Abstract
The coronavirus pandemic led to worldwide disruption in the delivery of face-to-face mental health services. This impact was marked for individuals with long-term health conditions and comorbid depression and anxiety. Many face-to-face mental health services switched to remote delivery or paused therapeutic input entirely, despite the lack of research on the efficacy of switching between modalities mid-therapy or having breaks in therapy. This paper presents the case of a patient with long-term health conditions who experienced both breaks in therapy and a switch in modalities from face-to-face to telephone delivery. The intervention used was based on transdiagnostic cognitive behavioral therapy and self-report measures were completed at the beginning and end of the twelve sessions. Despite the shift in modalities, the patient experienced clinically significant recovery on all measures, indicating the efficacy of therapy was not greatly affected by the shift in modalities. Long breaks in therapy were linked to deterioration in mental health, although this could be due to the deterioration in physical health that necessitated these breaks. This case highlights the benefits and challenges of a shifting modality of therapy during treatment and in response to a pandemic for a shielding population. From the work presented here, it seems beneficial for services to be able to work across multiple modalities to suit the needs of the patients and ensure continuity of treatment. It also indicates that pauses in therapy may risk deterioration. Further work is needed to prevent digital exclusion of patients.
Highlights
The coronavirus pandemic led to worldwide disruption in the delivery of face-to-face mental health services
Shielding referred to limiting social contact by not leaving home or having face-to-face contact with others, unless necessary
Reports from the Office of National Statistics indicated an increased level of anxiety across the Great British public in May 2020 (Office for National Statistics, 2020)
Summary
On the 23rd March 2020, the UK government announced a nationwide lockdown to combat the coronavirus disease 2019 (COVID-19). By the January 2021 report, mean anxiety had fallen, albeit not to pre-pandemic levels (Office for National Statistics, 2021) It is unclear how the pandemic will impact services and public mental and physical health long-term. It is important to examine whether a switch in modality impacts therapy more than ever, due to the aforementioned stresses of COVID-19 and the possibility of exacerbation of pre-existing mental health conditions if service-delivery is adapted in an inefficient way. This case study examines the benefits, challenges, and effectiveness of transitioning modalities for an individual who was shielding It will provide clarity on effective treatment options for higher-risk clients during a time of global pandemic and provoke discussion on how care can be adapted to meet present needs using the pre-existing research base available
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