Altering Dynamics of Autonomic Processing Therapy (ADAPT) Trial: A Novel, Targeted Treatment for Reducing Anxiety in Joint Hypermobility

Abstract Background: Hypermobility is a poorly-recognised and understood musculoskeletal disorder thought to affect around 20% of the population. Hypermobility is associated with reduced physiological and psychological functioning, quality of life, and is a known risk factor for the development of an anxiety disorder. To date no evidence-based, targeted treatment for anxiety in the context of hypermobility exists. The present intervention (ADAPT) is a novel therapy combining cognitive approaches from clinical health psychology targeting the catastrophisation of internal sensations, with bio-behavioural training improving autonomic trait prediction error. Method: Eighty individuals with diagnosed hypermobility will be recruited and the efficacy of ADAPT to treat anxiety will be compared to an Emotion-Focused Supportive Therapy (EFST) comparator therapy in a randomised, controlled trial. The primary treatment target will be post therapy score on the Beck Anxiety Inventory and secondary outcomes will also be considered in relation to anxiety, depression, alexithymia, social and work adjustment, panic symptoms and dissociation. Due to COVID restrictions, the intervention will be moved to online delivery and qualitative assessment of treatment tolerance to online therapy will also be assessed. Discussion: Online delivery of an intervention targeting anxiety would improve the quality of life for those experiencing anxiety disorder, and help the £11.7 billion that anxiety disorders cost the UK economy annually.WHO trial registration serial number 40233 registered 20/2/2019 available at https://doi.org/10.1186/ISRCTN17018615