Exploring social factors in the psychological treatment of anxiety and mood disorders

Anxiety and depression are highly prevalent and debilitating disorders, with huge economic and social costs. To address the large number of untreated individuals struggling with these disorders, the UK Improving Access to Psychological Therapy (IAPT) initiative was started in 2008. IAPT provides evidence-based psychological therapies for patients with anxiety and depression in a primary care setting. However, substantial variation in responses to these treatments is evident, with roughly 50% of patients not showing significant improvements in symptom levels following treatment. Little is known about the source of these individual differences, and even less is understood about outcomes in terms of changes in social functioning. Evidence currently suggests a need to tailor treatments around risk variables, in order to promote improvements in long-term outcomes and cost-effectiveness of the IAPT service.

To date, the majority of research exploring predictors of psychological treatment response has only focused on clinical trials. Childhood trauma has been found to be a key risk factor in the development and persistence of psychological disorders, and in clinical trials has been shown to relate to psychological treatment outcomes. More recently, associations have been shown between childhood trauma and risk of relapse following treatment in IAPT. These associations may reflect negative biases regarding social situations. Genetic factors have also been found to provide important information when exploring predictors of psychological therapy outcomes.

The aim of this research is to explore the social and genetic risk variables relevant to the outcomes of psychological treatments in IAPT. Specifically, it will (i) address whether social risk factors such as childhood trauma predict treatment response; (ii) extend the assessment of treatment response to include measures of social functioning; (iii) investigate psychosocial factors associated with the relationship between a history of childhood trauma and psychological treatment response; and (iv) incorporate genetic and social risk factors in the overall prediction of treatment response in IAPT.

This project will involve large-scale prospective recruitment of IAPT service users using an online recruitment platform. This will enable greater communication with participants as well as online data collection at pre-treatment, post-treatment and follow-up, including demographic and social information. Collaborating with the NIHR-funded BioResource at the Institute of Psychiatry, Psychology and Neuroscience will enable the exploration of genome-wide polygenetic risk scores for anxiety, depression and risk of poor response to psychological treatment. Through this research, the potential to use social and genetic risk factors as predictors of the treatments that will be most beneficial to patients' outcomes in IAPT will be explored.