Enhancing outcomes of Cognitive Behavioural Therapy for anxiety and depression using between-session support

Millions of people in the UK struggle with anxiety and depression. These problems have a large negative impact on our physical and mental health and are costly in financial terms and to society.

The most common psychological treatment for anxiety and depression is Cognitive Behavioural Therapy, or CBT. There is strong evidence that CBT is effective for these problems. NHS Talking Therapies are the main provider of mental health treatments in England, including CBT.

In 2021/22 they treated 664,000 people. Just over half recovered, and around two-thirds showed at least some improvement. However, many do not benefit.

One reason for this is that many people leave treatment after just 2-4 sessions, whereas UK guidelines recommend 6-12 sessions to be effective.

Whilst CBT is a 'talking' therapy, it also involves practical tasks that are vital for overcoming problems. For example, someone anxious about social situations might learn strategies for chatting with others. Patients are encouraged to practise what they have learned between therapy sessions.

However, many patients struggle with this. It is hard to remember and apply what you have learned, especially if anxiety and depression reduce your concentration and motivation. Unfortunately, patients do not typically receive any support from their therapist between sessions. Lack of such support could be a major contributor to patients leaving early.

Currently, we know little about what patients do between sessions, how they use their learning, what they find helpful or difficult, and how this impacts their progress. We need to understand this so we can design ways to support patients between sessions, using efficient digital methods. Aims To enhance the benefits of CBT by:

1) Understanding how patients work on their treatment between sessions and how this links to treatment progress 2) Providing patients with between-session digital support 3) Evaluating the impact of this support Methods Phase 1: What do people do between sessions?

An online study of patients receiving CBT for anxiety or depression. I will ask how participants worked on their treatment between recent sessions, and relate participants' responses to their treatment progress. I will also interview participants about their between-session experiences. Phase 2: What should support look like?

A package of between-session digital support, developed together with patients and therapists. This might include encouragement, guidance in taking action and reminders, using text messages or emails. The Phase 1 results will help determine what is most likely to support patients in reducing anxiety and depression.

Phase 3: Is the between-session support package practical and value-for-money?

A preliminary study to compare enhanced CBT using the new between-session support, with standard CBT. This study will test if the between-session support is possible to deliver, helpful to patients, and if it shows promising results. I will measure how much it costs and interview participants about their experiences. The results will show if a future larger study should go ahead and inform how to do this.

Impact

This research could help many patients achieve bigger reductions in anxiety and depression in a shorter time. It aims to help patients complete a full course of therapy instead of leaving early. It will provide crucial information for patients, carers and families about how best to use the time between sessions. Results will be shared with patients and their families, therapists, NHS organisations, researchers and the wider public.