Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-14T16:39:57.323Z Has data issue: false hasContentIssue false
  • English
  • Français

Acceptability and effectiveness of CBT and psychologically based interventions for emergency department attenders with medical complaints: a systematic literature review

Published online by Cambridge University Press:  01 December 2022

Sally McGuire Open the ORCID record for Sally McGuire [Opens in a new window] ,
Mashal Hajar Safi  and
Jo Daniels Open the ORCID record for Jo Daniels [Opens in a new window]
Sally McGuire
Affiliation:
Avon and Wiltshire Partnership NHS Trust, Bristol, UK Department of Psychology, University of Bath, Bath, UK
Mashal Hajar Safi
Affiliation:
Department of Psychology, University of Bath, Bath, UK
Jo Daniels*
Affiliation:
Department of Psychology, University of Bath, Bath, UK
*
*Corresponding author. Email: j.daniels@bath.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

This systematic literature review surveyed the evidence for the acceptability and effectiveness of CBT and psychologically based interventions for emergency department (ED) attenders with physical health complaints as their primary concern, in light of over-burdened EDs and the existing evidence base for psychological interventions in other medical settings. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018087860). A systematic search of three databases (APAPsychNet, Cochrane and PubMed) was performed to identify psychological treatment studies targeting physical health problems presenting in the ED, with broad inclusion criteria to capture a coherent understanding of the current knowledge base. A total of 2606 potential studies for inclusion were identified; 45 proceeded to full review. Twenty papers met the full inclusion. Included studies covered four clinical areas: trauma/PTSD-prevention, panic attacks, non-cardiac chest-pain and miscellaneous. A narrative description of findings reflected positive outcomes across all groups, but this was not consistent across any group. Few studies measured ED attendance (20%) or satisfaction/acceptability (10%). The majority of studies (90%) were underpinned by a cognitive behavioural framework, consistent with the current evidence base as applied to the management of medical conditions. Findings suggest there is some evidence that interventions in the ED are effective and acceptable to patients, but interpretation of findings is limited by the mixed quality of designs and risk of bias.

Key learning aims

  1. (1) To understand the current body of evidence for the feasibility and effectiveness of psychological interventions in the emergency department.

  2. (2) To gain a clear understanding of the models and format of the delivery of CBT and psychological interventions in an acute setting.

  3. (3) To identify gaps in the evidence to inform future development of CBT-based interventions to improve outcomes and clinical care.

Keywords

accident and emergencyCBTemergency departmentpsychological interventionssystematic review
Type
Review Paper
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e51
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Blane, D., Williams, C., Morrison, J., Wilson, A., & Mercer, S. (2013). Cognitive behavioural therapy: why primary care should have it all. British Journal of General Practice, 63, 103–104. https://doi.org/10.3399/bjgp13x663235 CrossRefGoogle Scholar
Daniels, J., Griffiths, M., & Fisher, E. (2019b). Assessment and management of recurrent abdominal pain in the emergency department. Emergency Medicine Journal. https://doi.org/10.1136/emermed-2019-209113 CrossRefGoogle Scholar
Witt, K. (2017). The use of emergency department-based psychological interventions to reduce repetition of self-harm behaviour. The Lancet Psychiatry, 4, 428–429. https://doi.org/10.1016/s2215-0366(17)30152-9 CrossRefGoogle ScholarPubMed

References

Abbass, A., Campbell, S., Magee, K., & Tarzwell, R. (2009). Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre–post intervention study. Canadian Journal of Emergency Medicine, 11, 529–534. https://doi.org/10.1017/s1481803500011799 CrossRefGoogle ScholarPubMed
Balabanovic, J., & Hayton, P. (2020). Engaging patients with ‘medically unexplained symptoms’ in psychological therapy: an integrative and transdiagnostic approach. Psychology and Psychotherapy, 93, 347–366. https://doi.org/10.1111/papt.12213 CrossRefGoogle ScholarPubMed
Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20, 261–282. https://doi.org/10.1016/s0005-7894(89)80073-5 CrossRefGoogle Scholar
Brunet, A., des Groseilliers, I. B., Cordova, M. J., & Ruzek, J. I. (2013). Randomized controlled trial of a brief dyadic cognitive-behavioral intervention designed to prevent PTSD. European Journal of Psychotraumatology, 4, 21572. https://doi.org/10.3402/ejpt.v4i0.21572 CrossRefGoogle Scholar
Carroll, S., Moss-Morris, R., Hulme, K., & Hudson, J. (2021). Therapists’ perceptions of barriers and facilitators to uptake and engagement with therapy in long-term conditions. British Journal of Health Psychology, 26, 307–324.CrossRefGoogle ScholarPubMed
Chambers, J. B., Marks, E., Knisley, L., & Hunter, M. (2013). Non-cardiac chest pain: time to extend the rapid access chest pain clinic? International Journal of Clinical Practice, 67, 303–306. https://doi.org/10.1111/ijcp.12030 CrossRefGoogle ScholarPubMed
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18. https://doi.org/10.1037//0022-006x.66.1.7 CrossRefGoogle ScholarPubMed
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470. https://doi.org/10.1016/0005-7967(86)90011-2 CrossRefGoogle ScholarPubMed
Coster, J. E., Turner, J. K., Bradbury, D., & Cantrell, A. (2017). Why do people choose emergency and urgent care services? A rapid review utilizing a systematic literature search and narrative synthesis. Academic Emergency Medicine, 24, 1137–1149. https://doi.org/10.1111/acem.13220 CrossRefGoogle ScholarPubMed
Damian, A. J., & Gallo, J. J. (2018). Models of care for populations with chronic conditions and mental/behavioral health comorbidity. International Review of Psychiatry, 30, 157–169. https://doi.org/10.1080/09540261.2019.1568233 CrossRefGoogle ScholarPubMed
Daniels, J., Griffiths, M., & Fisher, E. (2019). Assessment and management of recurrent abdominal pain in the emergency department. Emergency Medicine Journal. https://doi.org/10.1136/emermed-2019-209113 CrossRefGoogle Scholar
Daniels, J., Ingram, J., Pease, A., Wainwright, E., Beckett, K., Iyadurai, L., Harris, S., Donnelly, O., Roberts, T., & Carlton, E. (2021). The COVID-19 Clinician Cohort (CoCCo) study: empirically grounded recommendations for forward-facing psychological care of frontline doctors. International Journal of Environmental Research and Public Health, 18, 9675. https://doi.org/10.3390/ijerph18189675 CrossRefGoogle ScholarPubMed
Daniels, J., Osborn, M., & Davis, C. (2017). Better safe than sorry? Frequent attendance in a hospital emergency department: an exploratory study. British Journal of Pain, 12, 10–19. https://doi.org/10.1177/2049463717720635 CrossRefGoogle Scholar
Daniels, J., & Sheils, E. (2017). A complex interplay: cognitive behavioural therapy for severe health anxiety in Addison’s disease to reduce emergency department admissions. Behavioural and Cognitive Psychotherapy, 45, 419–426. https://doi.org/10.1017/s1352465817000182 CrossRefGoogle ScholarPubMed
Des Groseilliers, I. B., Marchand, A., Cordova, M. J., Ruzek, J. I., & Brunet, A. (2013). Two-year follow-up of a brief dyadic cognitive-behavioral intervention designed to prevent PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 462–469. https://doi.org/10.1037/a0031967 CrossRefGoogle Scholar
Di Bona, L., Saxon, D., Barkham, M., Dent-Brown, K., & Parry, G. (2014). Predictors of patient non-attendance at Improving Access to Psychological Therapy services demonstration sites. Journal of Affective Disorders, 169, 157–164.CrossRefGoogle ScholarPubMed
Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2015). Overcrowding in emergency department: an international issue. Internal and Emergency Medicine, 10, 171–175. https://doi.org/10.1007/s11739-014-1154-8 CrossRefGoogle ScholarPubMed
Foster, Dr (2018). High intensity users: reducing the burden on accident & emergency departments. https://www.telstrahealth.com/content/dam/telstrahealth/pdf-downloads/Dr-Foster_High-Intensity-Users-Report.pdf Google Scholar
Dyckman, J. M., Rosenbaum, R. L., Hartmeyer, R. J., & Walter, L. J. (1999). Effects of psychological intervention on panic attack patients in the emergency department. Psychosomatics, 40, 422–427. https://doi.org/10.1016/s0033-3182(99)71207-7 CrossRefGoogle ScholarPubMed
Esler, J. L., Barlow, D. H., Woolard, R. H., Nicholson, R. A., Nash, J. M., & Erogul, M. H. (2003). A brief cognitive-behavioral intervention for patients with noncardiac chest pain. Behavior Therapy, 34, 129–148. https://doi.org/10.1016/s0005-7894(03)80009-6 CrossRefGoogle Scholar
Fordham, B., Sugavanam, T., Edwards, K., Stallard, P., Howard, R., das Nair, R., Copsey, B., Lee, H., Howick, J., Hemming, K., & Lamb, S. E. (2021). The evidence for cognitive behavioural therapy in any condition, population or context: a meta-review of systematic reviews and panoramic meta-analysis. Psychological Medicine, 51, 21–29. https://doi.org/10.1017/s0033291720005292 CrossRefGoogle ScholarPubMed
Higgins, J. P., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (eds). (2019). Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons.CrossRefGoogle Scholar
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research, 36, 427–440. https://doi.org/10.1007/s10608-012-9476-1 CrossRefGoogle ScholarPubMed
Holdsworth, E., Bowen, E., Brown, S., & Howat, D. (2014). Client engagement in psychotherapeutic treatment and associations with client characteristics, therapist characteristics, and treatment factors. Clinical Psychology Review, 34, 428–450. https://doi.org/10.1016/j.cpr.2014.06.004 CrossRefGoogle ScholarPubMed
Hunt, K. A., Weber, E. J., Showstack, J. A., Colby, D. C., & Callaham, M. L. (2006). Characteristics of frequent users of emergency departments. Annals of Emergency Medicine, 48, 1–8. https://doi.org/10.1016/j.annemergmed.2005.12.030 CrossRefGoogle ScholarPubMed
Iyadurai, L., Blackwell, S. E., Meiser-Stedman, R., Watson, P. C., Bonsall, M. B., Geddes, J. R., Nobre, A. C., & Holmes, E. A. (2017). Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial. Molecular Psychiatry, 23, 674–682. https://doi.org/10.1038/mp.2017.23 CrossRefGoogle Scholar
Kantor, V., Knefel, M., & Lueger-Schuster, B. (2017). Perceived barriers and facilitators of mental health service utilization in adult trauma survivors: a systematic review. Clinical Psychology Review, 52, 52–68. https://doi.org/10.1016/j.cpr.2016.12.001 CrossRefGoogle ScholarPubMed
Katz, D. A., Graber, M., Lounsbury, P., Vander Weg, M. W., Phillips, E. K., Clair, C., Horwitz, P. A., Cai, X., & Christensen, A. J. (2017). Multiple risk factor counseling to promote heart-healthy lifestyles in the chest pain observation unit: pilot randomized controlled trial. Academic Emergency Medicine, 24, 968–982. https://doi.org/10.1111/acem.13231 CrossRefGoogle ScholarPubMed
Lessard, M. J., Marchand, A., Pelland, M. V., Belleville, G., Vadeboncoeur, A., Chauny, J. M., Poitras, J., Dupuis, G., Fleet, R., Foldes-Busque, G., & Lavoie, K. L. (2011). comparing two brief psychological interventions to usual care in panic disorder patients presenting to the emergency department with chest pain. Behavioural and Cognitive Psychotherapy, 40, 129–147. https://doi.org/10.1017/s1352465811000506 CrossRefGoogle Scholar
Liebherz, S., Schmidt, N., & Rabung, S. (2016). How to assess the quality of psychotherapy outcome studies: a systematic review of quality assessment criteria. Psychotherapy Research, 26, 573–589. https://doi.org/10.1080/10503307.2015.1044763 CrossRefGoogle ScholarPubMed
Lynch, R. M. (2000). Regular attenders to the accident and emergency department. Emergency Medicine Journal, 17, 351–354. https://doi.org/10.1136/emj.17.5.351 CrossRefGoogle Scholar
Marchand, A., Belleville, G., Fleet, R., Dupuis, G., Bacon, S. L., Poitras, J., Chauny, J. M., Vadeboncoeur, A., & Lavoie, K. L. (2012). Treatment of panic in chest pain patients from emergency departments: efficacy of different interventions focusing on panic management. General Hospital Psychiatry, 34, 671–680. https://doi.org/10.1016/j.genhosppsych.2012.06.011 CrossRefGoogle ScholarPubMed
Marks, E. M., & Hunter, M. S. (2014). Medically unexplained symptoms: an acceptable term? British Journal of Pain, 9, 109–114. https://doi.org/10.1177/2049463714535372 CrossRefGoogle Scholar
McAndrew, L. M., Friedlander, M. L., Litke, D. R., Phillips, L. A., Kimber, J. M., & Helmer, D. A. (2019). Medically unexplained physical symptoms: why counseling psychologists should care about them. The Counseling Psychologist, 47, 741–769. https://doi.org/10.1177/0011000019888874 CrossRefGoogle Scholar
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal, 339, b2535. https://doi.org/10.1136/bmj.b2535 CrossRefGoogle ScholarPubMed
Mulder, R., Zarifeh, J., Boden, J., Lacey, C., Tyrer, P., Tyrer, H., Than, M., & Troughton, R. (2019). An RCT of brief cognitive therapy versus treatment as usual in patients with non-cardiac chest pain. International Journal of Cardiology, 289, 6–11. https://doi.org/10.1016/j.ijcard.2019.01.067 CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2011). Generalised anxiety disorder and panic disorder in adults: management. https://www.nice.org.uk/guidance/cg113 Google Scholar
National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder. https://www.nice.org.uk/guidance/ng116 Google Scholar
NHS England (2018). The Improving Access to Psychological Therapies (IAPT) Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms. National Health Service England. https://www.england.nhs.uk/publication/the-improving-access-to-psychological-therapies-iapt-pathway-for-people-with-long-term-physical-health-conditions-and-medically-unexplained-symptoms/ Google Scholar
NHS England (2019). The NHS long term plan. National Health Service England. https://www.england.nhs.uk/long-term-plan/ Google Scholar
Nuthall, A., & Townend, M. (2007). CBT-based early intervention to prevent panic disorder: a pilot study. Behavioural and Cognitive Psychotherapy, 35, 15. https://doi.org/10.1017/s1352465806003031 CrossRefGoogle Scholar
Pelland, M. V., Marchand, A., Lessard, M. J., Belleville, G., Chauny, J. M., Vadeboncoeur, A., Poitras, J., Foldes-Busque, G., Bacon, S. L., & Lavoie, K. L. (2011). Efficacy of 2 interventions for panic disorder in patients presenting to the ED with chest pain. American Journal of Emergency Medicine, 29, 1051–1061. https://doi.org/10.1016/j.ajem.2010.06.027 CrossRefGoogle Scholar
Pines, J. M., Asplin, B. R., Kaji, A. H., Lowe, R. A., Magid, D. J., Raven, M., Weber, E. J., & Yealy, D. M. (2011). Frequent users of emergency department services: gaps in knowledge and a proposed research agenda. Academic Emergency Medicine, 18, e64–e69. https://doi.org/10.1111/j.1553-2712.2011.01086.x CrossRefGoogle Scholar
Post, L. M., Michopoulos, V., Stevens, J. S., Reddy, R., Maples, J. L., Morgan, J. R., Rothbaum, A. O., Jovanovic, T., Ressler, K. J., & Rothbaum, B. O. (2017). Psychological and psychobiological responses to immediate early intervention in the emergency department: case report of one-session exposure therapy for the prevention of PTSD. Practice Innovations, 2, 55–65. https://doi.org/10.1037/pri0000043 CrossRefGoogle ScholarPubMed
Roberts, T., Daniels, J., Hulme, W., Hirst, R., Horner, D., Lyttle, M. D., Samuel, K., Graham, B., Reynard, C., Barrett, M., Foley, J., Cronin, J., Umana, E., Vinagre, J., & Carlton, E. (2021). Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study. BMJ Open, 11, e049680. https://doi.org/10.1136/bmjopen-2021-049680 CrossRefGoogle Scholar
Rothbaum, B. O., Houry, D., Heekin, M., Leiner, A. S., Daugherty, J., Smith, L. S., & Gerardi, M. (2008). A pilot study of an exposure-based intervention in the ED designed to prevent posttraumatic stress disorder. American Journal of Emergency Medicine, 26, 326–330. https://doi.org/10.1016/j.ajem.2007.07.006 CrossRefGoogle ScholarPubMed
Rothbaum, B. O., Kearns, M. C., Price, M., Malcoun, E., Davis, M., Ressler, K. J., Lang, D., & Houry, D. (2012). Early intervention may prevent the development of posttraumatic stress disorder: a randomized pilot civilian study with modified prolonged exposure. Biological Psychiatry, 72, 957–963. https://doi.org/10.1016/j.biopsych.2012.06.002 CrossRefGoogle ScholarPubMed
Royal College of Emergency Medicine (2017). Best Practice Guideline: Frequent Attenders in the Emergency Department. https://www.rcem.ac.uk/docs/RCEM%20Guidance/Guideline%20-%20Frequent%20Attenders%20in%20the%20ED%20(Aug%202017).pdf Google Scholar
Savioli, G., Ceresa, I. F., Gri, N., Bavestrello, P. G., Longhitano, Y., Zanza, C., Piccioni, A., Esposito, C., Ricevuti, G., & Bressan, M. A. (2022). Emergency department overcrowding: understanding the factors to find corresponding solutions. Journal of Personalized Medicine, 12, 279. https://doi.org/10.3390/jpm12020279 CrossRefGoogle ScholarPubMed
Swinson, R. P., Soulios, C., Cox, B. J., & Kuch, K. (1992). Brief treatment of emergency room patients with panic attacks. American Journal of Psychiatry, 149, 944–946.Google ScholarPubMed
Thornton, J. (2020). Covid-19: the challenge of patient rehabilitation after intensive care. British Medical Journal, 1787. https://doi.org/10.1136/bmj.m1787 CrossRefGoogle Scholar
Tyrer, P., Tyrer, H., Morriss, R., Crawford, M., Cooper, S., Yang, M., Guo, B., Mulder, R. T., Kemp, S., & Barrett, B. (2017). Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: a multicentre, randomised controlled trial. Open Heart, 4, e000582. https://doi.org/10.1136/openhrt-2016-000582 CrossRefGoogle ScholarPubMed
van Beek, M., Oude Voshaar, R., Beek, A., van Zijderveld, G., Visser, S., Speckens, A., Batelaan, N., & van Balkom, A. (2013). A brief cognitive-behavioral intervention for treating depression and panic disorder in patients with noncardiac chest pain: a 24-week randomized controlled trial. Depression and Anxiety, 30, 670–678. https://doi.org/10.1002/da.22106 CrossRefGoogle ScholarPubMed
Wilkinson, M., Venning, A., Redpath, P., Ly, M., Brown, S., & Battersby, M. (2019). Can low intensity cognitive behavioural therapy for non-cardiac chest pain presentations to an emergency department be efficacious? A pilot study. Australian Psychologist, 54, 494–501. https://doi.org/10.1111/ap.12424 CrossRefGoogle Scholar
Wu, K. K., Li, F. W., & Cho, V. W. (2014). A randomized controlled trial of the effectiveness of brief-cbt for patients with symptoms of posttraumatic stress following a motor vehicle crash. Behavioural and Cognitive Psychotherapy, 42, 31–47. https://doi.org/10.1017/s1352465812000859 CrossRefGoogle ScholarPubMed
Zatzick, D., O’Connor, S. S., Russo, J., Wang, J., Bush, N., Love, J., Peterson, R., Ingraham, L., Darnell, D., Whiteside, L., & van Eaton, E. (2015). Technology-enhanced stepped collaborative care targeting posttraumatic stress disorder and comorbidity after injury: a randomized controlled trial. Journal of Traumatic Stress, 28, 391–400. https://doi.org/10.1002/jts.22041 CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.