In the first part of this two part blog we introduced our new suite of online programmes to address co-morbid depression and anxiety for those with long-term conditions (LTCs) such as Diabetes, COPD and Chronic Pain. Here we discuss the reasons why online CBT interventions should be adapted to meet the needs of people with LTCs and co-morbid mental health conditions.
Treating mental health difficulties in those with LTCs
CBT based interventions for those with LTCs have been demonstrated to improve treatment adherence, coping skills, quality of life and reduce healthcare costs (Thompson, Delaney, Flores & Szigethy, 2011) and are recommended by NICE (2009) for the treatment of those with chronic physical conditions. However, standalone mental health interventions have not always demonstrated improved physical symptoms (Cimpean & Drake, 2011). In fact, overlaying mental health interventions on physical care pathways, in this stand-alone way is discouraged (Naylor et al., 2012; NICE, 2009) as it can ignore the complex link between mind and body, can invalidate the individual’s experience of their difficulty and importantly it can hamper engagement as some patients report that it doesn’t feel relevant to them or that they are wholly inappropriate for their level of physical ability (Hadert, 2013; Hind et al., 2010)
Guidance on adapting CBT interventions for those with LTCs
Currently, there is limited research, agreement or best practice guidance on how to best incorporate the challenges of living with an LTC into standard CBT protocol. However, a number of key points have emerged:
- The need to adapt content to adequately reflect the complex interaction between living with an LTC and having a mental health difficulty through psycho-education, examples and homework. Hadert (2013)
- The need to adapt traditional cognitive restructuring examples for LTC patients, as some negative thoughts may be more realistic in the face of their poor health. Beatty and Koczwara (2010)
- The need to use clinical jargon sparingly and adapt communication to be appropriate for the population the intervention is targeting. NICE (2009)
Our new programmes have been developed taking on board this guidance to make interventions relevant and engaging for those with LTCs. When working with patients with LTCs it is important to understand that the programmes do not aim to be a full self-management tool or to be a treatment for the physical aspects of living with an LTC.
At their core, these programmes are tailored to improve engagement, treatment satisfaction and acceptability for those with long-term conditions by:
- Providing tailored programme content for an individual living with an LTC so it feels relevant to their physical ability
- Providing a platform where individuals can understand the complex interaction between their body and their mind in a joined up manner
- Help someone better cope with the difficulties they encounter, including difficulties related to their mental health, their LTC and everyday life
In our next blog we will look at the key dos and don’ts when working with individuals with LTCs. Please contact us for more information on our LTC programme suite or to request a demo.
Beatty, L. & Koczwara, B. (2010). An effectiveness study of a CBT group program for women with breast cancer. Clinical Psychologist, 14(2), 45–53. doi:10.1080/13284207.2010.500307
Cimpean, D. & Drake, R.E. (2011). Treating co-morbid medical conditions and anxiety/ depression. Epidemiology and Psychiatric Sciences, vol 20, no 2, pp 141–50.
Hadert, A. (2013). Adapting Cognitive Behavioural Therapy Interventions for Anxiety or Depression to Meet the Needs of People with Long-Term Physical Health Conditions. Exeter: University of Exeter.
Hind, D., O'Cathain, A., Cooper, C. L. , Parry, G. D. , Isaac, C. L. , Rose, A., & Sharrack, B. (2010). The acceptability of computerised cognitive behavioural therapy for the treatment of depression in people with chronic physical disease: a qualitative study of people with multiple sclerosis. Psychology & Health, 25(6), 699–712. doi:10.1080/08870440902842739
Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M. & Galea, A. (2012). Long term condition and mental health; the cost of co-morbidities. London: The Kings Fund and Centre for Mental Health.
NICE (2009). Depression in adults with chronic physical health problem: recognition and management. London: National Institute for Health and Care Excellence.
Thompson, R.D., Delaney, P., Flores, I. & Szigethy, E. (2011). Cognitive-behavioral therapy for children with comorbid physical illness. Child and Adolescent Psychiatric Clinics of North America, vol 20, no 2, pp 329–48.