Stratifying cognitive behavioural therapy for anxiety and depression: from discovery to impact

Essential background (up to 500 words including key references)

Describe background to the work including that carried out in the supervisor's own team and previous work. [This information will be used by the reviewers to understand the context of the proposed study].

Mood and anxiety disorders are incredibly disabling and increasingly common, particularly in young adults. The leading evidence-based treatment is Cognitive Behavioural Therapy (CBT), but as with medication, only around 50% of those treated recover. There is an urgent need to improve our understanding of what works for whom, enabling stratified treatment.

The NHS Talking Therapies service offers CBT and other psychological treatments to patients with anxiety or depressive disorders. One of their providers is ieso. ieso is the largest UK provider of online typed one-to-one CBT, delivering treatment to patients through both low- or high-intensity interventions. Our KCL team have been working with ieso scientists for several years building a robust collaboration with two completed projects exploring outcomes following psychological treatment1. We now propose a new jointly developed collaboration which will push this work from discovery through to translation.

Existing studies including ours have shown treatment response is related to specific patient characteristics. Analyses of ieso, NHS Talking Therapies services more widely, and clinical trial data have identified clinical, demographic and environmental predictors of poor treatment response1-3. Notably, symptom severity, comorbidity, unemployment, disability and trauma are all associated with poorer responses to CBT. Taken together, these predictors account for ~20% of the variance in continuously assessed outcomes3, but this is insufficient to accurately identify groups who will respond and who will not.

This project aims to go further by identifying how treatment response is related to therapy content. By adopting a more granular approach, we...