Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T07:42:58.309Z Has data issue: false hasContentIssue false
  • English
  • Français

The use of transdiagnostic cognitive behavioural therapy for a patient with multi-morbidity: a case study

Published online by Cambridge University Press:  21 April 2020

Lisa Walshe Open the ORCID record for Lisa Walshe [Opens in a new window]  and
Chris Allen
Lisa Walshe*
Affiliation:
Berkshire Healthcare NHS Foundation Trust
Chris Allen
Affiliation:
Berkshire Healthcare NHS Foundation Trust
*
*Corresponding author. Email: lisa.walshe@berkshire.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Multi-morbidity, having more than two diagnosed health conditions, is becoming increasingly common within healthcare services. Approximately one third of these patients are likely to have a mental health condition. Those with multi-morbidity with physical and mental health conditions have poorer outcomes in terms of their health, increased mortality rates, and higher usage of healthcare services.

This paper presents a case of a patient with multi-morbidity, with associated mental health conditions of anxiety and depression. She was seen as part of an integrated service which provides psychological support at home alongside the nursing team. The intervention used was based on transdiagnostic cognitive behavioural therapy (tCBT), provided over nine initial sessions and two additional booster sessions. Self-report measures were completed at intervals throughout the intervention and at follow-up. Improvements on the depression and anxiety measures were seen over the initial nine sessions, followed by a relapse at the 3-month follow-up. This was the result of a deterioration in physical health which led to a deterioration in mental health. The booster sessions mitigated further deterioration in mental health, despite the physical health worsening during this time.

This case suggests that tCBT can be helpful in reducing anxiety and depression in people with multi-morbidity. However, additional booster sessions may be required as further physical deterioration can re-trigger core beliefs and result in further mental health problems.

Key learning aims

  1. (1) Transdiagnostic CBT can be beneficial for patients with multi-morbidity.

  2. (2) Integrated care addressing both physical and mental health problems is beneficial for people with multi-morbidity.

  3. (3) Monitoring deterioration in physical health is important, as this has an impact on mental health and may need addressing through psychological support.

  4. (4) Formulation for people with multi-morbidity needs to include mental and physical health factors and their interaction.

Keywords

case formulationCBThealth anxietymixed anxiety-depression disorder
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e9
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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

Bennett, S. D., Heyman, I., Varadkar, S., & Coughtrey, A. E. (2017). Simple or complex? A case study of physical and mental health co-morbidity. Cognitive Behavioural Therapist, 10, e18.CrossRefGoogle Scholar
Cassell, A., Edwards, D., Harshfield, A., Rhodes, K., Brimicombe, J., Payne, R., & Griffin, S. (2018). The epidemiology of multimorbidity in primary care: a retrospective cohort study. British Journal of General Practice, 68, e245–251.CrossRefGoogle ScholarPubMed
Cully, J. A., Stanley, M. A., Petersen, N. J., Hundt, N. E., Kauth, M. R., Naik, A. D., … & Kunik, M. E. (2017). Delivery of brief cognitive behiavoural therapy for medically ill patients in primary care: a pragmatic randomised clinical trial. Journal of General Internal Medicine, 32, 1014–1024.CrossRefGoogle Scholar
Dear, B. F., Fogliati, V. J., Fogliati, R., Gandy, M., McDonald, S., Talley, N., … & Jones, M. (2018). Transdiagnostic internet-delivered cognitive-behaviour therapy (CBT) for adults with functional gastrointestinal disorders (FGID): a feasibility open trial. Journal of Psychosomatic Research, 108, 61–69.CrossRefGoogle ScholarPubMed
Hague, B., Scott, S., & Kellett, S. (2015). Transdiagnostic CBT treatment of co-morbid anxiety and depression in an older adult: single case experimental design. Behavioural and Cognitive Therapy, 43, 119–124.Google Scholar

References

Barlow, D. H., Allen, L. B., & Choate, M. L. (2016). Toward a unified treatment for emotional disorders – republished. Behaviour Therapy, 47, 838–853.CrossRefGoogle Scholar
Baxter, S., Johnson, M., Chambers, D., Sutton, A., Goyder, E., & Booth, A. (2018). Understanding new models of integrated care in developed countries: a systematic review. Health Services and Delivery Research, doi: 10.3310/hsdr06290.CrossRefGoogle ScholarPubMed
Beecham, J., & Knapp, M. (1992). Costing psychiatric interventions. In Thornicroft, G., Brewin, C., & Wing, J., Measuring Mental Health Needs (pp. 200–224). London, UK: Gaskell.Google Scholar
Carney, R. M., Freedland, K. E., & Sheps, D. S. (2004). Depression is a risk for mortality in coronary heart disease. Psychosomatic Medicine, 66, 799–801.CrossRefGoogle ScholarPubMed
Cassell, A., Edwards, D., Harshfield, A., Rhodes, K., Brimicombe, J., Payne, R., & Griffin, S. (2018). The epidemiology of multimorbidity in primary care: a retrospective cohort study. British Journal of General Practice, 68, e245–251.CrossRefGoogle ScholarPubMed
Clark, D., & Oates, M. (2014). Improving Access to Psychological Therapies: Measuring Improvement and Recovery. Adult Services. NHS England.Google Scholar
Coventry, P., Lovell, K., Dickens, C., Bower, P., Chew-Graham, C., McElvenny, D., … & Gask, L. (2015). Integrated primary care for patients wtih mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients wtih depression comorbid with diabetes or cardiovascular disease. BMJ, 350, h638.CrossRefGoogle ScholarPubMed
Cowles, M., & Nightingale, J. (2015). Diagnosis-specific CBT as a stepping stone to transdiagnostic CBT in a complex case. Cognitive Behaviour Therapist, 8, e18.CrossRefGoogle Scholar
Cully, J. A., Stanley, M. A., Petersen, N. J., Hundt, N. E., Kauth, M. R., Naik, A. D., … & Kunik, M. E. (2017). Delivery of brief cognitive behiavoural therapy for medically ill patients in primary care: a pragmatic randomised clinical trial. Journal of General Internal Medicine, 32, 1014–1024.CrossRefGoogle Scholar
Dear, B. F., Fogliati, V. J., Fogliati, R., Gandy, M., McDonald, S., Talley, N., … & Jones, M. (2018). Transdiagnostic internet-delivered cognitive-behaviour therapy (CBT) for adults with functional gastrointestinal disorders (FGID): a feasibility open trial. Journal of Psychosomatic Research, 108, 61–69.CrossRefGoogle ScholarPubMed
Dombrovski, A. Y., Mulsant, B. H., Houck, P. R., Mazumdar, S., Lenze, E. J., Andreescu, C., … & Reynolds, C. F. III (2007). Residual symptoms and recurrence during maintenance treatment of late-life depression. Journal of Affective Disorders, 103, 77–82.CrossRefGoogle ScholarPubMed
Hague, B., Scott, S., & Kellett, S. (2015). Transdiagnostic CBT treatment of co-morbid anxiety and depression in an older adult: single case experimental design. Behavioural and Cognitive Therapy, 43, 119–124.Google Scholar
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. New York, USA: Guilford Press.Google Scholar
Hjerl, K., Andersen, E. W., Keiding, N., Mouridsen, H. T., Mortensen, P. B., & Jorgensen, T. (2003). Depression as a prognostic factor for breast cancer mortality. Psychosomatics, 44, 24–30.CrossRefGoogle ScholarPubMed
Kingston, A., Robinson, L., Booth, H., Knapp, M., & Jagger, C. (2018, March 20). Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age and Ageing, 47, 374–380.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Laidlaw, K., Thompson, L. W., & Gallagher-Thompson, D. (2004). Comprehensive conceptualization of cognitive behaviour therapy for late life depression. Behavioural and Cognitive Psychotherapy, 4, 389–899.CrossRefGoogle Scholar
Mental Health Taskforce (2016). The Five Year Forward View for Mental Health. Mental Health Taskforce.Google Scholar
Mohlman, J., Cedeno, L. A., Price, R. B., Hekler, E. B., Yan, G. W., & Fishman, D. B. (2008). Deconstructing demons: the case of Geoffrey. Pragmatic Case Studies in Psychotherapy, 4, 1–39.CrossRefGoogle Scholar
Monitor (2014, May 27). Delivering better integrated care. Retrieved from: https://www.gov.uk/guidance/enabling-integrated-care-in-the-nhsGoogle Scholar
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110.CrossRefGoogle ScholarPubMed
Rector, N. A., Man, V., & Lerman, B. (2014). The expanding cognitive-behavioural therapy treatment umbrella for the anxiety disorders: disorder-specific and transdiagnostic approaches. Canadian Journal of Psychiatry, 59, 301–309.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J., & Lowe, B. (2006). A brief measure for assessing generalised anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle Scholar
Uijen, A., & Lisdonk, E. (2008). Multimorbidity in primary care: prevalence and trends over the last 20 years. In European Journal of General Practice, pp. 28–32. Taylor & Francis.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.