A novel biopsychosocial, cognitive behavioural, stepped care intervention for patients with noncardiac chest pain

Background: Non-cardiac chest pain (NCCP) is associated with
psychological distress, work absenteeism, impaired functioning
and reduced quality of life. This study explores how a novel
biopsychosocial, stepped-care treatment for NCCP works, and
explores outcomes at each step and process variables. Methods:
Patients with persistent NCCP were referred to a new
biopsychosocial, multidisciplinary clinic for chest pain (CP). There
were three possible ‘steps’ of treatment: (1) biopsychosocial
assessment (BA) only, (2) BA plus low-intensity cognitive
behaviour therapy (CBT) and (3) BA plus high-intensity CBT.
Outcome measures assessed chest pain (frequency and
interference), anxiety (GAD7), depression (Patient Health
Questionnaire-9 (PHQ-9)), somatic symptoms (PHQ-15) and illness
perceptions (Brief Illness Perception Questionnaire) at baseline, 3
and 6 months post-assessment. Participants gave feedback about
treatment once completed, which was analysed using content
analysis. Results: Significant improvements were found on all
outcome measures at 3 months and 6 months compared to
baseline. Benefits were found in all treatment steps and occurred
regardless of baseline distress, chest pain or demographic
characteristics. The strongest predictor of improvement in chest
pain at 6 months was a positive change in illness perceptions at 3
months. Patients reported how treatment helped by increasing
their understanding of chest pain, reducing concern and
improving their sense of control. Conclusions: A biopsychosocial,
stepped-care intervention appears to be effective, efficient and
acceptable for a variety of patients with NCCP. Changes in beliefs
about chest pain were the main predictors of improvement
(reduced chest pain interference and frequency) at 6 months
follow up.