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

A study from King’s College London shows that the COMPASS programme is effective in helping people develop strategies to manage stressors related to living with a long-term condition

20th February 2024 about a 4 minute read
“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.” Federica Picariello, research associate, King's College London

Digital cognitive behavioural therapy (CBT), guided by a therapist, can reduce symptoms of distress in people with long-term health conditions, research has found.

The study, carried out by King’s College London and published in Psychological Medicine, found that 89% of participants showed a significant reduction in psychological distress (a combined score of anxiety and depression) within 12 weeks.

The researchers recruited 194 patients through charities such as Crohn’s & Colitis UK, Kidney Care UK, MS Society, and Psoriasis Association. They were divided into two groups, of whom half received the COMPASS programme. Both groups continued to access their usual charity support.

Nearly nine in 10 of those who received COMPASS showed a clinically significant improvement in distress, compared to 45% of the control group.

As well as improvements in anxiety and depression, COMPASS participants experienced an improved ability to undertake daily activities, a reduction in illness-specific distress and a better quality of life.

Participants complete interactive sessions at home

The study is the first randomised controlled trial (RCT) to measure the effectiveness of COMPASS for managing anxiety and depression in people with a long-term condition. Using interactive pathways tailored to the individual’s needs, the programme helps individuals manage their symptoms of anxiety and depression and build strategies to manage stressors associated with living with a long-term condition, such as relapses or unpleasant treatments.

During the 12-week programme, participants could complete any of the 11 interactive digital COMPASS sessions at home and receive up to five 30-minute support calls with their therapist.

Dr Katrin Hulme, a research associate at King’s and joint first author of the study, said: “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.”

Hulme’s joint first author, Dr Federica Picariello, also a research associate at King’s, 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.”

Children with language disorder need more support

While the research shows positive outcomes for adults with long-term conditions, another group, young people with language disorder, are being neglected, researchers have argued.

In a comment piece in The Lancet Child and Adolescent Health, researchers at University College London, argue that children with developmental language disorder (DLD) are roughly twice as likely to experience poor mental health by adolescence as their peers. Between 40% and 66% of young people referred to child and adolescent mental health services (CAMHS) have language difficulties.

The researchers made several recommendations:

  • Raising awareness of DLD among all health-care professionals so they can refer children who are not developing as expected for further evaluation by speech-language therapists
  • Language interventions that target language skills that specifically support social and emotional understanding
  • Language interventions that include support and guidance for conversation partners and significant others
  • Adaptations to existing mental health interventions, such as cognitive behavioural therapy, to make them more accessible to young people with DLD

The UCL team, led by Professor Courtenay Norbury wrote: “There is an urgent need to address inequality in access to health services, especially mental health provision for young people with DLD. To overcome this gap, we must increase awareness of DLD, develop and test novel interventions, and amplify the voices of affected young people through international interventions.”

FCC Insight

The King’s study is the first large-scale RCT to measure the effectiveness of COMPASS, an online therapy programme, in treating depression and anxiety among people with long-term health conditions. The results are highly promising, showing that those who participated in the programme were twice as likely to see an alleviation of their symptoms as the control group. People with chronic conditions are at high risk of mental health problems and, at a time when demand for mental health services is soaring, a digital programme such as COMPASS, accompanied by support calls with a therapist, could be an effective and cost-efficient way of meeting that demand. At the same time, UCL researchers are right to call for better mental health support for an overlooked group, namely children and adolescents with development language disorder. This group is twice as likely to experience mental health problems as their peers, but they are not receiving the support they need, further worsening their difficulties in school and socially.