Internet-delivered cognitive behavioural therapy for patients with non-cardiac chest pain (IKSIT)

Internet-delivered CBT for Patients With NCCP (IKSIT)
Patient and societal benefits of guided internet-delivered cognitive behavioural therapy for patients with non-cardiac chest pain hocus-focus

The IKSIT research study focuses on patients who experience anxiety and worry over recurrent non-cardiac chest pain. These patients often fall between two cracks since they have no clear cause for their chest pain, and contribute at the same time to high healthcare and societal costs. Cognitive behavioural therapy over the internet may be a solution.

Many patients seek medical care for chest pain with no conclusive evidence of acute heart disease. Despite recurrent chest pain episodes, many of these patients are discharged without an explanation of their chest pain, and are for this reason convinced that they are suffering from undiagnosed heart disease. This leads them to avoid activities that they believe may exacerbate the chest pain and harm the heart, which in turn can have detrimental effects on their daily life.

A large fraction of the Swedish healthcare system is currently highly focused on physiological aspects, and only a small fraction considers psychological aspects. Cognitive behavioural therapy (CBT) has proved to be effective in the treatment of mild to moderate psychological distress, such as anxiety and depressive symptoms. It is, however, a problem that the healthcare system does not have the resources required to provide CBT to this patient group. For this reason, CBT over the internet (I-CBT) may be a solution. The full name of the research study is: Patient and societal benefits of guided internet-delivered cognitive behavioural therapy for patients with non-cardiac chest pain.



Studies have shown that psychological distress – such as depressive symptoms, cardiac anxiety (i.e. anxiety over having a heart disease), and fear of bodily symptoms – occurs frequently in this patient group. We have also found that psychological distress, and in particular cardiac anxiety, is highly related to increased healthcare utilization, and therefore increased costs. Thus, the treatment of psychological distress may reduce patient problems, and in this way also the healthcare utilization.

We believe that these patients need to change their patterns of thought that are related to their chest pain, acquire increased knowledge about chest pain, and understand that chest pain may have many other causes than the heart. Furthermore, these patients need to be convinced that the heart can cope with physical exertion, so that they do not avoid physical activity, which they often consider to be harmful for the heart. In addition, the patients need tools to manage recurrent chest pain episodes, which are often associated with stress and anxiety.

In order for this patient group to learn to manage their chest pain and to stop setting limitations in their everyday life, the I-CBT treatment is based on education, physical activity, and exercises in mindfulness. The overall aim of the intervention is to break down existing negative patterns of thought and find constructive ones to build upon. The project has started, and patient recruitment is ongoing. The aim is to recruit 120 patients, of which just over one third have been included, in either treatment or control group.


Various connections implying a world mapThe IKSIT research project collaborates with several institutions in Sweden. One close collaboration is, naturally, the Vrinnevi Hospital in Norrköping. The Ryhov County Hospital in Jönköping is another collaboration partner.

Discussions are in progress concerning international collaboration in London.