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  • Peter J, Johan L, Gerhard A, Erland S, Ghassan M
  • Internet-Based Cognitive Behavioral Therapy and its Association With Self-efficacy, Depressive Symptoms, and Physical Activity: Secondary Analysis of a Randomized Controlled Trial in Patients With Cardiovascular Disease
  • JMIR Cardio
  • DOI: 10.2196/11848
  • PMID: 30303485
  • PMCID: 6352016
Preprints Accepted Manuscript

Internet-Based Cognitive Behavioral Therapy and its Association With Self-efficacy, Depressive Symptoms, and Physical Activity: Secondary Analysis of a Randomized Controlled Trial in Patients With Cardiovascular Disease

Abstract

background

In patients with cardiovascular disease (CVD), knowledge about the associations among changes in depressive symptoms, self-efficacy, and self-care activities has been requested. This is because such knowledge can be helpful in the design of behavioral interventions aimed to improve self-efficacy, reduce depressive symptoms, and improve performance of self-care activities in CVD patients.

objective

We aim to evaluate if internet-based cognitive behavioral therapy (iCBT) improves self-efficacy and explore the relationships among changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT on these relationships.

methods

This study received funding in January 2015. Participant recruitment took place between January 2017 and February 2018, and the main findings were published in 2019. This study is a secondary analysis of data collected in a randomized controlled study evaluating the effects of a 9-week iCBT program compared to an online discussion forum (ODF) on depressive symptoms in patients with CVD (N=144). Data were collected at baseline and at the 9-week follow-up. Analysis of covariance was used to evaluate the differences in self-efficacy between the iCBT and ODF groups. Structural equation modeling explored the relationships among changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT on these relationships.

results

At follow-up, a significant difference in the increase in self-efficacy favoring iCBT was found (<i>P</i>=.04, Cohen <i>d</i>=0.27). We found an indirect association between changes in depressive symptoms and physical activity (<i>β=</i>–.24, <i>P</i>&lt;.01), with the change in self-efficacy acting as a mediator. iCBT had a direct effect on the changes in depressive symptoms, which in turn influenced the changes in self-efficacy (<i>β</i>=.23, <i>P</i>&lt;.001) and physical activity (<i>β</i>=.12, <i>P</i>&lt;.001).

conclusions

Self-efficacy was improved by iCBT. However, the influence of iCBT on self-efficacy and physical activity was mostly mediated by improvements in depressive symptoms.

clinicalTrial

ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074

As per the author’s request the PDF is not available.
Copyright

© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it’s website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.

Citation

Please cite as:

Peter J, Johan L, Gerhard A, Erland S, Ghassan M

Internet-Based Cognitive Behavioral Therapy and its Association With Self-efficacy, Depressive Symptoms, and Physical Activity: Secondary Analysis of a Randomized Controlled Trial in Patients With Cardiovascular Disease

JMIR Cardio

DOI: 10.2196/14886

URL: https://preprints.jmir.org/preprint/11848

PMID: 31789598

PMCID: 6352016

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