The role of psychologists in managing mental health comorbidities in adults with neurological disorders

ABSTRACT

Neurological disorders are associated with very high rates of depression and anxiety, which significantly increase disease burden, but remain an area of considerable unmet need. Psychological therapies, especially those based on the principles of cognitive and behavioural therapy, appear to be efficacious for improving both mental health (e.g., depression and anxiety) and functional outcomes (e.g., sleep, fatigue) in patients with a variety of neurological disorders. However, access to these therapies is limited. Neuropsychologists rarely have the capacity to deliver ongoing psychological therapy and there appears to be a lack of community psychologist that specialise in this area. This commentary argues that these barriers need to be addressed and psychologists should play a greater role in reducing the burden of neurological disorders. One step towards this is building the confidence and competence of psychologists to effectively work with patients with neurological symptoms, especially common cognitive difficulties (e.g., inattention, poor memory, slower processing speed). Thus, this commentary provides a practical guide for modifying psychological therapies for adults with neurological disorders, including principles of compensatory cognitive rehabilitation. It aims to provide principles to help maximise engagement, learning and retention of psychological concepts and ultimately to encourage more psychologists to work with this under-served group.

Key Points

What is already known about this topic:

1. Depression and anxiety are common in neurological disorders but often go untreated.

2. Psychological therapies can improve mental health and functional outcomes across neurological disorders, but access to these interventions is very limited.

3. Neuropsychologists report a lack of confidence providing ongoing psychological interventions for mental health, and identifying community psychologists specialising in neurology is challenging.

What this topic adds:

1. A discussion of the mental health burden of neurological disorders and role of psychological therapy.

2. A guide to modifying psychological therapies for adults with neurological disorders, especially for cognitive difficulties.

3. Tips for maximising engagement, learning and retention within therapy to support effective work with people with neurological disorders.

KEYWORDS:

• Neurology
• cognitive behaviour therapy
• cognitive rehabilitation
• modifying therapy
• psychological intervention

Disclosure statement

Dr Gandy is the author and developer of an Internet-delivered psychological treatment program, the Wellbeing Neuro Course, but derives no personal or financial benefit from it.

Additional information

Funding

 Dr Gandy is supported by a Postdoctoral Fellowship from MS Australia.