Iranian Journal of Psychiatry 2017. 12(3):206-213.

Comparison of the Effects of Religious Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT), and Sertraline on Depression and Anxiety in Patients after Coronary Artery Bypass Graft Surgery: A Study Protocol for a Randomized Controlled T
Nazanin Vaezzadeh, Seyed Hamzeh Hosseini, Alireza Rafiei, Ali Gaemian, Abdolhakim Tirgari, Aliasghar Zakavi, jamshid Yazdani, Jafar Bolhari, Mahmood Golzari, Zahra Esmaeili Douki


Objectives: Our objective is to compare the effects of RCBT, CBT, and sertraline on depression, anxiety, biomarker levels, and the quality of life in patients after coronary artery bypass graft (CABG) surgery.

Method/Design: This is a randomized controlled trial with parallel groups. A total of 160 patients after CABG surgery will be screened for anxiety and depression according to clinical interviews based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and Hospital  Anxiety Depression Scale (HADS) scores (≥ 8). To assess religious attitude, Golriz and Baraheni’s religious attitude questionnaire will be used. Participants will be randomly allocated to four groups of 40 including three intervention groups (RCBT, CBT, and sertraline) and one control group (usual care). RCBT and CBT programs will consist of 12 one-hour weekly sessions. The participants in the pharmacological intervention group will receive 25-200 mg/d of sertraline for three months. The (SF-36) will be administered to assess the patients’ quality of life. Blood samples will be taken and biomarker levels will be determined using the enzyme-linked immunosorbent assay (ELISA). The primary outcome will be the reduction in anxiety and depression scores after the interventions. The secondary outcomes will be increases in quality of life scores and normalized biomarker levels after the interventions.

Discussion: If RCBT is found to be more effective than the other methods, it can be used to improve patients’ health status after CABG surgery.

Irct ID: IRCT201404122898N5


religious cognitive behavioral therapy, cognitive behavioral therapy, Sertraline, anxiety, depression, biomarker

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Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360(10):961-72.

Gallo LC, Malek MJ, Gilbertson AD, Moore JL. Perceived cognitive function and emotional distress following coronary artery bypass surgery. J Behav Med. 2005; 28(5):433-42.

Pignay-Demaria V, Lesperance F, Demaria RG, Frasure-Smith N, Perrault LP. Depression and anxiety and outcomes of coronary artery bypass surgery. Ann Thorac Surg. 2003; 75(1):314-21.

Strik JJ, Denollet J, Lousberg R, Honig A. Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am CollCardiol. 2003; 42(10):1801-7.

Tully PJ, Baker RA, Turnbull DA, Winefield HR, Knight JL. Negative emotions and quality of life six months after cardiac surgery: the dominant role of depression not anxiety symptoms. J Behav Med. 2009; 32(6):510-22.

Burg MM, Benedetto MC, Soufer R. Depressive symptoms and mortality two years after coronary artery bypass graft surgery (CABG) in men. Psychosom Med. 2003; 65(4):508-10.

Tully PJ, Baker RA, Turnbull D, Winefield H. The role of depression and anxiety symptoms in hospital readmissions after cardiac surgery. J Behav Med. 2008; 31(4):281-90.

Goyal TM, Idler EL, Krause TJ, Contrada RJ. Quality of life following cardiac surgery: impact of the severity and course of depressive symptoms. Psychosom Med. 2005; 67(5):759-65.

Glassman AH, Bigger JT, Jr., Gaffney M. Psychiatric characteristics associated with long-term mortality among 361 patients having an acute coronary syndrome and major depression: seven-year follow-up of SADHART participants.Arch Gen Psychiatry. 2009; 66(9):1022-9.

Empana JP, Sykes DH, Luc G, Juhan-Vague I, Arveiler D, Ferrieres J, et al. Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: the Prospective Epidemiological Study of Myocardial Infarction (PRIME).Circulation. 2005; 111(18):2299-305.

Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, et al.A meta-analysis of cytokines in major depression.Biol Psychiatry. 2010; 67(5):446-57.

McCraty R, Barrios-Choplin B, Rozman D, Atkinson M, Watkins AD.The impact of a new emotional self-management program on stress, emotions, heart rate variability, DHEA and cortisol.Integrative Physiological and Behavioral Science. 1998; 33(2):151-70.

Heaney JL, Phillips AC, Carroll D. Ageing, depression, anxiety, social support and the diurnal rhythm and awakening response of salivary cortisol. Int J Psychophysiol. 2010; 78(3):201-8.

Whooley MA, Caska CM, Hendrickson BE, Rourke MA, Ho J, Ali S. Depression and inflammation in patients with coronary heart disease: findings from the Heart and Soul Study. Biol Psychiatry. 2007; 62(4):314-20.

Murphy BM, Elliott PC, Higgins RO, Le Grande MR, Worcester MU, Goble AJ, et al. Anxiety and depression after coronary artery bypass graft surgery: most get better, some get worse. Eur J CardiovascPrevRehabil. 2008; 15(4):434-40.

Schuurmans J, Comijs H, Emmelkamp PM, Gundy CM, Weijnen I, Van Den Hout M, et al.A randomized, controlled trial of the effectiveness of cognitive–behavioral therapy and Sertraline versus a waitlist control group for anxiety disorders in older adults.The American journal of geriatric psychiatry. 2006; 14(3):255-63.

O'Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, et al. Safety and Efficacy of Sertraline for Depression in Patients With Heart Failure Results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) Trial. J Am CollCardiol. 2010; 56(9):692-9.

Hersen M, Van Hasselt VB. Behavioral assessment and treatment of anxiety in the elderly.Clinical Psychology Review. 1992; 12(6):619-40.

Rizzo M, Creed F, Goldberg D, Meader N, Pilling S.A systematic review of non-pharmacological treatments for depression in people with chronic physical health problems. J Psychosom Res. 2011; 71(1):18-27.

Beltman MW, Voshaar RC, Speckens AE. Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials.Br J Psychiatry. 2010; 197(1):11-9.

Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, Svardsudd K. Randomized controlled trial of cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary Health Care project (SUPRIM). Arch Intern Med. 2011; 171(2):134-40.

Freedland KE, Skala JA, Carney RM, Rubin EH, Lustman PJ, Davila-Roman VG, et al. Treatment of depression after coronary artery bypass surgery: a randomized controlled trial. Arch Gen Psychiatry.2009; 66(4):387-96.

Dekker RL. Cognitive therapy for depression in patients with heart failure: a critical review.Heart Failure Clinics. 2011; 7(1):127-41.

Koenig HG. Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results. Depress Res Treat. 2012; 2012:460419.

Hamid N, Bashlideh K, Aedi BM, Dehghanizadh Z.A study of the effect of religion –based cognitive-behavior therapy on depression in divorced women. Journal of Family Counseling.2011; 1(1):54-64.

Razali S, Hasanah C, Aminah K, Subramaniam M. Religious-sociocultural psychotherapy in patients with anxiety and depression.Australasian Psychiatry. 1998; 32(6):867-72.

Pearce MJ, Koenig HG, Robins CJ, Nelson B, Shaw SF, Cohen HJ, et al. Religiously integrated cognitive behavioral therapy: A new method of treatment for major depression in patients with chronic medical illness. Psychotherapy. 2015;52(1):56-66.

Sharifi, V., et al., Reliability and feasibility of the Persian version of the structured diagnostic interview for DSM-IV (SCID). Advances in cognitive science, 2004

Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health and quality of life outcomes. 2003; 1(1):14.

Koenig H. Cognitive Behavioral Treatments for Depression in Patients with Chronic Illness. www.spiritualityandhealthdukeedu//Full%20Protocol. March 20, 2014.

Sadeghi MR, BagherzadehLadari R, Haghshenas M.A study of religious attitude and mental health in students of Mazandaran University of Medical Sciences. Journal of Mazandaran University of Medical Sciences. 2010; 20(75):7.

Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of life research. 2005; 14(3):875-82.

Beck JS. Cognitive behavior therapy: Basics and beyond.Second Edition. new york :Guilford Press ;2011.


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