Rebecca L. Dekker

Bio: Rebecca L. Dekker is an academic researcher from University of Kentucky. The author has contributed to research in topics: Heart failure & Anxiety. The author has an hindex of 18, co-authored 41 publications receiving 891 citations.

Effects of cognitive behavioural therapy for depression in heart failure patients: a systematic review and meta-analysis

Abstract: This systematic review and meta-analysis aimed to evaluate the effects of cognitive behavioural therapy (CBT) on depression, quality of life, hospitalisations and mortality in heart failure patients. The search strategy was developed for Ovid MEDLINE and modified accordingly to search the following bibliographic databases: PubMed, EMBASE, PsycINFO, CENTRAL and CINAHL. Databases were searched from inception to 6 March 2016 for randomised controlled trials (RCTs) or observational studies that used CBT in heart failure patients with depression or depressive symptoms. Six studies were identified: 5 RCTs and 1 observational study, comprising 320 participants with predominantly NYHA classes II-III, who were mostly male, with mean age ranging from 55 to 66 years. Compared to usual care, CBT was associated with a greater improvement in depression scores both initially after CBT sessions (standardised mean difference -0.34, 95% CI -0.60 to -0.08, p = 0.01) and at 3 months follow-up (standardised mean difference -0.32, 95% CI -0.59 to -0.04, p = 0.03). Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but with no difference at 3 months. Hospital admissions and mortality were similar, regardless of treatment group. CBT may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months. Larger and more robust RCTs are needed to evaluate the long-term clinical effects of CBT in heart failure patients.

Living With Depressive Symptoms: Patients With Heart Failure

Abstract: Background—Patients with heart failure often experience depressive symptoms that affect healthrelated quality of life, morbidity, and mortality. Researchers have not described the experience of patients with heart failure living with depressive symptoms. Understanding this experience will help in developing interventions to decrease depressive symptoms. Objective—To describe the experience of patients with heart failure living with depressive symptoms. Methods—This study was conducted by using a qualitative descriptive design. The sample consisted of 10 outpatients (50% female, mean age 63 [SD, 13] years, 70% New York Heart Association class III or IV) with heart failure who were able to describe depressive symptoms. Data were collected via taped, individual, 30- to 60-minute interviews. ATLAS ti (version 5) was used for content analysis. Results—Participants described emotional and somatic symptoms of depression. Negative thinking was present in all participants and reinforced their depressed mood. The participants experienced multiple stressors that worsened depressive symptoms. The overarching strategy for managing depressive symptoms was “taking my mind off of it.” Patients managed depressive symptoms by engaging in activities such as exercise and reading, and by using positive thinking, spirituality, and social support. Conclusions—Patients with heart failure experience symptoms of depression that are similar to those experienced by the general population. Clinicians should assess patients with heart failure for stressors that worsen depressive symptoms. Strategies that researchers and clinicians can use to reduce depressive symptoms in patients with heart failure include engaging patients in activities, positive thinking, and spirituality. Helping patients find enhanced social support may also be important. Heart failure is a chronic syndrome that affects 5 million people in the United States 1 and is the most common cause of hospitalization in elderly adults. 2 Major depressive disorder is common in hospitalized patients with heart failure. One-third of hospitalized patients with heart failure have major depression, and 40% of these persons are still depressed 1 year later. 3

Marital Status as an Independent Predictor of Event-Free Survival of Patients With Heart Failure

Abstract: BACKGROUND Depressive symptoms are a well-known predictor of mortality in patients with heart failure, and positive spousal support is associated with improved outcomes in these patients. However, in the context of depressive symptoms, the effect on survival of having a spouse is unknown. OBJECTIVE To determine the effect of marital status on event-free survival in patients with heart failure who did or did not have depressive symptoms. METHODS Depressive symptoms were assessed by using the Beck Depression Inventory-II in patients with heart failure who were followed-up for up to 4 years to collect data on mortality and hospitalizations. Patients were grouped according to the presence and absence of depressive symptoms by using the standard cutoff score of 14 on the Beck Depression Inventory-II. Kaplan-Meier and Cox regression analyses were used to compare event-free survival for married and nonmarried patients who were stratified according to the presence or absence of depressive symptoms. RESULTS Of 166 patients, 56% were married, and 33% had depressive symptoms. Levels of depressive symptoms were similar between married and nonmarried patients (10.9 vs 12.1; P = .39). Married patients experienced longer event-free survival than did nonmarried patients (P = .009), even with stratification according to depressive symptoms (P = .01). CONCLUSIONS Patients with a spouse had longer event-free survival than nonmarried patients did, even in the context of depressive symptoms.

Depression and cardiovascular disease: a clinical review

Abstract: Cardiovascular disease (CVD) and depression are common. Patients with CVD have more depression than the general population. Persons with depression are more likely to eventually develop CVD and also have a higher mortality rate than the general population. Patients with CVD, who are also depressed, have a worse outcome than those patients who are not depressed. There is a graded relationship: the more severe the depression, the higher the subsequent risk of mortality and other cardiovascular events. It is possible that depression is only a marker for more severe CVD which so far cannot be detected using our currently available investigations. However, given the increased prevalence of depression in patients with CVD, a causal relationship with either CVD causing more depression or depression causing more CVD and a worse prognosis for CVD is probable. There are many possible pathogenetic mechanisms that have been described, which are plausible and that might well be important. However, whether or not there is a causal relationship, depression is the main driver of quality of life and requires prevention, detection, and management in its own right. Depression after an acute cardiac event is commonly an adjustment disorder than can improve spontaneously with comprehensive cardiac management. Additional management strategies for depressed cardiac patients include cardiac rehabilitation and exercise programmes, general support, cognitive behavioural therapy, antidepressant medication, combined approaches, and probably disease management programmes.

Cognitive Therapy: Basics and Beyond

Abstract: Cognitive behavioral therapy WikipediaCognitive Behavioral Therapy (CBT): Definition, Types 31 Best Cognitive Behavioral Therapy (CBT) Books In 2021What is Cognitive Behavioral Therapy (CBT)? A Psychologist The Basic Principles of Cognitive Behavior TherapyCognitive therapy WikipediaThe key principles of cognitive behavioural therapy Cognitive Behavioral Therapy | Psychology Today(PDF) Cognitive Behavioural Therapy ResearchGateThe Complete List of CBT Cognitive Behavioral Therapy Cognitive Behavioral Therapy for Substance Use DisordersGoodTherapy Find the Right TherapistWhat is Cognitive Behavioral Therapy (CBT)? | Psychology ToolsTreating Depression With Aaron Beck's Cognitive Therapy The Comprehensive Clinician's Guide to Cognitive The CBT Model of Emotions Cognitive Behavioral Therapy Cognitive Behavioral Therapy (CBT) Case StudyCognitive Behavioral Therapy (CBT) Worksheets | Psychology Beyond Worksheets in Cognitive-Behavioral Therapy Cognitive Impairment and Rehabilitation Strategies After Cognitive therapy: basics and beyond PDF Free DownloadResources from Cognitive Behavior Therapy: Basics and Cognitive Behavioral Therapy (CBT) Simply PsychologyChallenging Negative Thoughts (Worksheet) | Therapist AidWhat About Cognitive Rehabilitation Therapy? | BrainLineCognitive Distortions, Humor Styles, and Depression30 Best CBT Books to Teach Yourself Cognitive Behavioural Cognitive Therapy for Depression

Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles

Abstract: Objective To review evidence regarding the prevalence, causation, clinical implications, aspects of healthcare utilisation and management of depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease. Design A critical review of the literature (1994–2009). Findings The prevalence of depression and anxiety is high in both chronic obstructive pulmonary disease (8–80% depression; 6–74% anxiety) and chronic heart failure (10–60% depression; 11–45% anxiety). However, methodological weaknesses and the use of a wide range of diagnostic tools make it difficult to reach a consensus on rates of prevalence. Co-morbid depression and anxiety are associated with increased mortality and healthcare utilisation and impact upon functional disability and quality of life. Despite these negative consequences, the identification and management of co-morbid depression and anxiety in these two diseases is inadequate. There is some evidence for the positive role of pulmonary/cardiac rehabilitation and psychotherapy in the management of co-morbid depression and anxiety, however, this is insufficient to guide recommendations. Conclusions The high prevalence and associated increase in morbidity and mortality justifies future research regarding the management of anxiety and depression in both chronic heart failure and chronic obstructive pulmonary disease. Current evidence suggests that multi-faceted interventions such as pulmonary and cardiac rehabilitation may offer the best hope for improving outcomes for depression and anxiety. Copyright © 2009 John Wiley & Sons, Ltd.