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Digital therapy reduces anxiety and depression in people with long-term physical health conditions

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A therapist-guided digital cognitive behavioural therapy (CBT) treatment reduced distress in 89 per cent of participants living with long-term physical health conditions, a new King’s College London study found.

Researchers at the university’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN) found that people living with long-term conditions who engaged in the COMPASS programme showed a significant reduction in psychological distress (a combined score of anxiety and depression) 12 weeks after starting the study.

Dr Katrin Hulme is a post-doctoral health psychology research associate at King’s IoPPN, and joint first author of the study.

The researcher said: “This trial is the culmination of several years of work, starting in 2018; throughout the project, we developed the COMPASS programme and training for therapists, conducted user testing, got regulatory approval, launched in healthcare clinics and conducted this trial.

“The valuable insights of our patient and clinician representatives helped us create an online programme specifically tailored to help people manage the challenges that can come with living with a long-term health condition, and support healthcare services in addressing this unmet need.”

A total of 194 patients were recruited via long-term condition charities, including Crohn’s & Colitis UK, Kidney Care UK, MS Society, Shift.ms and Psoriasis Association in the UK.

Half of the participants received the COMPASS programme and the other half did not and both groups continued to access their usual charity support.

In all, 89 per cent of participants who received COMPASS showed a clinically significant improvement in distress, compared to 45 per cent of those who did not have access to the programme.

Alongside improvements in anxiety and depression, COMPASS was also associated with improved ability to undertake daily activities, a reduction in illness-specific distress and a better quality of life.

Dr Federica Picariello is a post-doctoral health psychology research associate at King’s IoPPN and joint first author of the study.

She said: “Currently, the main treatments for anxiety and depression in people with long-term physical health conditions are psychotherapies, such as cognitive behavioural therapy, combined with medication.

“However, growing evidence shows that NHS Talking Therapies services are less effective for people with long-term physical health conditions.

“This may be because the challenges of living with the long-term physical health condition are often not central to the treatment approach.

“Our study shows that COMPASS offers an effective and potentially scalable intervention for people whose long-term physical health condition is, in fact, the key driver for their anxiety and/or depression.”

An estimated 15.4 million people in England have one or more long-term physical health conditions and 30 per cent of these individuals also have a co-occurring mental health condition.

The study, published in the journal Psychological Medicine, is the first randomised controlled trial to measure the effectiveness of COMPASS for managing anxiety and depression related to living with a long-term condition.

Developed with the support of the Mind and Body Programme at King’s Health Partners, COMPASS adapted standard CBT protocols to integrate mental and physical health needs and specifically address the challenges of living with a long-term health condition.

Using interactive pathways tailored to the individual’s needs, the programme helps individuals manage their symptoms of anxiety and depression alongside building strategies to manage stressors associated with living with a long-term condition, such as relapses or unpleasant treatments.

After 12 weeks, during which participants could complete any of the 11 interactive digital COMPASS sessions as home and receive up to five 30-minute support calls with their therapist, participants who received COMPASS reported greater improvements in most outcomes compared to those who did not have access to the programme.

As the treatment can be administered remotely, the study authors believe an efficient delivery pathway could be through a national hub linked to self-referral through charities or the NHS, rather than setting up within each regional primary or secondary health service with limited resources.

Such a delivery pathway could alleviate the demand on charities who already provide some essential support services and enable them to facilitate access to further specialised treatment.

Senior author, Professor Rona Moss-Morris is Digital Therapies theme lead at NIHR Maudsley BRC and Professor Psychology as Applied to Medicine at King’s College London.

The researcher said: “Accessing psychological therapies which are tailored to the needs of people with long-term conditions is challenging for both the patient (due to time, travel, and/or mobility) and healthcare providers (due to treatment costs and availability of adequately trained therapists).

“As a CE-marked digital therapy with minimal therapist input, COMPASS offers a potential solution to overcome some of these challenges, whilst being an effective intervention to reduce psychological distress.”

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