“Cognitive-behavioral treatment of depression in patients with acute coronary syndrome”

State of the art: Depression in association with acute coronary syndromes (ACS) is an independent risk factor for subsequent cardiac events and mortality. However, the only randomised behavioral intervention trial attempting to reduce cardiac risk in depressed ACS patients showed that changes in depression did not translate into improved survival. Such intervention did not address issues such as lifestyle modification and improvement in psychological well-being, which were found to affect individual vulnerability to medical disease. Our research group has developed a well-being enhancing psychotherapeutic strategy, well-being therapy (WBT), which has been validated in a number of controlled clinical trials. Objective and rationale: To evaluate the efficacy of cognitive behavioral treatment (CBT) with WBT in reducing cardiac risk in depressed and/or demoralized ACS patients compared to clinical management (CM). The same protocol will be carried out in two centres (Bologna and Torino). Experimental plan: 100 patients after a first episode of ACS, meeting DSM-IV criteria for depressive disorders and DCPR criteria for demoralization will be randomized to one of two treatment groups: 1) CBT supplemented by WBT; 2) CM. In both groups, treatment will consist of twelve, 45-minute sessions once a week. A two-year follow-up will be performed. Expected results and their relevance: It is expected that psychological treatment may significantly decrease cardiac morbility and mortality at follow-up compared to clinical management. The findings may entail considerable preventive implications and possible large reductions in health costs