Discovering therapeutic mechanisms and predicting psychological treatment outcome: towards stratified interventions for anxiety

Anxiety rates are alarmingly high and increasing. Response to psychological treatment is variable, only 50% recover. Stratified interventions offer promise of improved outcomes, but rely on accurate screening tools. We will create new resources to understand how and for whom psychological treatments work, by examining mechanisms and prediction. First, in a major new study, we will assess cognitive processes in ~3,500 previously-genotyped anxious participants before they undergo Interpretation Training. This psychological intervention addresses interpretation bias, the interpretation of ambiguous information as threatening, a key target of Cognitive Behavioural Therapy (CBT). Second, we will link NHS Talking Therapies data for patients from five pre-existing genetic cohorts. Our third and fourth aims identify how psychological treatments work. We will identify genetic factors associated with cognitive processes targeted by, and outcomes following Interpretation Training, then test whether cognitive processes mediate genetic influences on outcome. Fifth, to identify for whom psychological treatments work, we will develop a prediction model combining genetic and cognitive process measures with traditional predictors. In parallel, we will identify genetic predictors of CBT outcome, and translate our model to real-world treatment data. Our sixth aim is to collaborate with stakeholders beyond academia to maximise the likely impact of our findings.