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Delivering Effective Psychological Therapies and Interventions for people with physical health conditions

Applied psychologists and psychological therapists working in physical health care settings provide specialist evidence-based expertise to improve psychological, medical and physical outcomes for individuals and families living with physical health conditions. This work may include assessment and preparation prior to medical, or surgical procedures, adjustment to long term illness, behaviour change to improve self-management, or as an alternative to medical intervention. Psychological therapists can also provide an understanding of the psychological factors that impact upon a person’s ability to engage with their physical healthcare, treatment to improve acceptance of physical limitations associated with ill health, development of coping skills and mood management and preventative work to improve overall health and wellbeing.

Psychological expertise in physical health care settings can be utilised in a range of ways (working with individuals, carers and family members, groups, healthcare staff and wider healthcare systems) to improve physical and mental health outcomes for patients. The work is rooted in the biopsychosocial model, which recognises that biological, psychological, and social factors interact to shape physical health outcomes, wellbeing, and quality of life.

Do people with physical health difficulties benefit from psychological interventions and therapy?

People living with physical health conditions are more likely to experience significant psychological problems and there is strong evidence that they can benefit from psychological therapies and interventions. Treatments focused on adjustment to, and self-management of, acute and chronic physical health conditions and the psychological impacts of medical diagnoses and treatments are known to be effective. Psychological therapies can elicit improvements in physical functioning, through improved coping, treatment adherence and quality of life as well as impacting on mental health difficulties, such as mood. The interaction between mind and body is also well established, where psychological processes are known to directly influence physical health outcomes and illness trajectories.

Psychological interventions are evidenced based across multiple national guidelines (e.g., SIGN and NICE guidance on depression in chronic illness; diabetes; chronic pain; cancer) which provide guidance for the management of chronic conditions (1,2). Summaries of the recommended interventions, such as CBT (Cognitive Behavioural Therapy), ACT (Acceptance and Commitment Therapy), behaviour change approaches, and systemic therapies are found in the relevant Matrix pages.

Are Psychological therapies in physical health care settings cost effective?

Addressing the psychological needs of people with physical health difficulties is often viewed as a non-essential element of physical health care, when in fact it is a vital part of taking a “whole person” approach, which can lead to reduced utilisation of health care resources and improved health outcomes for patients (3,4).

Research has demonstrated the cost-effectiveness of psychological therapies in physical healthcare settings. Emerging evidence from health economic data includes better management of long-term health conditions, quicker recovery from acute medical conditions, shorter hospital stays, reduced hospital readmission rates, better engagement and adherence to medical treatments, reduced A&E attendances and improved staff wellbeing (5-7).

Working Within Physical Healthcare Settings

Psychological therapy and interventions are provided in a diverse range of physical healthcare settings, including hospital inpatient wards, outpatient clinics, community settings and home environments.

Working in acute physical healthcare settings requires adaptation of psychological interventions to suit the context and needs of patients and families. This might include delivery of brief interventions during acute medical instability, adjustments to therapy to take into account treatment side effects, or cognitive changes associated with ill health, trauma-informed care, support through treatment decision-making, adjustment and coping and end of life psychological care.

Psychological therapy can also be adapted to address barriers to access in a variety of ways, when travel to appointments is difficult due to ill health. This includes providing in person, remote video call and telephone appointments and digital therapy interventions (such as Silvercloud Long Term Condition Management Modules).

The Biopsychosocial Model

The biopsychosocial model provides a holistic framework of understanding which integrates biological, psychological, and social domains in assessment, formulation, and treatment. This approach enables tailored, person centred care to be provided that considers life stage, illness stage, and individual context. The model emphasises a “whole person” understanding of health and illness, which aligns well with a more integrated approach to healthcare. In Psychology Services application of the model is useful in the following contexts:

Assessment integrates illness and treatment related symptoms, psychological responses, developmental factors, early experiences and the broader social context.
Formulation creates an understanding of the complex interactions between life stage, physical symptoms and illness stage, and contextual factors to understand distress and functional impact.
Treatment is collaborative and person centred, drawing on a range of psychological therapies and adapted to severity of symptoms, cognitive functioning, treatment side effects, and practical barriers. Therapists integrate psychological expertise with knowledge of medical conditions and the lived experiences of illness. Common themes include adjustment to diagnosis, illness related anxiety and fear, mood and coping problems, symptom management, adherence to treatment and lifestyle and behavioural change.

Group-Based Psychological Interventions and treatment

Group psychological interventions (condition specific and trans-diagnostic) are highly effective and recommended for people with physical health conditions (e.g. Pain Management Programmes, Post ICU Groups). Group interventions increase access to psychological therapies and contribute to prevention of more severe psychological problems, normalisation of illness experience, reduce stigma, create shared learning and promote peer support.

Psychologically Informed Self-Management Approaches

Self-management is an important element of living well with a physical health condition. Self-management approaches provided by multidisciplinary teams are significantly enhanced when psychologically informed practice is embedded within the treatment offered. Psychological approaches can provide the framework to underpin self-management approaches provided within multidisciplinary teams (e.g. acceptance and commitment therapy as the framework for Pain Management Programmes). Effective self-management interventions may include behavioural activation, health behaviour change, activity management and pacing, emotion regulation and mood management, problem solving, communication and assertiveness skills.

Functional Symptoms and Persistent Physical Symptoms

Functional symptoms are physical symptoms that persist, but do not have a clear underlying medical explanation. They are called “functional” as the cause of the physical symptom is not located in the biology of the body but is demonstrated in the function of the body (i.e. the body is not working as we would expect it to). Not understanding the cause can make the physical symptoms distressing and difficult to cope with and the interaction between physical symptoms (such as unexplained weakness, or functional seizures) and psychological processes (such as anxiety or stress), can exacerbate functional physical symptoms which then impacts on quality of life, mood and coping.

Functional and persistent physical symptoms benefit substantially from psychologically informed care including evidence-based assessment and intervention strategies to support:

Validation and shared understanding
Stabilisation and symptom management
Reducing unhelpful behavioural avoidance
Improving functioning and confidence
Improving quality of life
Collaborative medical–psychological care models

Working With Multidisciplinary Teams and Healthcare Systems

Psychological therapies and interventions are most effective when embedded within multidisciplinary medical teams (MDT’s) and pathways. As well as direct patient work, psychological therapists can work with MDT staff to provide consultation, psychologically informed communication with patients, training related to the psychological aspects of physical healthcare, supervision and reflective practice sessions to enhance psychologically informed care provision across healthcare systems. System-level psychological practice includes:

Multidisciplinary Team working

Shared team biopsychosocial formulations to enhance understand of complex patient needs
Joint treatment and care planning
Interdisciplinary care pathways (e.g. psychologically informed MDT groups, assessments)

Training and Consultation

Training staff in communication, behaviour change, and psychologically informed care
Consultation for highly complex patient presentations
Reflective practice, coaching and supervision
Trauma-informed and relational approaches

Staff Wellbeing

Psychologists working in physical health care settings play an important role in supporting MDT medical staff wellbeing, reducing burnout in teams, and facilitating psychological safety.

Resources and Further Reading

Education and training modules for health and social care staff who are providing care to individuals with long term conditions. Psychological skills in physical health | Turas | Learn:

Acknowledgement

Jackie Fearn, Deby Graham and Esther Murray on behalf of Leads of Clinical Health Psychology Services Scotland (LOCHS).

Key References

1.SIGN. SIGN (Scottish Intercollegiate Guidelines Network) Guidelines for Long term conditions- specific conditions. Accessed Mar 27, 2026.

2.NICE. Overview | Depression in adults with a chronic physical health problem: recognition and management | Guidance | NICE. 2009; . Accessed Mar 27, 2026.

3.Steptoe, A.&nbsp. The links between psychological wellbeing and physical health. 2020.

4.Whomsley S. The Case for holistic psychological and physical healthcare. Working holistically: Body, mind, spirit, social world and political context.

5.Nicklas L, Albiston M, Dunbar M, Gillies A, Hislop J, Moffat H, et al. A systematic review of economic analyses of psychological interventions and therapies in health-related settings. BMC Health Services Research 2022 Sep 07;22(1):1131.

6.Das P, Naylor C, Majeed A. Bringing together physical and mental health within primary care: a new frontier for integrated care. J R Soc Med 2016 Oct;109(10):364–366.

7.West, M., Eckert, R., Collins, B. and Rachna, C. Caring to Change. How Compassionate Leadership Can Stimulate Innovation in Health Care. 2017; . Accessed Mar 18, 2026.