Improving Distress in Dialysis (iDiD): A tailored CBT self-management treatment for patients undergoing dialysis.

Abstract

There is significant psychological distress in adults with end-stage kidney disease (ESKD). However, psychological treatments tailored to address the unique challenges of kidney failure are absent. We identified psychological correlates of distress in ESKD to develop a cognitive-behavioural therapy (CBT) treatment protocol that integrates the mental health needs of patients alongside their illness self-management demands. Studies which examined relationships between distress and psychological factors that apply in the context of ESKD including: health threats, cognitive illness representations and illness management behaviours were narratively reviewed. Review findings were translated into a CBT formulation model to inform the content of a renal-specific seven session CBT treatment protocol, which was commented on and refined by patient representatives. Health threats related to distress were grouped into four themes including: acute ESKD events, loss of role, uncertainty and illness self-management. Having pessimistic illness and treatment perceptions were associated with elevated distress. Non-adherence and avoidance behaviours were related to feelings of distress, whereas cognitive reappraisal, acceptance, social support and assertiveness were associated with less distress. The dialysis-specific CBT formulation identifies the importance of targeting ESKD-specific correlates of distress to allow the delivery of integrated mental and physical health care. The 'Improving Distress in Dialysis (iDiD)' treatment protocol now requires further evaluation in terms of content, feasibility and potential efficacy.