The effects and experiences of internet-delivered cognitive behavioural therapy: The perspectives of patients with non-cardiac chest pain and healthcare professionals in the emergency and cardiac care

Background Non-cardiac chest pain (NCCP) is a common issue, accounting for roughly half of all emergency department visits related to chest pain. Patients afflicted with NCCP often endure cardiac anxiety, misinterpreting the pain as heart-related and fearing it, despite the absence of any life-threatening cardiac issues. This anxiety often leads to the avoidance of physical activities, negatively impacting their quality of life. Cognitive behavioural therapy (CBT) has been shown to be effective in managing psychological distress such as anxiety and depression. CBT is a structured process that helps patients identify and restructure their negative thoughts, get a corrected and more realistic perception of their symptoms, and learn to manage their thoughts about chest pain. Despite its effectiveness, CBT is resource-intensive, and therefore internet-delivered cognitive behavioural therapy (iCBT) may be an alternative as it increases accessibility and is more cost-effective compared to traditional therapy methods. However, there is a lack of re-search on the effectiveness of this treatment approach for patients with NCCP and cardiac anxiety. Moreover, digital care technologies are still relatively unfamiliar in clinical practice, particularly in emergency departments, and the successful implementation of iCBT relies on healthcare professionals' acceptance and integration of digital care into clinical practice. Aim The overall aim of this dissertation was to evaluate the short- and long-term effects of a nurse-led iCBT program on psychological distress in patients with NCCP, and to explore their experiences participating in the iCBT program. In addition, the study aimed to describe healthcare professionals' perceptions of digital care in the emergency and cardiac care for patients with NCCP. Methods This dissertation comprises two quantitative and two qualitative studies. A randomised clinical trial (RCT) (studies I, II, and III) was conducted to evaluate cardiac anxiety, measured with the Cardiac Anxiety Questionnaire (CAQ); and secondary outcomes such as fear of body sensations, measured with The Body Sensations Questionnaire (BSQ); depressive symptoms, assessed with the Patient Health Questionnaire-9 (PHQ-9); health-related quality of life (HRQoL), measured using the EuroQol Visual Analog Scale (EQ-VAS); and chest pain frequency with a self-developed question. The RCT cohort consisted of 109 patients who had at least two healthcare consultations for