The mental health of children and young people with some long term physical conditions could benefit from cognitive behavioural therapy (CBT), according to a recent study from the University of Exeter Medical School. The systematic review used robust methods to bring together and make sense of the best science in this area.
Among a range of findings, the team identified some evidence of the benefits of CBT in inflammatory bowel disease, chronic pain and epilepsy.
The research was funded by the National Institute for Health Research (NIHR) and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC).
Long term conditions are common in children.
In England, 23% of secondary school age pupils reported that they had a long-term medical illness or disability in a recent survey.
Children and young people who have long term conditions are four times more likely to experience feelings of depression, anxiety and other mental health issues than those who are physically healthy.
Study author Dr. Liz Shaw, said: “As well as looking at whether treatments worked for these children, we also included studies that explored the experiences of people giving and receiving the treatments.
These studies highlighted the benefits of building good relationships and providing treatments in what feels like a ‘safe space’.”
Fiona Lockhart, Co-investigator from the Biomedical Research Centre Patient & Public Involvement Group at University College London, said:
“Children and young people with long-term health conditions face enormous challenges.
As well as their physical illness, many of these young people suffer from mental health problems as a consequence of their condition.”
The team also found some benefit from parenting programmes to reduce behavioural problems in children with acquired brain injury and/or cerebral palsy.
Further studies showed that children and young people valued treatments that considered a range of needs rather than just focussing on their mental health.
The opportunity to meet and build a supportive relationship with people who are managing their long term condition was also seen to help some young people by providing them with a sense of hope for the future and learn skills to manage their physical and mental health.
Study author Dr. Michael Nunns, of the University of Exeter Medical School, said:
“The mental health of children and young people is important and offering the best response is vital.
When we set out to do this research we were hoping to make recommendations about what works to support children and young people with long term conditions, who are also having difficulties with their mental health.
However, we were disappointed in the lack of good quality evidence available to guide treatment decisions for these children.”
Throughout the study, the team worked with a group of children and young people who provided a real-world perspective on the issues they face.
They were particularly disappointed in the lack of available research and urged researchers to do something about it.
This sentiment was echoed by consultant paediatrician Professor Stuart Logan: ‘The two things that are needed alongside managing a medical condition like this are something to help the family manage and something to help with the children’s emotional problems that so often go alongside these medical conditions.
The exciting thing about this project is that it provides researchers with a roadmap for what to do next – we need to work sensibly with parents and children to carefully design treatments and test them in a way that helps us understand whether they actually work.”
The systematic review will be published in Health Technology Assessment.
The full title of the paper is: Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses.
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.
It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.
How CBT works
CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.
CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts.
You’re shown how to change these negative patterns to improve the way you feel.
Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past.
It looks for practical ways to improve your state of mind on a daily basis.
Uses for CBT
CBT has been shown to be an effective way of treating a number of different mental health conditions.
In addition to depression or anxiety disorders, CBT can also help people with:
- obsessive compulsive disorder (OCD)
- panic disorder
- post-traumatic stress disorder (PTSD)
- eating disorders – such as anorexia and bulimia
- sleep problems – such as insomnia
- problems related to alcohol misuse
CBT is also sometimes used to treat people with long-term health conditions, such as:
- irritable bowel syndrome (IBS)
- chronic fatigue syndrome (CFS)
Although CBT can’t cure the physical symptoms of these conditions, it can help people cope better with their symptoms.
What happens during CBT sessions
If CBT is recommended, you’ll usually have a session with a therapist once a week or once every 2 weeks.
The course of treatment usually lasts for between 5 and 20 sessions, with each session lasting 30 to 60 minutes.
During the sessions, you’ll work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.
You and your therapist will analyse these areas to work out if they’re unrealistic or unhelpful, and to determine the effect they have on each other and on you.
Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.
After working out what you can change, your therapist will ask you to practise these changes in your daily life and you’ll discuss how you got on during the next session.
The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your daily life.
This should help you manage your problems and stop them having a negative impact on your life, even after your course of treatment finishes.
Pros and cons of CBT
Cognitive behavioural therapy (CBT) can be as effective as medication in treating some mental health problems, but it may not be successful or suitable for everyone.
Some of the advantages of CBT include:
- it may be helpful in cases where medication alone hasn’t worked
- it can be completed in a relatively short period of time compared with other talking therapies
- the highly structured nature of CBT means it can be provided in different formats, including in groups, self-help books and apps (you can find mental health apps and tools in the NHS apps library)
- it teaches you useful and practical strategies that can be used in everyday life, even after the treatment has finished
Some of the disadvantages of CBT to consider include:
- you need to commit yourself to the process to get the most from it – a therapist can help and advise you, but they need your co-operation
- attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time
- it may not be suitable for people with more complex mental health needs or learning difficulties, as it requires structured sessions
- it involves confronting your emotions and anxieties – you may experience initial periods where you’re anxious or emotionally uncomfortable
- it focuses on the person’s capacity to change themselves (their thoughts, feelings and behaviours) – this doesn’t address any wider problems in systems or families that often have a significant impact on someone’s health and wellbeing
Some critics also argue that because CBT only addresses current problems and focuses on specific issues, it doesn’t address the possible underlying causes of mental health conditions, such as an unhappy childhood.
More information:Health Technology Assessment, DOI: 10.3310/hta23220
Provided by University of Exeter