Peer-Supported CBT Eased Anxiety for ER Chest Pain Patients
Online therapy reduced anxiety symptoms in low-risk emergency room patients who were often misdiagnosed as having cardiac issues.
Updated on Sept. 30, 2026 in Heart Disease
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A clinical trial found that a peer-supported online cognitive behavioral therapy program successfully reduced anxiety symptoms in adults visiting the emergency room for low-risk chest pain. The study, which aimed to address the high prevalence of anxiety among these patients, provides a potential new pathway for care after cardiac causes are ruled out.
Why it matters
Up to 80% of emergency chest pain cases are not related to heart disease, yet many patients continue to struggle with untreated anxiety or panic disorders. This approach offers a way to manage these conditions without the high therapist time requirements associated with traditional weekly counseling.
In a randomized trial involving 375 adult emergency room patients, researchers tested primary care referral against peer-supported online CBT or therapist-led CBT. Participants were eligible if they had a HEART risk score below 7 and a GAD-7 anxiety score of 8 or higher.
The players
Patient-Centered Outcomes Research Institute
An independent non-profit organization that funds research to help patients and caregivers make informed healthcare decisions.
JAMA Internal Medicine
A peer-reviewed medical journal that publishes research on clinical issues, health policy, and the science of medical practice.
The details
The program consisted of a six-lesson cognitive behavioral therapy course completed over eight to 12 weeks. By using peer support to facilitate the therapy, the model reduces the direct therapist time required compared to standard weekly sessions. This helps streamline treatment for the 58% of emergency chest pain patients who present with anxiety or panic disorders.
Timeline
July 2024: The clinical trial finished participant enrollment.
September 28, 2026: Trial results were published in JAMA Internal Medicine.
Health Landscape
The PACER trial represents a significant shift in emergency medicine, where the focus has historically been limited to ruling out acute cardiac events. This research bridges the gap between emergency triage and long-term mental health management for a large, underserved population.
If you have experienced chest pain and were told it was not heart-related, it is worth discussing with your doctor whether your symptoms might be linked to an underlying anxiety or panic disorder. Ask your primary care provider about available digital cognitive behavioral therapy programs that may be appropriate for your situation.
The takeaway
Anxiety is a common but often overlooked component of non-cardiac chest pain, and digital therapy could offer an accessible path to relief. Consider tracking your symptoms and speaking with a primary care physician to determine if an anxiety screening or referral to a therapist is appropriate for you.
Further reading
For more on managing cardiac symptoms and associated conditions, visit Heart Disease.
Source note: This article includes information reported by Medical Daily.
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