Skip to main content Accessibility help

Developing Services for Patients with Depression or Anxiety in the Context of Long-term Physical Health Conditions and Medically Unexplained Symptoms: Evaluation of an IAPT Pathfinder Site

  • Stephen Kellett (a1), Kimberley Webb (a2), Nic Wilkinson (a3), Paul Bliss (a4), Tom Ayers (a4) and Gillian Hardy (a2)...


Background: There are national policy drivers for mental health services to demonstrate that they are effectively meeting the psychological needs of people with long-term health conditions/medically unexplained symptoms (LTC/MUS). Aims: To evaluate the implementation of a stepped-care service delivery model within an Improving Access to Psychological Therapies (IAPT) service for patients with depression or anxiety in the context of their LTC/MUS. Method: A stepped-care model was designed and implemented. Clinical and organizational impacts were evaluated via analyses of LTC/MUS patient profiles, throughputs and outcomes. Results: The IAPT service treated N = 844 LTC and N = 172 MUS patients, with the majority (81.81%) receiving a low intensity intervention. Dropout across the service steps was low. There were few differences between LTC and MUS outcome rates regardless of step of service, but outcomes were suppressed when compared to generic IAPT patients. Conclusions: The potential contribution of IAPT stepped-care service delivery models in meeting the psychological needs of LTC/MUS patients is debated.


Corresponding author

Correspondence to Stephen Kellett, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK. E-mail:


Hide All
Aggarwal, V. R., McBeth, J., Zakrzewskai, J. M., Lunt, M. and McFarlane, G. J. (2006). The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors. International Journal of Epidemiology, 35, 468476.
Chalder, T., Wallace, P. and Wessley, S. (1997). Self-help treatment of chronic fatigue in the community: a randomized controlled trial. British Journal of Health Psychology, 2, 189197.
Chan, S. and Adams, M. (2014). Service use, drop-out rate and clinical outcomes: a comparison between high and low intensity treatments in an IAPT Service. Behavioural and Cognitive Psychotherapy, 42, 747759.
Deary, V., Chalder, T. and Sharpe, M. (2007). The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clinical Psychology Review, 27, 781797.
Department of Health (2011a). Ten Things You Need to Know about Long-term Conditions. Department of Health website. Available at:
Department of Health (2011b). No Health Without Mental Health. UK: Department of Health; .
Dewhurst, E., Novakova, B. and Reuber, M. (2015). A prospective service evaluation of acceptance and commitment therapy with refractory epilepsy. Epilepsy and Behaviour, 46, 234241.
Egede, L. E. and Ellis, C. (2010). Diabetes and depression: global perspectives. Diabetes Research and Clinical Practice, 87, 302310.
Flo, E. and Chalder, T. (2014). Prevalence and predictors of recovery from chronic fatigue syndrome in a routine clinical practice. Behaviour Research and Therapy, 63, 18.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N. and Turk, D. C. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133, 581624.
Goodwin, R. D., Davidson, K. W. and Keyes, K. (2009). Mental disorders and cardiovascular disease among adults in the United States. Journal of Psychiatric Research, 43, 239246.
Hopko, D. R. and Colman, L. K. (2010). The impact of cognitive interventions in treating depressed breast cancer patients. Journal of Cognitive Psychotherapy, 24, 314328.
IAPT (2011). IAPT Programme Review. Department of Health.
IAPT (2014a). Medically Unexplained Symptoms/functional Symptoms Positive Practice Guidelines. Department of Health.
IAPT (2014b). Measuring Recovery and Improvement in Adult Services. Department of Health.
Ismail, K., Winkley, K. and Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet, 363, 15891597.
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.
Konnopka, A., Schaefert, R., Heinrich, S., Kaufmann, C., Luppa, M., Herzog, W., et al. (2012). Economics of medically unexplained symptoms: a systematic review of the literature. Psychotherapy and Psychosomatics, 81, 265275.
Kroenke, K., Spitzer, R. L. and Williams, J.B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613.
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O. and Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity and detection. Annals of Internal Medicine, 146, 317326.
Kroenke, K., Spitzer, R. L., Williams, J. B. and Lowe, B. (2010). The Patient Health Questionnaire somatic, anxiety and depressive symptom scales: a systematic review. General Hospital Psychiatry, 32, 345359.
Lindsay, C., Greve, B., Cabras, I., Ellison, N. and Kellett, S. (2015). Assessing the evidence base on health, employability and the labour market: lessons for activation in the UK. Social Policy and Administration, 49, 143160.
de Lusignan, S., Chan, T., Tejerina-Arreal, M. C., Parry, G., Dent-Brown, K. and Kendrick, T. (2013). Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: controlled before and after study. Behaviour Research and Therapy, 51, 377385.
Lundahl, B. and Burke, B. L. (2009). The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses. Journal of Clinical Psychology, 65, 12321245.
Marquis, M. M., de Gucht, V., Gouveia, M. J., Leal, I. and Maes, S. (2015). Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): an updated systematic review and meta-analysis. Clinical Psychology Review, 40, 123137.
McCracken, L. M. and Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: model, process and progress. American Psychologist, 69, 178187.
Morris, R., Dowrick, C., Salmon, P., Peters, S., Dunn, G., Rogers, A., et al. (2007). Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms. British Journal of Psychiatry, 191, 536542.
Moss-Morris, R., McAlpine, L., Didsbury, L. P. and Spence, M. J. (2010). A randomised controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychological Medicine, 40, 8594.
Moss-Morris, R. and Wearden, A. (2013). Medically Unexplained Symptoms: functional symptoms/syndromes. IAPT presentation.
Ost, L-G. (2008). Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behaviour Research and Therapy, 46, 296321.
Richards, D. and Whyte, M. (2009). Reach Out: national programme educator materials to support the delivery of training for practitioners delivering low intensity interventions (2nd edn). London: Rethink. Available at:
Rimes, K. A., Wingrove, J., Moss-Morris, R. and Chalder, T. (2014). Competences required for the delivery of high and low-intensity cognitive behavioural interventions for chronic fatigue, chronic fatigue syndrome/ME and irritable bowel syndrome. Behavioural and Cognitive Psychotherapy, 42, 760764.
Roth, A. and Pilling, S. (2007). The Competencies Required to Deliver Effective Cognitive and Behavioural Therapy for People with Depression and Anxiety Disorders. London: Department of Health.
Sage, N., Sowden, M., Chorlton, E. and Edeleanu, A. (2008). CBT for Chronic Illness and Palliative Care: a workbook and toolkit. Chichester: Wiley.
Spitzer, R. L., Kroenke, K., Williams, J. B. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 10921097.
Unigwe, C., Rowett, M. and Udo, I. (2014). Reflections of the management of medically unexplained symptoms. British Journal of Psychiatry Bulletin, 38, 252.
White, P. D., Goldsmith, K. A., Johnson, A. L., Potts, L., Walwyn, R., Decesare, J. C., et al. (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet, 377, 823836.
Wileman, L., May, C. and Chew-Graham, C. (2001). Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study. Family Practice, 19, 178182.
Wroe, A. L., Rennie, E. W., Gibbons, S., Hassy, A. and Chapman, J. E. (2015). IAPT and long-term medical conditions: what can we offer? Behavioural and Cognitive Psychotherapy, 43, 412425.


Related content

Powered by UNSILO

Developing Services for Patients with Depression or Anxiety in the Context of Long-term Physical Health Conditions and Medically Unexplained Symptoms: Evaluation of an IAPT Pathfinder Site

  • Stephen Kellett (a1), Kimberley Webb (a2), Nic Wilkinson (a3), Paul Bliss (a4), Tom Ayers (a4) and Gillian Hardy (a2)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Developing Services for Patients with Depression or Anxiety in the Context of Long-term Physical Health Conditions and Medically Unexplained Symptoms: Evaluation of an IAPT Pathfinder Site

  • Stephen Kellett (a1), Kimberley Webb (a2), Nic Wilkinson (a3), Paul Bliss (a4), Tom Ayers (a4) and Gillian Hardy (a2)...
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *