Metacognitive therapy (MCT) is a psychological treatment that targets how people think about their own thoughts, rather than challenging the thoughts themselves.

Standard cognitive behavioral therapy (CBT) asks patients to test and challenge negative beliefs. MCT instead teaches people to cut down worry and rumination.

The PATHWAY study tested six sessions of group MCT alongside cardiac rehabilitation in 332 heart disease patients. MCT plus rehab improved anxiety and depression more than rehab alone, and the benefits held at 12 months.

Researchers say CBT can struggle with heart patients because fears about health may be realistic, not distorted thoughts.

The findings were published in Circulation, the American Heart Association journal. About one-third of cardiac rehabilitation patients experience anxiety or depression, which raises the risk of further heart problems. UK services do not yet include specific mental health treatment in cardiac rehab. The study authors want the therapy tested in larger, more diverse groups.