Depression and anxiety in long-term conditions – the RE-EDITT project

Prof Rona Moss-Morris, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, blogs about developing online CBT treatments for anxiety and depression in people with long-term conditions.

Research shows that around 30% of people with a physical long-term condition (LTC) also have a mental health problem. Cognitive Behaviour Therapy (CBT) is recommended by NICE to treat mental health conditions, including anxiety or depression. There is increasing evidence to show that CBT delivered on the web, with some guided therapist support, is an effective way of delivering these therapies to a wider group of patients (Andersson et al., 2014). However, these treatments in their current form may not be as applicable for the growing number of patients whose anxiety or depression is linked to having a LTC. This is because the reasons for the depression and/or anxiety may be different to when a patient has a primary mental health disorder. This is illustrated nicely in the quote below where a patient describes how her feelings of worthlessness are related to a recent increase in disability.

[Image: The RE-EDITT research team, l-r, Jo Hudson, Professor Rona Moss Morris, and Zoë Moon.]

So, of course I don’t feel as worthy as I did before in that sense, if you know what I mean... And I don’t align that with depression. I think it’s just a realistic assessment of my situation.

This quote comes from a study by Daniel Hind and colleagues in 2010, where they tested the acceptability of online CBT for depression in patients with Multiple Sclerosis (MS). Patients felt the standard programs for depression did not acknowledge the interaction between their MS and their depression. A similar study by the same group in 2011 found poor uptake of the therapy from people with MS even when their scores on a self-report questionnaire suggested they were depressed. Studies such as these suggest CBT should be adapted for the specific needs of patients with LTCs. 

The RE-EDITT project

This is where the RE-EDITT project comes in. RE-EDDITT is part of the King’s Health Partners Mind & Body Programme, which has placed integrating mental and physical healthcare at the top of the agenda in our hospital trusts. The project is led by Professor Rona Moss-Morris, Dr Joanna Hudson, Dr Katherine Rimes and Dr Zoe Moon, all clinical health psychology researchers at King’s College London.  The team has close links with the King’s Health Partners Southwark and Lambeth Improving Access to Psychological Therapies (LTC) services.

The aim of Re-EDITT is to develop an online CBT treatment for anxiety and depression in people with long-term conditions. To do this, we will review the literature on understanding distress in LTCs, including work we have done on adjustment to MS, inflammatory bowel disease and end stage renal disease. This information will be used to alter current evidenced based CBT treatments for anxiety and depression so that it is more specific to people with LTCs. For instance, patients often feel anxiety because of the uncertainty about whether their illness may progress or not. To help with this we will develop an anxiety module specifically around managing uncertainty. The work will develop iteratively alongside an expert advisory panel made up of people with different LTCs and other psychologists who specialise in psychological treatment for people with LTCs. Feedback from the expert group will be used to modify and revise early drafts.

We will also work with our colleagues across King’s Health Partners, particularly the Southwark and Lambeth Improving Access to Psychological Therapies (IAPT) services, to make sure that the treatments being developed can be supported by them further along the track. Re-EDITT will explore the best way for patients to enter and progress through the treatment by linking with our Mind & Body partners, the IMPARTS (Integrating Mental and Physical Healthcare: Research, Training and Services) screening programme, as well as IAPT,  clinical health psychology and liaison psychiatry. 

[Image: A Patient, Public Involvement (PPI) meeting with the RE-EDITT team.]

Our other important partner is SPIKA, a technical agency which focuses on writing software solutions to create engagement, build relationships, enhance wellbeing and boost performance. SPIKA will create the interactive software for our online programme.  The initial programme will be generic – i.e. it will broadly focus on anxiety and/or depression in the context of having any LTC.  Once we have this generic platform, we will work over the next few years to develop disease specific versions e.g. for MS, coronary heart disease, or asthma, so that the relevance of the treatment is maximised. 

This pioneering project has the potential to make a real difference to people struggling with adjustment to long-term conditions.  We are very excited about the projects potential and being part of the ground-breaking Mind & Body Programme.