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Developing Psychological Treatments For Depression and Anxiety
Principal investigator: Dr Colette Hirsch
Institution: King's College London
Location: UK
Research award: PsyImpact
Funding Period: 2015-2019
We all worry about the future and focus on negative events from the past from time-to-time. When this kind of thinking becomes persistent, however, it can damage our mental health.
The project
Worry is one of the major symptoms of anxiety and rumination is one of the major symptoms of depression. The exact processes by which worry and rumination come about, and whether they are linked, were more mysterious. Research has shown that worry and rumination were linked by a thought process called repetitive negative thinking (RNT), where people are more likely to draw negative conclusions from ambiguous situations. In her MQ project, Colette worked to test this theory by developing a treatment targeting RNT.
The process
Using computerised tasks Colette and her team developed a treatment called cognitive bias modification for interpretation (CBT-I). In ten 25-minute sessions, participants with depression or anxiety were presented with situations that could be interpreted negatively or positively. They were given repeated training to interpret situations more positively, helping to overcome the negative thinking habits of RNT.
This treatment was co-designed with those with lived experience, helping to ensure the selected scenarios felt pertinent to their daily lives. Their involvement also helped ensure the trials success, by increasing the acceptability of the treatment. An entirely web-based version of CBT-I was also trialled, which should help to increase the accessibility of the treatment.
The potential
Cognitive Bias modification for interpretation (CBT-I) is showing highly promising results in reducing Repetitive negative Thinking (RNT) in people with anxiety or depression. This provides a new way to overcome one of the most life-affecting symptoms of two major mental illnesses, but also confirm the underlying processes that bring them about helping further research in the future.
The findings
CBT-I was effective at reducing RNT among people who underwent the treatment. They also had reduced levels of worry and rumination, and therefore, of anxiety and depression.
This finding confirms Colette’s hypothesis that the processes of RNT underlie both worry and rumination, pointing to potential shared causes between anxiety and depression. The web-based version was also effective.
Feng et al (2020) Impact of imagery-enhanced interpretation training on offline and online interpretations in worry Behaviour Research & Therapy
Where next?
Colette is already using CBT-I in her clinic for people with Generalised Anxiety Disorder at South London and Maudsley (SLaM). She is also developing CBT-I for other groups, including those with multiple sclerosis and it has been included in the consortium application to UKRI in response to Covid-19. The team hope that following further trials CBT-I will be available on the NHS.
RNT also provides a new exciting area for research.
Dr Colette Hirsch
Dr Colette Hirsch is a senior lecture in the Psychology department at Kings College London and a Professor of Cognitive Clinical Psychology. and Consultant Clinical Psychologist leading the Generalised Anxiety Disorder Service at the Centre for Anxiety Disorders and Trauma at the South London Maudsley NHS Trust.
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