Metacognitive Therapy in Cardiac Rehabilitation: Staff Barriers and Enablers to Training in an Evidence‐Based Psychological Treatment for Anxiety and Depression

BACKGROUND: This study was designed to explore cardiac rehabilitation (CR) practitioners' experiences and perceptions of group metacognitive therapy training, identifying the facilitators and barriers encountered. METHODS: A nested qualitative study using reflexive thematic analysis was conducted as part of PATHWAY-Beacons (National Institute for Health and Care Research 202956), a mixed-methods study evaluating the implementation of group metacognitive therapy as part of routine care in CR services. Practitioners from 6 CR services in England enrolled in interviews at 3 stages: before training, after training, and after delivering all group sessions. RESULTS: Nine practitioners participated in the study, with 7 completing all 4 interviews, 1 completing 2 interviews (pre- and posttraining), and another completing just 1 (pretraining). Key enablers for effective training emerged in 3 subthemes: training delivery style, essential training components, and the online training format. These aspects contributed positively to the practitioners' training experiences and improved their understanding of group metacognitive therapy. Conversely, barriers included issues related to training structure, staff skepticism, and specific additional training needs. CONCLUSION: The findings support the positive value of training CR staff in group metacognitive therapy and offer important insights for enhancing the delivery and uptake of training within the National Health Service. Although the study findings represent views of a predominantly female sample, this reflects the composition of the current CR workforce.