Cognitive-behavioral therapy (CBT) is an evidence-based treatment for depression and anxiety recommended for those with and without physical long-term conditions (LTCs). However, the cognitive-behavioral mechanisms targeted in CBT protocols are based on empirical cognitive-behavioral models of depression and anxiety. In these models, emotions are conceptualized as primary mental health disorders rather than a reaction to the challenges of living with a LTC commonly referred to as illness distress. This raises important clinical questions with theoretical implications. These include: Is the experience of illness distress conceptually distinct from primary mental health diagnoses of anxiety and mood disorder? Are there unique cognitive-behavioral mechanisms related to illness self-management, which should be incorporated into CBT for illness distress? How can illness self-management interventions be embedded within existing CBT protocols for depression and anxiety? To address these questions, we distinguish between primary mental health disorders and illness distress conceptually and explore the impact of this on tailored treatment planning and engagement. Second, we review how health psychology theoretical models can help to inform modifications of existing cognitive-behavioral treatments for anxiety and depression to better support the needs of individuals experiencing illness distress. Third, we provide examples of how to embed processes important for illness self-management including, illness cognitions and adherence, alongside existing CBT techniques. The mechanisms and intervention techniques discussed may help to inform the development of integrated CBT treatments for illness distress for future hypothesis testing in comparative effectiveness trials.

中文翻译：

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在慢性疾病中治疗疾病困扰

认知行为疗法（CBT）是针对患有和不患有身体长期疾病（LTC）的患者推荐的针对抑郁和焦虑的循证治疗方法。但是，针对CBT协议的认知行为机制基于抑郁和焦虑的经验认知行为模型。在这些模型中，情感被概念化为主要的心理健康障碍，而不是对通常称为疾病困扰的LTC生活挑战的反应。这提出了具有理论意义的重要临床问题。这些问题包括：疾病困扰的经历在概念上是否与焦虑和情绪障碍的主要心理健康诊断有所不同？是否存在与疾病自我管理相关的独特认知行为机制，哪些应纳入CBT以解决疾病困扰？如何将疾病自我管理干预措施纳入现有的抑郁症和焦虑症CBT方案中？为了解决这些问题，我们从概念上区分了原发性心理健康障碍和疾病困扰，并探讨了这对量身定制的治疗计划和参与的影响。其次，我们回顾了健康心理学理论模型如何能够帮助告知现有的针对焦虑和抑郁的认知行为治疗方法的修改，以更好地满足遭受疾病困扰的个人的需求。第三，我们提供了一些示例，说明如何将对疾病自我管理重要的过程嵌入到疾病认知和依从性中，以及现有的CBT技术。