Transitioning Transdiagnostic CBT from Face-to-Face to Telephone Delivery During the Coronavirus Pandemic: A Case Study

Abstract

The coronavirus pandemic led to worldwide disruption in the delivery of face-to-face mental health services. This impact was marked for individuals with long-term health conditions and comorbid depression and anxiety. Many face-to-face mental health services switched to remote delivery or paused therapeutic input entirely, despite the lack of research on the efficacy of switching between modalities mid-therapy or having breaks in therapy. This paper presents the case of a patient with long-term health conditions who experienced both breaks in therapy and a switch in modalities from face-to-face to telephone delivery. The intervention used was based on transdiagnostic cognitive behavioral therapy and self-report measures were completed at the beginning and end of the twelve sessions. Despite the shift in modalities, the patient experienced clinically significant recovery on all measures, indicating the efficacy of therapy was not greatly affected by the shift in modalities. Long breaks in therapy were linked to deterioration in mental health, although this could be due to the deterioration in physical health that necessitated these breaks. This case highlights the benefits and challenges of a shifting modality of therapy during treatment and in response to a pandemic for a shielding population. From the work presented here, it seems beneficial for services to be able to work across multiple modalities to suit the needs of the patients and ensure continuity of treatment. It also indicates that pauses in therapy may risk deterioration. Further work is needed to prevent digital exclusion of patients.

Improving access to psychological therapies: Analysis of effects associated with remote provision during COVID‐19

“…Nevertheless, patients who received remote therapy had a greater reduction in symptoms of anxiety and depression than those who received face-to-face treatment pre-COVID-19 even after controlling for age, gender, type of therapy and therapist category. Previous research has noted that remote psychological therapy is an effective format through which to deliver treatment (Berryhill et al, 2019;Saunders & Allen, 2021), which may also have been the case in the present cohort, but we cannot know given the design. Previous analyses have compared the outcomes of patients who received treatment within IAPT pre-COVID-19 and during COVID-19.…”

“…To date, very little is known about the effectiveness of remote therapy during COVID‐19 within the context of Improving Access to Psychological Therapies (IAPT) Services. To our knowledge, there are only two published studies assessing the effectiveness of remote therapy within IAPT services (Nguyen et al, 2022; Saunders & Allen, 2021). Saunders and Allen (2021) conducted a case study assessing the effectiveness of remote therapy delivery within IAPT services during COVID‐19, which highlighted that following 12 sessions of telephone CBT the patient experienced clinically significant changes in symptoms of anxiety and depression.…”

“…To our knowledge, there are only two published studies assessing the effectiveness of remote therapy within IAPT services (Nguyen et al, 2022; Saunders & Allen, 2021). Saunders and Allen (2021) conducted a case study assessing the effectiveness of remote therapy delivery within IAPT services during COVID‐19, which highlighted that following 12 sessions of telephone CBT the patient experienced clinically significant changes in symptoms of anxiety and depression. More recently, Nguyen et al (2022) compared the outcomes of remote therapy delivered during COVID‐19 with face‐to‐face treatment prior to COVID‐19 in two London IAPT services.…”

CBT treatment delivery formats for panic disorder: a systematic review and network meta-analysis of randomised controlled trials

“…Cognitive-behavioural therapy (CBT) is the most viable and recommended psychological treatment for panic disorder (American Psychiatric Association, 2009 ; NICE, 2011 ; Papola et al, 2022 ). The last decades saw an important growth of demand for it (Kaczkurkin & Foa, 2015 ), an increase in waiting lists (Saunders & Allen, 2021 ), and consequently, pressure for more accessible and efficient forms of treatment delivery. On the other hand, the delivery of CBT may be hampered by difficulties in treatment delivery common to all forms of psychotherapies.…”

“…Ranking CBT delivery formats based on their efficacy on panic symptomatology is of critical importance for the future of mental health care system resources, optimisation, and organisation. This especially holds true at the dawn of the post-corona era, since it is unclear how the pandemic will impact services and public mental health in the long-term (Saunders & Allen, 2021 ).…”