A CONTROLLED TRIAL OF COGNITIVE-BEHAVIORAL THERAPY FOR NONCARDIAC CHEST PAIN

Background. The majority of patients presenting to cardiac clinics wit h chest pain who are reassured they do not have heart disease or other serious physical disorder continue to experience symptoms, worry abou t heart disease and restrict their activities. This randomized trial i nvestigated the effectiveness of psychological treatment within routin e cardiac care. Methods. Consecutive patients presenting with chest pa in and reassured by a cardiologist they do not have heart disease were reassessed 6 weeks later. Those with persistent limiting symptoms wer e offered the opportunity to participate in a trial of cognitive behav ioural therapy. Results. Thirty-seven subjects agreed to take part. A number of subjects were unenthusiastic about psychological interventio n or, following explanation of the study, regarded further treatment a s not being necessary. At 3 months there were significant differences between the treatment group and the control group on key outcome measu res of symptoms, mood and activity. At 6 months there were fewer diffe rences but significant advantages of treatment in terms of limitation of activities and worry about physical symptoms. Conclusion. We conclu de that there is a need for 'stepped' further care following reassuran ce in the cardiac clinic and that cognitive behavioural treatment is e ffective with those with persistent disabling symptoms.