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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
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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

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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
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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

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