Information for Researchers
Why are we conducting MODS?
Older adults and those with long term health conditions such as diabetes, asthma and heart problems represent a ‘high risk’ group for the development of depression and low mood. The risk of depression is increased by around 2-3 times in older adults with long-term health conditions.
What is Behavioural Activation?
Behavioural Activation (BA) is a brief psychological intervention in the form of a talking therapy. The primary focus of BA is to help people maintain or introduce activities that are important to them. Supporting people to identify valued activities that they are doing less frequently, stopped entirely or new activities they would like to take up, is an essential component.
Often, activities that someone once enjoyed are no longer possible – for reasons such as ill-health and individual circumstances (including financial or relocating). Identifying and reflecting on the benefits of those valued activities is a key element of BA; this can enable similar or replacement activities to be introduced that can provide similar benefits and values. It may be that more than one new activity is required to meet the values of an activity that can no longer be carried out. Maintaining these activities may benefit physical and emotional wellbeing, by helping people to stay connected with the world and remain active. The overall goal of BA is to re-engage participants with stable and diverse sources of positive reinforcement from their environment and to develop depression management strategies for future use.
The BA intervention (known as 'BA support' within MODS) aims to help people with long-term health conditions stay connected with the people and activities which are important to them. During MODS, a support worker will help participants use and work through a self-help booklet (the ‘MODS booklet’) which guides them through Behavioural Activation in manageable steps to support their physical and emotional well-being.
The BA support will be delivered via the telephone, video calling or face-to-face.
What is Collaborative Care?
The term collaborative care is used when health and support workers work together as a team with patients and GPs. In the MODS programme the patient and the support worker work together to facilitate communication with other members of the participants' healthcare team (such as the participant’s’ GP or other relevant services) when required. The patient is always at the core of collaborative care.
In the graphic to the left the MODS support worker would be considered the case manager.
What is the evidence base for Behavioural Activation and Collaborative Care?
Behavioural Activation has been shown to be effective at reducing and preventing depression in multiple trials across a wide range of populations, including older adults. A recent systematic review found BA was equally as acceptable to adults and as effective as the ‘gold-standard’ therapy Cognitive Behavioural Therapy (CBT) for the treatment of depression. A recent review of BA for adults with LTCs identified the need for further research due to limited number of trials within this specific population.
An advantage of BA is that support workers from community-based third sector services who work closely with older people (such as Age UK) can be trained to deliver BA effectively. BA can be delivered by a range of individuals. These can be people with or without mental health experience and backgrounds; because of this more junior workers with less intensive and costly training can be trained to deliver this low intensity treatment, which has no lesser effect than CBT. Mental health nurses can also be trained to deliver BA, increasing the availability and accessibility of non-pharmacological treatments for late-life depression in primary care.
The evidence supporting collaborative care for people with depression is strong especially when it includes a structured psychological intervention, such as BA. Evidence suggests that telephone-delivered BA with collaborative care has potential for implementation in a resource-poor health service, however further research is needed to evaluate the effectiveness of BA as a practical intervention suited to a range of health care settings and its potential to improve outcomes other than depression and anxiety. An approach informed by behaviour theory may be suitable to understand the development and maintenance of health-related behaviour change. The simplicity of BA may make it suitable for delivery across mental-physical healthcare provision.
MODS Support Workers
The support we have developed for use in the MODS study involves people working through a self-help booklet ('MODS booklet’) over a number of sessions supported by a trained MODS Support Worker.
The MODS Support Worker will also liaise where necessary, with health professionals in the participant’s care team, such as their GP or Practice nurse, to help them to get the care they need.
Who are we?
We are a team of researchers, clinicians and stakeholders. The research is led by the NHS (Tees, Esk and Wear Valleys NHS Foundation Trust, TEWV) and the University of York. Our partners include the Universities of Leeds, Keele and Manchester and Age UK.
Other Collaborations
The NIHR MODS programme aligns with the NIHR Yorkshire and Humber Applied Research Collaboration (ARC), where Professors Simon Gilbody and Andy Clegg lead programmes of research into physical health and mental health, particularly among older people and those with frailty.
To find out more about the NIHR Yorkshire and Humber Applied Research Collaboration please click on the below link:
Who Funded This Research?
The MODS programme of research is funded by the National Institute for Health Research Programme Grants for Applied Research.
Reference number: RP-PG-0217-20006.
