Effectiveness of cognitive behavioral therapy for hypertension-related psychological distress: a two-phase randomized controlled trial in a Nigerian tertiary hospital

Addah Temple Tamuno-Opubo; Wandile F Tsabedze; Curwyn Mapaling; Egbewuare Emmanuel Idehen; Jamiu Tinuoye Uthman

doi:10.3389/fpsyg.2025.1684461

Effectiveness of cognitive behavioral therapy for hypertension-related psychological distress: a two-phase randomized controlled trial in a Nigerian tertiary hospital

Front Psychol. 2026 Jan 12:16:1684461. doi: 10.3389/fpsyg.2025.1684461. eCollection 2025.

Authors

Addah Temple Tamuno-Opubo¹, Wandile F Tsabedze², Curwyn Mapaling³, Egbewuare Emmanuel Idehen⁴, Jamiu Tinuoye Uthman⁴

Affiliations

¹ Department of Psychology, Faculty of Social Science, Olabisi Onabanjo University, Ago-Iwoye, Ogun, Nigeria.
² Department of Psychology, University of South Africa, Pretoria, South Africa.
³ Optentia Research Unit, North-West University, Potchefstroom, South Africa.
⁴ Department of Psychology, Faculty of Social Science, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria.

Abstract

Background: Hypertension is a major contributor to cardiovascular morbidity globally and is frequently accompanied by psychological distress, including anxiety and depression. Evidence on the efficacy of psychological interventions, particularly Cognitive Behavioral Therapy (CBT), for hypertension-related distress remains limited in the Sahara South of Africa.

Objective: This study examined the effectiveness of an 8-week CBT program in reducing psychological distress among adults with hypertension attending a Nigerian tertiary hospital, compared with a waitlist/usual care control group.

Methods: A two-phase randomized controlled trial was conducted. In Phase I, 242 hypertensive patients were screened for psychological distress. Phase II involved 42 participants with moderate to severe distress (mean age = 44.9 years) who were randomly assigned to either an 8-week CBT intervention or a waitlist control, continuing usual hypertension care. Psychological distress was assessed using the Symptom Checklist-13 (SCL-13). Data were analyzed per protocol using paired and independent t-tests and ANCOVA, controlling for baseline distress and age.

Results: The CBT group showed significant reductions in distress from baseline (M = 13.78, SD = 3.04) to post-test (M = 9.45, SD = 2.31), t ₍₂₀₎ = 8.12, p < 0.001, whereas the control group showed no meaningful change (baseline M = 13.42, SD = 2.92; post-test M = 13.21, SD = 2.85), t ₍₂₀₎ = 0.48, p = 0.630. Between-group comparisons confirmed greater improvement in the CBT group, t ₍₄₀₎ = 5.64, p < 0.001, Hedges' g = -1.42. Subgroup analyses revealed large effects for participants with severe [t ₍₉₎ = 5.85, p < 0.001, partial η² = 0.62] and moderate distress [t ₍₁₀₎ = 4.42, p = 0.012, partial η² = 0.48]. Age significantly influenced outcomes, F _{(1, 40)} = 5.24, p = 0.040, while gender and marital status did not.

Conclusion: These findings provide evidence that an 8-week CBT intervention significantly reduces psychological distress in individuals with hypertension. The results support the integration of CBT into hypertension care within Nigerian tertiary hospitals, highlighting the potential for broader implementation in similar clinical settings. Future research, involving larger and longer-term studies, is recommended to confirm the durability and generalizability of these findings.

Keywords: behavioral medicine; chronic disease; cognitive behavioral therapy; hypertension; mental health; non-pharmacological interventions; psychological distress; randomized controlled trial.