Application effects of internet-based cognitive behavioral therapy in patients with cardiovascular disease: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yujie ¹ , GONG Xiaoxue ² , LIU Ziyue ³ , WANG Lei ¹ , FANG Dongdong ¹ , CUI Liwei ⁴ ,  WANG Meng ¹ ,  LI Hui ¹

1. Department of Medicine, Jining N0.1 People’s Hospital, Jining, 272011, Shandong, P. R. China;
2. Department of Clinical Pharmacy, Jining No.1 People’s Hospital, Jining, 272011, Shandong, P. R. China;
3. Department of Ophthalmology, Jining N0.1 People’s Hospital, Jining, 272011, Shandong, P. R. China;
4. Department of quality management, Jining N0.1 People’s Hospital, Jining, 272011, Shandong, P. R. China;

Corresponding?author：

WANG Meng, Email: wangmeng106@163.com; LI Hui, Email: ydfqinglhjy@163.com

Keywords：

Internet-based cognitive behavioral therapy; cardiovascular diseases; intervention; depress; anxiety; meta-analysis; systematic review

DOI：

10.7507/1007-4848.202511029

Video：

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Objective To systematically evaluate the efficacy of Internet-based cognitive behavioral therapy (ICBT) in patients with cardiovascular disease (CVD). Methods A computerized search was conducted in PubMed, EMbase, CNKI, and Wanfang databases to retrieve studies investigating the effects of ICBT on CVD patients, with the retrieval period extending from database inception to August 2025. After screening studies based on inclusion and exclusion criteria and extracting relevant data, a meta-analysis was performed using RevMan 5.3 software. Results A total of 13 RCTs involving 1 365 CVD patients were included. The meta-analysis results indicated that ICBT significantly improved depressive symptoms [SMD=?0.31, 95%CI(?0.44, ?0.19), P<0.001] and overall mental health status [SMD=0.44, 95%CI (0.23, 0.64), P<0.001] in CVD patients. However, no statistically significant differences between the two groups were observed in anxiety levels [SMD=?0.60, 95%CI (?1.33, 0.13), P=0.10], sleep quality [MD=2.60, 95%CI (?2.02, 7.23), P=0.27], or overall physical health status [MD=1.77, 95%CI (?0.16, 3.71), P=0.07].Conclusion ICBT serves as an effective tool for mental health management in CVD patients. However, its efficacy in alleviating anxiety, improving sleep quality, and enhancing physical health remains inconclusive. Future studies should focus on optimizing intervention modules and exploring personalized strategies to improve comprehensive therapeutic outcomes.

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2.	國家心血管病中心, 中國心血管健康與疾病報告編寫組. 中國心血管健康與疾病報告2023概要. 中國循環雜志, 2024, 39(7): 625-660.National Center for Cardiovascular Diseases, The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on cardiovascular health and diseases in China 2023: an updated summary. Chin Circ J, 2024, 39(7): 625-660.
3.	中華醫學會心血管病學分會, 中華心血管病雜志編輯委員會. 中國慢性冠脈綜合征患者診斷及管理指南. 中華心血管病雜志, 2024, 52(6): 589-614.Chinese Society of Cardiology, Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology. Chinese guidelines for the diagnosis and management of patients with chronic coronary syndrome. Chin J Cardiol, 2024, 52(6): 589-614.
4.	Karami N, Kazeminia M, Karami A, et al. Global prevalence of depression, anxiety, and stress in cardiac patients: a systematic review and meta-analysis. J Affect Disord, 2023, 324: 175-189.
5.	李慶印, 吳岳, 劉湉, 等. 心血管病康復護理實踐與思考. 中國護理管理, 2021, 21(11): 1601-1607.Li QY, Wu Y, Liu T, et al. Practice and development of cardiovascular rehabilitation nursing: a literature review. Chin Nurs Manag, 2021, 21(11): 1601-1607.
6.	Ritterband LM, Andersson G, Christensen HM, et al. Directions for the International Society for Research on Internet Interventions (ISRII). J Med Internet Res, 2006, 8(3): e23.
7.	張嫄婧. 中青年卒中后疲勞患者網絡化認知行為療法干預方案的構建與應用. 新鄉醫學院, 2023.Zhang YJ. Construction and application of networked cognitive behavioral intervention scheme for middle-aged and young patients with post-stroke fatigue. Xinxiang Medical University, 2023.
8.	WHO CVD Risk Chart Working Group. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health, 2019, 7(10): e1332-e1345.
9.	Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.1 (updated September 2020). The Cochrane Collaboration, 2020. [cited 2025 Sep 17]. Available from: www. training. cochrane. org/handbook.
10.	O'Neil A, Taylor B, Sanderson K, et al. Efficacy and feasibility of a tele-health intervention for acute coronary syndrome patients with depression: results of the "MoodCare" randomized controlled trial. Ann Behav Med, 2014, 48(2): 163-174.
11.	Schneider LH, Hadjistavropoulos HD, Dear BF, et al. Efficacy of Internet-delivered cognitive behavioural therapy following an acute coronary event: a randomized controlled trial. Internet Interv, 2020, 21: 100324.
12.	Norlund F, Wallin E, Olsson EMG, et al. Internet-based cognitive behavioral therapy for symptoms of depression and anxiety among patients with a recent myocardial infarction: the U-CARE heart randomized controlled trial. J Med Internet Res, 2018, 20(3): e88.
13.	Lin TK, Yu PT, Lin LY, et al. A pilot-study to assess the feasibility and acceptability of an Internet-based cognitive-behavior group therapy using video conference for patients with coronary artery heart disease. PLoS One, 2018, 13(11): e0207931.
14.	Bendig E, Bauerei? N, Buntrock C, et al. Lessons learned from an attempted randomized-controlled feasibility trial on "WIDeCAD" - an Internet-based depression treatment for people living with coronary artery disease (CAD). Internet Interv, 2021, 24: 100375.
15.	郝瑞霞. 智能化心身調節系統輔助改善冠心病患者負性情緒的應用研究. 山西醫科大學, 2021.Hao RX. The application research of intelligent psychosomatic regulation system to improve negative emotion in patients with coronary heart disease. Shanxi Medical University, 2021.
16.	Lundgren JG, Dahlstr?m ?, Andersson G, et al. The effect of guided web-based cognitive behavioral therapy on patients with depressive symptoms and heart failure: a pilot randomized controlled trial. J Med Internet Res, 2016, 18(8): e194.
17.	O’Neil A, Taylor B, Hare DL, et al. Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial. Eur J Prev Cardiol, 2015, 22(9): 1111-1120.
18.	Jin L, Chen P, Fang X, et al. Application of "Internet+" cognitive-behavioral intervention in caregivers of children with congenital heart disease undergoing elective surgery during the COVID-19 pandemic. Am J Transl Res, 2023, 15(4): 2894-2902.
19.	S?rnholm J, Skúladóttir H, Rück C, et al. Cognitive behavioral therapy improves quality of life in patients with symptomatic paroxysmal atrial fibrillation. J Am Coll Cardiol, 2023, 82(1): 46-56.
20.	Johansson P, Westas M, Andersson G, et al. An Internet-based cognitive behavioral therapy program adapted to patients with cardiovascular disease and depression: randomized controlled trial. JMIR Ment Health, 2019, 6(10): e14648.
21.	Westas M, Lundgren J, Andersson G, et al. Effects of Internet-delivered cognitive behavioural therapy adapted for patients with cardiovascular disease and depression: a long-term follow-up of a randomized controlled trial at 6 and 12 months posttreatment. Eur J Cardiovasc Nurs, 2022, 21(6): 559-567.
22.	Schulz SM, Ritter O, Zniva R, et al. Efficacy of a web-based intervention for improving psychosocial well-being in patients with implantable cardioverter-defibrillators: the randomized controlled ICD-FORUM trial. Eur Heart J, 2020, 41(11): 1203-1211.
23.	Smith PJ, Blumenthal JA. Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment. Rev Esp Cardiol, 2011, 64(10): 924-933.
24.	Tu?ek-Bunc K, Petek D. Comorbidities and characteristics of coronary heart disease patients: their impact on health-related quality of life. Health Qual Life Outcomes, 2016, 14(1): 159.
25.	Pogosova N. Costs associated with cardiovascular disease create a significant burden for society and they seem to be globally underestimated. Eur J Prev Cardiol, 2019, 26(11): 1147-1149.
26.	Esfandiari N, Mazaheri MA, Akbari-Zardkhaneh S, et al. Internet-delivered versus face-to-face cognitive behavior therapy for anxiety disorders: systematic review and meta-analysis. Int J Prev Med, 2021, 12: 153.
27.	Qiu Y, Wu M, Liu J, et al. Effectiveness of information technology-based cognitive behavioral therapy on depression and anxiety symptoms among older adults: systematic review and meta-analysis. Gen Hosp Psychiatry, 2025, 93: 9-19.
28.	Ye YY, Chen NK, Chen J, et al. Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open, 2016, 6(11): e010707.
29.	Li M, Liu F, Han X, et al. Effect of Internet-based cognitive behavioral therapy on psychological distress and quality of life among breast cancer survivors: a meta-analysis of randomized controlled trials. Psychooncology, 2024, 33(11): e70014.
30.	Reavell J, Hopkinson M, Clarkesmith D, et al. Effectiveness of cognitive behavioral therapy for depression and anxiety in patients with cardiovascular disease: a systematic review and meta-analysis. Psychosom Med, 2018, 80(8): 742-753.
31.	Hofmann SG, Asnaani A, Vonk IJ, et al. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res, 2012, 36(5): 427-440.
32.	Andersen SG, S?terhagen H, Pacheco AP, et al. The effects of cognitive behavioral therapy for insomnia in patients with cardiovascular disease: a systematic review and meta-analysis. J Clin Sleep Med, 2025, 21(7): 1273-1284.
33.	Abdelaziz A, Hafez AH, Roshdy MR, et al. Cognitive behavioral therapy for the treatment of insomnia in patients with cardiovascular diseases: a meta-analysis with GRADE analysis. J Behav Med, 2024, 47(5): 819-827.
34.	Li Y, Li J, Qin J, et al. The sleep patterns and influencing factors of chronic heart failure patients in China: a latent profile analysis. Nat Sci Sleep, 2025, 17: 571-581.
35.	Javadi N, Darvishpour A, Mehrdad N, et al. Survey of sleep status and its related factors among hospitalized patients with heart failure. J Tehran Heart Cent, 2015, 10(1): 9-17.
36.	Moradi M, Mehrdad N, Nikpour S, et al. Sleep quality and associated factors among patients with chronic heart failure in Iran. Med J Islam Repub Iran, 2014, 28: 149.

1. World Health Organization. Cardiovascular diseases (CVDs). (2021-06-11) [cited 2025 Sep 15]. In: World Health Organization [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
2. 國家心血管病中心, 中國心血管健康與疾病報告編寫組. 中國心血管健康與疾病報告2023概要. 中國循環雜志, 2024, 39(7): 625-660.National Center for Cardiovascular Diseases, The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on cardiovascular health and diseases in China 2023: an updated summary. Chin Circ J, 2024, 39(7): 625-660.
3. 中華醫學會心血管病學分會, 中華心血管病雜志編輯委員會. 中國慢性冠脈綜合征患者診斷及管理指南. 中華心血管病雜志, 2024, 52(6): 589-614.Chinese Society of Cardiology, Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology. Chinese guidelines for the diagnosis and management of patients with chronic coronary syndrome. Chin J Cardiol, 2024, 52(6): 589-614.
4. Karami N, Kazeminia M, Karami A, et al. Global prevalence of depression, anxiety, and stress in cardiac patients: a systematic review and meta-analysis. J Affect Disord, 2023, 324: 175-189.
5. 李慶印, 吳岳, 劉湉, 等. 心血管病康復護理實踐與思考. 中國護理管理, 2021, 21(11): 1601-1607.Li QY, Wu Y, Liu T, et al. Practice and development of cardiovascular rehabilitation nursing: a literature review. Chin Nurs Manag, 2021, 21(11): 1601-1607.
6. Ritterband LM, Andersson G, Christensen HM, et al. Directions for the International Society for Research on Internet Interventions (ISRII). J Med Internet Res, 2006, 8(3): e23.
7. 張嫄婧. 中青年卒中后疲勞患者網絡化認知行為療法干預方案的構建與應用. 新鄉醫學院, 2023.Zhang YJ. Construction and application of networked cognitive behavioral intervention scheme for middle-aged and young patients with post-stroke fatigue. Xinxiang Medical University, 2023.
8. WHO CVD Risk Chart Working Group. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health, 2019, 7(10): e1332-e1345.
9. Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.1 (updated September 2020). The Cochrane Collaboration, 2020. [cited 2025 Sep 17]. Available from: www. training. cochrane. org/handbook.
10. O'Neil A, Taylor B, Sanderson K, et al. Efficacy and feasibility of a tele-health intervention for acute coronary syndrome patients with depression: results of the "MoodCare" randomized controlled trial. Ann Behav Med, 2014, 48(2): 163-174.
11. Schneider LH, Hadjistavropoulos HD, Dear BF, et al. Efficacy of Internet-delivered cognitive behavioural therapy following an acute coronary event: a randomized controlled trial. Internet Interv, 2020, 21: 100324.
12. Norlund F, Wallin E, Olsson EMG, et al. Internet-based cognitive behavioral therapy for symptoms of depression and anxiety among patients with a recent myocardial infarction: the U-CARE heart randomized controlled trial. J Med Internet Res, 2018, 20(3): e88.
13. Lin TK, Yu PT, Lin LY, et al. A pilot-study to assess the feasibility and acceptability of an Internet-based cognitive-behavior group therapy using video conference for patients with coronary artery heart disease. PLoS One, 2018, 13(11): e0207931.
14. Bendig E, Bauerei? N, Buntrock C, et al. Lessons learned from an attempted randomized-controlled feasibility trial on "WIDeCAD" - an Internet-based depression treatment for people living with coronary artery disease (CAD). Internet Interv, 2021, 24: 100375.
15. 郝瑞霞. 智能化心身調節系統輔助改善冠心病患者負性情緒的應用研究. 山西醫科大學, 2021.Hao RX. The application research of intelligent psychosomatic regulation system to improve negative emotion in patients with coronary heart disease. Shanxi Medical University, 2021.
16. Lundgren JG, Dahlstr?m ?, Andersson G, et al. The effect of guided web-based cognitive behavioral therapy on patients with depressive symptoms and heart failure: a pilot randomized controlled trial. J Med Internet Res, 2016, 18(8): e194.
17. O’Neil A, Taylor B, Hare DL, et al. Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial. Eur J Prev Cardiol, 2015, 22(9): 1111-1120.
18. Jin L, Chen P, Fang X, et al. Application of "Internet+" cognitive-behavioral intervention in caregivers of children with congenital heart disease undergoing elective surgery during the COVID-19 pandemic. Am J Transl Res, 2023, 15(4): 2894-2902.
19. S?rnholm J, Skúladóttir H, Rück C, et al. Cognitive behavioral therapy improves quality of life in patients with symptomatic paroxysmal atrial fibrillation. J Am Coll Cardiol, 2023, 82(1): 46-56.
20. Johansson P, Westas M, Andersson G, et al. An Internet-based cognitive behavioral therapy program adapted to patients with cardiovascular disease and depression: randomized controlled trial. JMIR Ment Health, 2019, 6(10): e14648.
21. Westas M, Lundgren J, Andersson G, et al. Effects of Internet-delivered cognitive behavioural therapy adapted for patients with cardiovascular disease and depression: a long-term follow-up of a randomized controlled trial at 6 and 12 months posttreatment. Eur J Cardiovasc Nurs, 2022, 21(6): 559-567.
22. Schulz SM, Ritter O, Zniva R, et al. Efficacy of a web-based intervention for improving psychosocial well-being in patients with implantable cardioverter-defibrillators: the randomized controlled ICD-FORUM trial. Eur Heart J, 2020, 41(11): 1203-1211.
23. Smith PJ, Blumenthal JA. Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment. Rev Esp Cardiol, 2011, 64(10): 924-933.
24. Tu?ek-Bunc K, Petek D. Comorbidities and characteristics of coronary heart disease patients: their impact on health-related quality of life. Health Qual Life Outcomes, 2016, 14(1): 159.
25. Pogosova N. Costs associated with cardiovascular disease create a significant burden for society and they seem to be globally underestimated. Eur J Prev Cardiol, 2019, 26(11): 1147-1149.
26. Esfandiari N, Mazaheri MA, Akbari-Zardkhaneh S, et al. Internet-delivered versus face-to-face cognitive behavior therapy for anxiety disorders: systematic review and meta-analysis. Int J Prev Med, 2021, 12: 153.
27. Qiu Y, Wu M, Liu J, et al. Effectiveness of information technology-based cognitive behavioral therapy on depression and anxiety symptoms among older adults: systematic review and meta-analysis. Gen Hosp Psychiatry, 2025, 93: 9-19.
28. Ye YY, Chen NK, Chen J, et al. Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open, 2016, 6(11): e010707.
29. Li M, Liu F, Han X, et al. Effect of Internet-based cognitive behavioral therapy on psychological distress and quality of life among breast cancer survivors: a meta-analysis of randomized controlled trials. Psychooncology, 2024, 33(11): e70014.
30. Reavell J, Hopkinson M, Clarkesmith D, et al. Effectiveness of cognitive behavioral therapy for depression and anxiety in patients with cardiovascular disease: a systematic review and meta-analysis. Psychosom Med, 2018, 80(8): 742-753.
31. Hofmann SG, Asnaani A, Vonk IJ, et al. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res, 2012, 36(5): 427-440.
32. Andersen SG, S?terhagen H, Pacheco AP, et al. The effects of cognitive behavioral therapy for insomnia in patients with cardiovascular disease: a systematic review and meta-analysis. J Clin Sleep Med, 2025, 21(7): 1273-1284.
33. Abdelaziz A, Hafez AH, Roshdy MR, et al. Cognitive behavioral therapy for the treatment of insomnia in patients with cardiovascular diseases: a meta-analysis with GRADE analysis. J Behav Med, 2024, 47(5): 819-827.
34. Li Y, Li J, Qin J, et al. The sleep patterns and influencing factors of chronic heart failure patients in China: a latent profile analysis. Nat Sci Sleep, 2025, 17: 571-581.
35. Javadi N, Darvishpour A, Mehrdad N, et al. Survey of sleep status and its related factors among hospitalized patients with heart failure. J Tehran Heart Cent, 2015, 10(1): 9-17.
36. Moradi M, Mehrdad N, Nikpour S, et al. Sleep quality and associated factors among patients with chronic heart failure in Iran. Med J Islam Repub Iran, 2014, 28: 149.

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