title: Improving Distress in Dialysis (iDiD): A tailored CBT self-management treatment for patients undergoing dialysis.
abstract: BACKGROUND
  There is significant psychological distress in adults with end-stage kidney disease (ESKD). However, psychological treatments tailored to address the unique challenges of kidney failure are absent. We identified psychological correlates of distress in ESKD to develop a cognitive-behavioural therapy (CBT) treatment protocol that integrates the mental health needs of patients alongside their illness self-management demands.
  
  
  METHODS
  Studies which examined relationships between distress and psychological factors that apply in the context of ESKD including: health threats, cognitive illness representations and illness management behaviours were narratively reviewed. Review findings were translated into a CBT formulation model to inform the content of a renal-specific seven session CBT treatment protocol, which was commented on and refined by patient representatives.
  
  
  RESULTS
  Health threats related to distress were grouped into four themes including: acute ESKD events, loss of role, uncertainty and illness self-management. Having pessimistic illness and treatment perceptions were associated with elevated distress. Non-adherence and avoidance behaviours were related to feelings of distress, whereas cognitive reappraisal, acceptance, social support and assertiveness were associated with less distress.
  
  
  CONCLUSIONS
  The dialysis-specific CBT formulation identifies the importance of targeting ESKD-specific correlates of distress to allow the delivery of integrated mental and physical health care. The 'Improving Distress in Dialysis (iDiD)' treatment protocol now requires further evaluation in terms of content, feasibility and potential efficacy.
authors.affiliation: Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Hudson
authors.affiliation: Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
authors.affiliation: Renal Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Game
authors.affiliation: Renal Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Carroll
authors.affiliation: Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chilcot
mesh_terms: D000223:Adaptation, Psychological; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008297:Male; D015201:Meta-Analysis as Topic; D016730:Program Development; D011446:Prospective Studies; D036301:Qualitative Research; D006435:Renal Dialysis / Q000523:psychology*; D000073278:Self-Management; D013315:Stress, Psychological / Q000628:therapy*
keywords: Anxiety; Cognitive behavioural therapy (CBT); Common sense model; Depression; End Stage Kidney Disease (ESKD)