Through hundreds of prevalence and interventional studies, it’s now firmly established that mental and physical health conditions can intensify each other when co-existing. More and more we read peer-reviewed articles and headlines stating how depression and/or anxiety increase morbidity and mortality rates in patients with physical health conditions, as well as contributing to rising health care costs. News items and editorials describe the difficulties in managing both mental and physical health problems simultaneously, often due to the fact that physical health is prioritised as it’s usually quicker to diagnose and measure.
Furthermore, people seem to be more understanding of a physical issue; it doesn’t need much explaining when a co-worker takes sick leave due to gastrointestinal issues, back pain or surgery recuperation. Conversely, how could one explain that a long-standing condition such as diabetes is causing depression, which is then leading to further complications? It’s not as straightforward and people are reluctant to recognise mental health issues when they can easily ascribe any ‘sadness’, ‘fatigue’, ‘anxiety’ etc. to their diabetes, for instance.
Complexity of the Physical Mental Health Interaction
Thankfully, much work is being done to further comprehend the difficulties that comorbid mental-physical issues create. Dozens of research articles are published each month; for example, recently a study on 125 patients showed that some residual symptoms remained even after successful cognitive-behavioural therapy (CBT) therapy for depression in coronary heart disease, specifically those related to fatigue and loss of energy1. Studies such as this are important to advance the science and knowledge on what can work (and how) in these situations. The physical/mental health interaction is complex but there are existing treatments that can make inroads into a better prognosis for these patients.
Benefits Specific to Chronic Conditions
Of all the advantages that internet-delivered CBT programs bring, some certainly stand out for patients with physical and mental health conditions. Mobility issues are easily overcome when patients do not have to make the journey to see a psychotherapist in person but can rather log in at home and access the content at their pace and leisure, while still receiving the necessary feedback from a trained specialist once a week. Let us also consider the fact that these are all chronic conditions, and an online program delivers content that patients can access constantly and continuously. If a standard CBT programme is delivered, patients can revisit it to re-take exercises, re-read the feedback they got, and re-watch the videos that appealed to them most, etc. Therefore, the content accompanies them through the ups and downs that a chronic condition can bring. Patients with different types of symptoms can access distinct parts of the programmes and there can even be unlockable content to adapt to a patient’s needs. This may address the findings referenced above of residual symptoms that some patients experience.
The ‘Game-Changing’ Aspect of Online CBT
Importantly, the ‘game-changing’ aspect of online platforms comes from their benefit to health care systems as a whole, by providing means to deliver treatment to a much larger cohort of patients, utilising fewer staff hours, and with considerably less costs. By allowing patients with a physical health condition to access programs that tackle and monitor their mental health, encouraging positive behaviour changes and improved self-management, the benefits will be wide-reaching. Physical health services are often in need of mental health experts that address issues which the specialist (for example a cardiologist within a heart clinic) is not trained to undertake. A successful implementation of an online platform could lead to less expenditure on complications from the chronic physical condition itself, and from possible intensification of the mental symptoms. Online platforms can also increase the benefits on offer for patients under private insurance, for workers at a company that offers an employee-assistance programme that includes both mental and physical health treatment under one roof, and for university students who must deal with emotional challenges that are exacerbated if they find themselves ailing from a physical condition.
SilverCloud Health Internet-Delivered Interventions
SilverCloud Health currently offers a variety of programmes that are designed to address symptoms of mental health affecting particular population groups who primarily have a diagnosis of a chronic physical condition. More programmes are being developed and are due to be rolled out in the next year, with clinical trials to be published alongside, as a recognition of the urgent need to address these issues. Through research, design, and development of our online platform we aim to contribute heartily to the wellbeing of those individuals who must deal with a complex comorbidity encompassing both the mental and physical worlds, lessen the burden on health care systems, and improve the offering of companies who insure and employ these affected individuals.
1Carney, RM et al, Residual Symptoms after Treatment for Depression in Patients with Coronary Heart Disease (2018) Psychosomatic Medicine, 80(4) pp 385-392