End of study reports

MCT Pathway

What is PATHWAY?

  • A five year programme of research funded by the National Institute for Health Research (NIHR) and sponsored by Greater Manchester Mental Health Foundation Trust (GMMH).
  • Professor Adrian Wells is the chief investigator and grant holder on the PATHWAY programme. He is the developer of a psychological therapy called Metacognitive Therapy (MCT) and co-director of the MCT-Institute. The aim of the PATHWAY programme is to provide evidence on integrating psychological therapy into cardiac rehabilitation (CR) services and to improve access to more effective psychological interventions for the range of heart disease patients attending CR.
  • The pathway programme targets cardiac rehabilitation patients experiencing anxiety and depression symptoms
  • Specifically, the PATHWAY programme will compare whether a psychological intervention called Metacognitive therapy delivered to patients in addition to their usual cardiac rehabilitation (CR) programme is more effective for patients who are currently experiencing –anxiety and depression symptoms following a cardiac event than patients who only receive the usual CR programme alone.
  • PATHWAY has -three work streams
    • Workstream 1: Pilot single-blind randomised controlled trial comparing usual CR plus group based metacognitive therapy (intervention) versus usual CR alone (control), with 4 and 12 months follow-up. 
    • Workstream 2: Full-scale single-blind randomized controlled trial comparing usual CR plus group based metacognitive therapy (intervention) versus usual CR alone (control), with 4 and 12 months follow-up.
    • Workstream 3:  Feasibility randomised controlled trial comparing usual CR (control) versus usual CR plus home-based self-help metacognitive therapy (intervention), with 4 and 12 months follow-up.

Background

Cardiac rehabilitation services aim to improve heart disease patients’ health and quality of life, and reduce the risk of further cardiac events.

  • Approximately 69,000 patients attend cardiac rehabilitation annually in the UK.
  • Around a third (47%) of patients accessing cardiac rehabilitation services experience significant anxiety and/or depressive symptoms
  • Psychological distress reduces quality of life and increases the risk of death, further cardiac events and increases healthcare use. 
  • Available drug and psychological treatments have only small effects on distress and quality of life, and no effects on physical health in cardiac rehabilitation patient populations.

Therefore, it is essential that more effective treatments for depression and anxiety are integrated into cardiac rehabilitation services.  

Aims of the Study

Our primary aim is to provide evidence of MCT integrated into CR services investigating MCT in two formats: a centre-based group intervention (Group-MCT) and a home-based self-help intervention (Home-MCT). Such treatment options are in line with a modern era menu-based approach and could add to the delivery of CR programmes by increasing the range of options for accessing psychological support that do not require referral to mental health services.. This will lead to better informed and integrated care within CR services and has the potential to improve psychological and physical well-being as well as reduce NHS costs.

Progression of the study

  • Recruitment has now ended for Workstream 2 and we recruited a total of 332
  • Recruitment has now ended for Workstream 3 and we recruited a total of  108
  • Follow-ups for Workstream 2 – Follow up has ended for WS2
  • 4 month follow up rate of return = 87%
  • 12 month follow up rate of return = 86%
  • Follow-ups for Workstream 3
  • 4 month follow up rate of return = 90%
  • 12 month follow up rate of return = 95%

Papers published to date

  • Shields, G.E., Wells, A., Doherty, P., Heagerty, P., Heagerty, A., Buck, D., Davies, L.M. (2018). Cost effectiveness of cardiac rehabilitation: a systematic review.Heart. doi: 10.1136/heartjnl-2017-312809
  • Wells, A., McNicol, K., Reeves, D., Salmon, P., Davies, L., Heagerty, A., Doherty, P., McPhillips, R., Anderson R., Faija, C., Capobianco, L., Morley, H., Gaffney, H., Shields, G., & Fisher, P. (2018). Improving the effectiveness of psychological interventions for depression and anxiety in the cardiac rehabilitation pathway: study protocol for a randomised controlled trial of group-based metacognitive therapy. Trials, 19, 215. doi: 10.1186/s13063-018-2593-8
  • Wells, A., Faija, C. (2018). MCT for Anxiety & Depression in Cardiac Rehabilitation: Commentary on the UK NIHR funded PATHWAY Programme. J Cardiology and Cardiovascular Sciences (2018) 2(3): 10-14
  • Wells A,. McNicol, K,. Reeves, D., Salmon, P., Davies, L., Heagarty, A., Doherty, P., McPhillips, R., Anderson, R., Faija, C,. Capobianco, L., Morley, H., Gaffney, H., Heal, C., Shields, G., & Fisher, P. (2018). Metacognitive therapy home-based self-help for cardiac rehabilitation patients experiencing anxiety and depressive symptoms: study protocol for a feasibility randomised controlled trial (PATHWAY Home-MCT). Trials, 19, 444. https://doi.org/10.1186/s13063-018-2826-x
  • McPhillips, R., Salmon, P., Wells, A., & Fisher, P. (2019). Qualitative Analysis of Emotional Distress in Cardiac Patients from the Perspectives of Cognitive Behavioural and Metacognitive Theories: Why Might Cognitive-Behavioural Therapy Have Little Benefit, and Might Metacognitive Therapy be More Effective?. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2018.02288

Service users’ stories (please see other attached document containing this information)

Contact details for Pathway

Twitter: @mctpathway

Website: www.mct-pathway.com

Tel: +44 (0)161 276 5278

Emails –

Adrian.Wells@manchester.ac.uk ; Professor Adrian Wells – Chief Investigator

Lora.Capobianco@GMMH.nhs.uk ; Dr Lora Capobianco – Programme Manager

Avinash.Atwal@GMMH.nhs.uk ; Avinash Atwal – Research Assistant

Zara.Husain@gmmh.nhs.uk; Zara Husain- Research Assistant

Wendy.Clarke@manchester.ac.uk ; Wendy Clarke – Programme Administrator