Nav: Home

Cognitive behavior therapy intervention effective for depression but not self-care for heart failure

September 28, 2015

A cognitive behavior therapy intervention that targeted both depression and heart failure self-care was effective for depression but not for heart failure self-care or physical functioning compared to enhanced usual care, according to an article published online by JAMA Internal Medicine.

Major depression is a common co-existing illness in heart failure (HF). Depression and inadequate self-care are common and interrelated problems that increase the risks of hospitalization and death in patients with HF. Self-care in HF includes behaviors that maintain physical functioning and prevent acute exacerbations, such as following a low-sodium diet, exercising and taking prescribed medications, according to background information in the article

Kenneth E. Freedland, Ph.D., of the Washington University School of Medicine, St. Louis, and colleagues randomly assigned 158 outpatients with heart failure and major depression to cognitive behavior therapy (CBT) delivered by experienced therapists plus usual care (UC; n = 79) or UC alone (n = 79). Usual care was enhanced in both groups with a structured HF education program delivered by a cardiac nurse. The intervention treatment followed standard CBT manuals and a supplemental manual on CBT for cardiac patients. The intensive phase of the intervention consisted of up to 6 months of weekly 1-hour sessions. Sessions tapered to biweekly and then monthly between the end of intensive (weekly) treatment and 6 months post-randomization.

One hundred thirty-two (84 percent) of the participants completed the 6-month posttreatment assessments; 60 (76 percent) of the UC and 58 (73 percent) of the CBT participants completed every follow-up assessment. Six-month depression scores were lower in the CBT than the UC group. CBT did not improve HF self-care or physical functioning, but it did improve anxiety, fatigue, social functioning, and quality of life, and additional analysis suggested that the intervention might help to decrease the hospitalization rate in clinically depressed patients.

The authors note that major depression in heart failure may respond to CBT even if antidepressant therapy is unsuccessful.

"The results suggest that CBT is superior to usual care for depression in patients with HF," the researchers write. "Further research is needed on interventions to improve depression, self-care, physical functioning, and quality of life in patients with HF and comorbid major depression.
(JAMA Intern Med. Published online September 28, 2015. doi:10.1001/jamainternmed.2015.5220. Available pre-embargo to the media at

Editor's Note: This study was conducted with support from the National Heart, Lung, and Blood Institute. No conflict of interest disclosures were reported.

Editor's Note: Reframing Depression Treatment in Heart Failure

Patrick G. O'Malley, M.D., M.P.H., Deputy Editor, JAMA Internal Medicine, writes that the good news is that the CBT in this study "did significantly improve emotional health and overall quality of life, and the improvement in depressive symptoms associated with CBT was larger than observed in pharmacotherapy trials for depression in patients with heart disease."

"This is supportive evidence for a shift in practice away from so much pharmacotherapy and more use of psychotherapy to achieve better mental health and overall quality-of-life outcomes in patients with heart failure. In reframing how we think about the management of depression in patients with heart failure, we should be talking more and prescribing less."

Editor's Note: No conflict of interest disclosures were reported.

Media Advisory: To contact corresponding author Kenneth E. Freedland, Ph.D., call Judy Martin at 314-286-0105 or email To contact Editor's Note author Patrick G. O'Malley, M.D., M.P.H. email

To place an electronic embedded link in your story: Links will be live at the embargo time:

The JAMA Network Journals

Related Depression Articles:

Which comes first: Smartphone dependency or depression?
New research suggests a person's reliance on his or her smartphone predicts greater loneliness and depressive symptoms, as opposed to the other way around.
Depression breakthrough
Major depressive disorder -- referred to colloquially as the 'black dog' -- has been identified as a genetic cause for 20 distinct diseases, providing vital information to help detect and manage high rates of physical illnesses in people diagnosed with depression.
CPAP provides relief from depression
Researchers have found that continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) can improve depression symptoms in patients suffering from cardiovascular diseases.
Post-natal depression in dads linked to depression in their teenage daughters
Fathers as well as mothers can experience post-natal depression -- and it is linked to emotional problems for their teenage daughters, new research has found.
Being overweight likely to cause depression, even without health complications
A largescale genomic analysis has found the strongest evidence yet that being overweight causes depression, even in the absence of other health problems.
More Depression News and Depression Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...