In new MQ-Funded research, Dr Colette Hirsch has developed a new online treatment targeting worry and rumination, which maintain anxiety and depression.
We all worry about the future and focus on negative events from the past from time-to-time, but when these ways of thinking become persistent, they can seriously damage our mental health. This often happens in people with anxiety and depression.
A new approach
Colette led this study at King’s College London. Her previous work has shown that worry and rumination come about because of a tendency to draw negative conclusions from unclear information.
When things happen to us, we can interpret what is happening in different ways. For example, feedback on a piece of work may be interpreted as a criticism or as a constructive opportunity to improve.
Colette’s theory suggested that a mental habit makes certain people more likely to interpret situations in a negative or threatening way – and might hold the key to understand how people get stuck in streams of negative thoughts like worry and rumination, which in turn lead to anxiety and depression. The theory suggested that correcting this unhelpful thinking habit could be a successful treatment for anxiety and depression.
Colette has been at the forefront of developing a new form of treatment called ‘cognitive bias modification for interpretation’ (CBM-I), which can be delivered online. In the treatment, a patient is presented with a number of short scenarios describing situations that can trigger worry or rumination, but that could be interpreted negatively or positively. Participants get repeated practice in resolving the situations in a more positive way, similar to people without anxiety or depression. The total course of treatment in the study was ten sessions lasting 25 minutes each and that could be completed at home over one month, whenever the patient wanted to do one.
The treatment was developed with input from people with lived experience of anxiety and depression. They helped identify situations that triggered worry and anxiety to ensure that the scenarios were pertinent to their day to day lives. They also provided feedback on the design of the study and how it was carried out. This had a major impact on the success of the study, as it ensured that the treatment met the needs of those living with anxiety and depression from the outset.
The results showed that people who had this new treatment did have their negative interpretation bias reduced, compared to a control group who completed the same number of online sessions but they were not designed to change interpretations. This means that those who received the new treatment were more likely to interpret situations positively following the treatment. They were also less likely to worry and ruminate, and they saw improvements in their levels of anxiety and depression.
Colette is already using CBM-I with patients she sees for CBT in her clinic for people with Generalised Anxiety Disorder at the South London and Maudsley (SLaM) NHS Trust. She is developing the treatment further and adapting it for different groups. For example, one of her current projects is to adapt the treatment for people with multiple sclerosis (MS), about one-third of whom have anxiety and half of whom have depression according to the MS Society.
Colette’s work has uncovered a whole new area for future research and treatment development. Importantly, it has also shown how effective computer-based or online treatments can be, at a time when these are needed more than ever. The lockdowns brought in by COVID-19 have reminded us of the vital need to get people treatments that work, wherever they are.
The team plan to continue developing and refining the treatment. They hope it can be picked up by further NHS trusts and mental health services: giving more people with anxiety and depression access to a potentially life-changing new treatment.
Last updated: 10 July 2020