# Sustaining Recovery After Low‐Intensity Treatment for Anxiety and Depression in NHS Talking Therapies: A Multiphase Participatory and Consensus‐Building Study of Stakeholder Priorities and Recommendations

## TL;DR

This study identifies strategies to prevent relapse after low-intensity mental health treatments by involving patients and professionals in developing evidence-based recommendations.

## Contribution

The study introduces a collaborative, multiphase approach to co-develop relapse prevention strategies for anxiety and depression.

## Key findings

- 41 evidence-based solutions were synthesized and rated by stakeholders.
- 24 solutions were deemed appropriate and necessary, leading to 13 core recommendations.
- A relapse prevention model was developed to guide clinical practice and policy.

## Abstract

Anxiety and depression affect over 500 million people globally. Despite the availability of effective low‐cost treatments, like those provided by NHS talking therapies (TT), over half of patients relapse within a year, highlighting the need to co‐develop solutions to maintain wellbeing and optimise healthcare. This study used a multiphase participatory design to synthesise evidence on relapse prevention and collaboratively develop evidence‐informed strategies for sustained mental health following low‐intensity treatment. The three‐phase project began by synthesising evidence from diverse sources. Phase 2 involved two patient and two NHS professional/key stakeholder co‐design workshops, using the RAND/UCLA appropriateness method. A sustained patient and public involvement (PPI) group reviewed and refined findings, co‐designing content for phase 3, which involved a mixed‐stakeholder online meeting to finalise key recommendations and priorities. Phase 1 identified 41 evidence‐based solutions for rating during phase 2. Across the four phase 2 workshops (n = 18), 24 solutions were rated as appropriate and necessary and ranked for priorities. These were refined with the PPI group into 13 core recommendations. These recommendations were incorporated into a relapse prevention model during the final workshop, forming a foundation to enhance post‐treatment support and inform clinical practice, service design, workforce training and policy. Preventing relapse and supporting wellbeing are essential for improving patient outcomes and reducing health inequalities. Identifying priorities across multiple levels lays the groundwork for a robust relapse prevention model that promotes sustained recovery. Future research should implement and evaluate the feasibility and impact of these recommendations in routine care.