How can patients with anxiety and/or depression maintain wellbeing following discharge from low-intensity interventions? A qualitative exploration of patient perspectives.

backgroundOver 500 million people experience anxiety and/or depression globally, underscoring the need for accessible and sustainable psychological support. In England, Talking Therapy (TT) services provide cost-effective, evidence-based low-intensity interventions for mild to moderate anxiety and/or depression. Although over half of patients reach recovery by the end of treatment, relapse rates exceed 50% within one year, highlighting the importance of understanding how recovery is maintained post-discharge. This study examined current practices supporting the maintenance of treatment gains, identified factors that help or hinder sustained recovery, and explored opportunities to strengthen long-term relapse prevention support.

methodsSemi-structured interviews were conducted with patients (N = 23) who met recovery criteria for anxiety and/or depression at the end of low-intensity treatment delivered across four NHS Trusts in Northern England. Data were analysed using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel influences on recovery maintenance.

resultsFindings mapped onto CFIR domains. Within the intervention domain, relapse-prevention components were limited and inconsistently delivered, with many patients receiving only brief discussion or written materials. In the inner setting, discharge processes and follow-up practices varied, creating gaps in structured maintenance. Outer-setting influences such as employment stressors, bereavement, and access barriers hindered recovery. At the level of individual characteristics, memory difficulties, self-regulation demands, and reliance on social networks shaped the sustainment of treatment gains and wellbeing. Process issues included the absence of planned transitions to community resources, highlighting opportunities to strengthen support pathways. Participants proposed improvements spanning both clinical maintenance (e.g., routine follow-up, consolidation of skills) and personal recovery (e.g., enhanced social/peer networks and clearer community linkages) to promote long-term wellbeing.

conclusionThe study highlights the need to strengthen both clinical relapse-prevention practices and broader personal-recovery supports to enhance long-term outcomes following low-intensity psychological treatment. Although situated within NHS TT services, the mechanisms identified-self-regulatory maintenance processes, memory-related barriers, and social-network influences-are internationally relevant and align with global efforts to scale brief psychological interventions. These findings provide transferable insights for improving sustained recovery in diverse mental-health systems. CLINICAL TRIAL NUMBER: Not applicable.