fear of bodily sensations, attributions and catastrophic cognit ions. Results: CBT had a differential effect on most of the cognitive measu res. Pain reduction was associated with the development of more adequate co gnitions with respect to chest pain, independent of anxiety reduction. Alth ough panic patients reported higher baseline scores on the cognitive measur es, no differences in treatment results were found between panic and no-pan ic patients. Conclusions: Pain reduction following CBT may be cognitively m ediated. The presence of panic did not affect the outcome of treatment, imp lying a broad applicability of the cognitive model for treatment of patient s with non-cardiac chest pain.