Background. The majority of patients presenting to cardiac
clinics with chest pain who are reassured they do not have heart disease
or other serious physical disorder continue to experience symptoms, worry
about heart disease and restrict their activities. This randomized trial
investigated the effectiveness of psychological treatment within routine
Methods. Consecutive patients presenting with chest pain and
reassured by a cardiologist they
do not have heart disease were reassessed 6 weeks later. Those with
persistent limiting symptoms were offered the opportunity to participate
in a trial of cognitive behavioural therapy.
Results. Thirty-seven subjects agreed to take part. A number
of subjects were unenthusiastic
about psychological intervention or, following explanation of the study,
regarded further treatment as not being necessary. At 3 months there were
significant differences between the treatment group and the control group
on key outcome measures of symptoms, mood and activity.
At 6 months there were fewer differences but significant advantages
of treatment in terms of
limitation of activities and worry about physical symptoms.
Conclusion. We conclude that there is a need for
‘stepped’ further care following reassurance in
the cardiac clinic and that cognitive behavioural treatment is
effective with those with persistent disabling symptoms.