A cognitive–behavioural therapy programme for managing depression and anxiety in long-term physical health conditions: mixed-methods real-world evaluation of the COMPASS programme

TY - JOUR

T1 - A cognitive–behavioural therapy programme for managing depression and anxiety in long-term physical health conditions: mixed-methods real-world evaluation of the COMPASS programme

AU - Seaton, Natasha

AU - Moss-Morris, Rona

AU - Hulme, Katrin

AU - Macaulay, Hannah

AU - Hudson, Joanna

N1 - Funding Information: The authors gratefully express their appreciation to the clinical and administrative staff at the London IAPT service and the secondary care services, whose support and guidance enabled the project. Publisher Copyright: © The Author(s), 2023.

PY - 2023/8/11

Y1 - 2023/8/11

N2 - Background Mental health comorbidities are common in physical long-term health conditions. Aims We evaluate the effectiveness of COMPASS, a therapist-supported, digital cognitive–behavioural therapy programme specifically designed to treat anxiety/depression in the context of long-term conditions. We also investigate patient experiences of the programme. Method We utilised a mixed-methods, non-randomised design. We analysed pre–post data from 76 patients with long-term conditions who were receiving psychological treatment (COMPASS) via local NHS services, using paired sample t-tests and Cohen’s d, with depression, anxiety, distress and functional impairment self-report scales. Qualitative interviews explored patients’ experiences of using COMPASS. Twenty-one semi-structured interviews were completed and underwent inductive thematic analysis. Results Patients who received COMPASS had significantly reduced depression (−2.47, 95% CI −3.7 to −1.3, P < 0.001; Cohen’s d = −0.376), anxiety (−2.30, 95% CI −3.6 to −1.2, P < 0.001; Cohen’s d = −0.420) and psychological distress (−4.87, 95% CI −7.0 to −2.7, P < 0.001; Cohen’s d = −0.422) and significantly improved functional impairment (−3.00, 95% CI −4.8 to −1.2, P ≤ 0.001; Cohen’s d = −0.282). Effect sizes were larger when analyses included only patients with clinically significant baseline symptoms: depression (−4.02, 95% CI −5.6 to −2.5, P < 0.001; Cohen’s d = −0.701), anxiety (−3.60, 95% CI −5.3 to −1.9, P < 0.001; Cohen’s d = −0.739), psychological distress (−5.58, 95% CI −7.9 to −3.2, P < 0.001; Cohen’s d = −0.523), functional impairment (−3.28, 95% CI −5.4 to −1.1, P ≤ 0.001; Cohen’s d = −0.355). Qualitative analysis yielded two meta-themes: engagement and integration of mental and physical health. Conclusions Results suggest that COMPASS is effective in NHS settings, and is acceptable to patients. Content tailored to long-term conditions, therapist support and clear delivery strategies should be priori-tised to aid intervention implementation.

AB - Background Mental health comorbidities are common in physical long-term health conditions. Aims We evaluate the effectiveness of COMPASS, a therapist-supported, digital cognitive–behavioural therapy programme specifically designed to treat anxiety/depression in the context of long-term conditions. We also investigate patient experiences of the programme. Method We utilised a mixed-methods, non-randomised design. We analysed pre–post data from 76 patients with long-term conditions who were receiving psychological treatment (COMPASS) via local NHS services, using paired sample t-tests and Cohen’s d, with depression, anxiety, distress and functional impairment self-report scales. Qualitative interviews explored patients’ experiences of using COMPASS. Twenty-one semi-structured interviews were completed and underwent inductive thematic analysis. Results Patients who received COMPASS had significantly reduced depression (−2.47, 95% CI −3.7 to −1.3, P < 0.001; Cohen’s d = −0.376), anxiety (−2.30, 95% CI −3.6 to −1.2, P < 0.001; Cohen’s d = −0.420) and psychological distress (−4.87, 95% CI −7.0 to −2.7, P < 0.001; Cohen’s d = −0.422) and significantly improved functional impairment (−3.00, 95% CI −4.8 to −1.2, P ≤ 0.001; Cohen’s d = −0.282). Effect sizes were larger when analyses included only patients with clinically significant baseline symptoms: depression (−4.02, 95% CI −5.6 to −2.5, P < 0.001; Cohen’s d = −0.701), anxiety (−3.60, 95% CI −5.3 to −1.9, P < 0.001; Cohen’s d = −0.739), psychological distress (−5.58, 95% CI −7.9 to −3.2, P < 0.001; Cohen’s d = −0.523), functional impairment (−3.28, 95% CI −5.4 to −1.1, P ≤ 0.001; Cohen’s d = −0.355). Qualitative analysis yielded two meta-themes: engagement and integration of mental and physical health. Conclusions Results suggest that COMPASS is effective in NHS settings, and is acceptable to patients. Content tailored to long-term conditions, therapist support and clear delivery strategies should be priori-tised to aid intervention implementation.

KW - Anxiety Disorders

KW - Cognitive-behavioural therapy

KW - Comorbidities

KW - Depressive Disorder

KW - QUALITATIVE RESEARCH

UR - http://www.scopus.com/inward/record.url?scp=85182172722&partnerID=8YFLogxK

U2 - https://doi.org/10.1192/bjo.2023.519

DO - https://doi.org/10.1192/bjo.2023.519

M3 - Article

SN - 2056-4724

VL - 9

SP - e153

JO - BJPsych Open

JF - BJPsych Open

IS - 5

M1 - e153

ER -