ISRCTN74643496.

Study name	Improving the effectiveness of psychological interventions for depression and anxiety in the cardiac rehabilitation pathway: a single blind randomised controlled trial with four month and twelve month follow up comparing GroupMCT plus usual CR (intervention) with usual CR (control).
Methods	RCT. Metacognitive therapy vs. usual care control.
Participants	Inclusion: Competent level of English language skills (able to read, understand and complete questionnaires in English). Acute coronary syndrome used for any condition brought on by sudden, reduced blood flow to the heart Following revascularisation is the restoration of perfusion to a body part or organ that has suffered ischaemia Stable heart failure Stable angina is chest pain or discomfort that most often occurs with activity or stress Following implantation of cardioverter defibrillators/cardiac resynchronisation devices Heart valve repair/replacement Heart transplantation and ventricular assist devices Adult congenital heart disease identified in adulthood A score of = 8 on either the depression or anxiety subscale of the HADS.
Interventions	Experimental: metacognitive therapy plus CR Group psychological treatment focused on reducing worry and rumination and modifying beliefs about thinking in addition to treatment as usual (standard cardiac rehabilitation). Metacognitive therapy (MCT) helps clients to identify episodes of worry and rumination in response to negative thoughts and bring these responses under control. This process is facilitated by exercises that enhance the flexibility of attention control, challenge unhelpful beliefs about thinking and enable new relationships with thoughts 2. Active Comparator: Usual group‐based cardiac rehabilitation (treatment as usual) involving stress management, exercise, education.
Outcomes	Primary Change in Hospital Anxiety and Depression Scale (HADS) (time frame: baseline pre treatment, four‐month post baseline, 12 months' follow‐up) Secondary Metacognitions Questionnaire Cognitive Attentional Syndrome Impact of Event Scale‐Revised Health‐related quality of life Economic Patient Questionnaire (EPQ)
Starting date	1 June 2015
Contact information	Jane Garnett, University of Manchester 5th Floor (Research) St. Mary's Hospital Oxford Road M13 9WL Manchester United Kingdom
Notes	Control group are exercise training. Mixed population of Non congenital heart as well as congenital heart patients. Would not be eligible for inclusion into this review unless the intervention group underwent no exercise/physical activity .