FOR INTEGRATION: THIS PARAGRAPH IS FROM THE SECTION ON ENVIRONMENT, BUT IS MORE RELEVANT TO SECTION ON INDIVIDUALS. Barriers - health care systems are typically fragmented with disease specific focus. Typically, there are major division and lack of communication between mental health and physical health services (reference). This leads to a bias in non-pharmacological treatments, for example, people with physical health difficulties are typically prescribed physical health treatments. For example, people with CVD disease are typically advised to partake in healthier diets and physical activity. This is a missed opportunity to prescribe psychological therapies and social connectivity - which have also been shown to contribute to, and ameliorate symptoms (reference - optimism study Seligman CDV and others). Conversely, mental health services typically focus on offering psychological therapies whereas much research has shown that people with mental health conditions typical have poor diets (reference), sleep (reference), lower levels of physical activity (reference) and are more social isolated (reference). Moreover, interventions that target these health behaviours significantly ameliorate symptoms (reference). 
ALSO THIS: In addition, health professions are typically specialist in 'their area'. Although, specialisms can add value to the treatment of conditions the limitation of this approach is that complex interactions between factors contributing to disease is often poorly understood and treated. For example, emerging evidence shows that sleep disorders such as insomnia may exacerbate chronic conditions for example, asthma. However, sleep problems are not generally considered by clinicians in the management of chronic inflammatory conditions such as asthma \citep{Ranjbaran_2007}. Moreover, even if sleep problems are identified and recognised as an important contributor to the course of asthma symptoms, specialists in this area would not be skilled in treating sleep disorders and the person would need to be referred to another service, if indeed such a service exists. This results in fragmented and disjointed care. Now say something about trans diagnostic trans diagnostic approaches to the management of chronic conditions. conditions. 
AND THIS:In addition, health professions are typically specialist in 'their area'. Although, specialisms can add value to the treatment of conditions the limitation of this approach is that complex interactions between factors contributing to disease is often poorly understood and treated. For example, emerging evidence shows that sleep disorders such as insomnia may exacerbate chronic conditions for example, asthma. However, sleep problems are not generally considered by clinicians in the management of chronic inflammatory conditions such as asthma \citep{Ranjbaran_2007}. Moreover, even if sleep problems are identified and recognised as an important contributor to the course of asthma symptoms, specialists in this area would not be skilled in treating sleep disorders and the person would need to be referred to another service, if indeed such a service exists. This results in fragmented and disjointed care. Now say something about trans diagnostic trans diagnostic approaches to the management of chronic conditions. conditions. 
5.1.2: Positive Psychological Moments/experiences: 
 
Our theoretical models outline mechanisms by which psychological experiences can, if positive, facilitate individual pathways to health and wellbeing and if negative, facilitate pathways to ill-health and premature mortality (Kemp, Arias, & Fisher, 2017a; Kemp, Koenig, & Thayer, 2017b). Our models provide extensive evidence that psychological experiences, alongside genetics, environmental influences and their interactions (epigenetic processes), play a critical role in the aetiology of mental and physical health conditions via a range of downstream allostatic processes (see Kemp et al, 2017 for a comprehensive review). In our updated GENIAL model we use the term ‘psychological experiences’ to refer to an individual’s interpretation of life events and the temporal narrative relating to the events over one’s life course via cognitive and emotional processes.
 
It is generally accepted that biology, the environment, adverse life events, personality and psychological attributions are all important in understanding the aetiology of mental health problems [Engel, 1977]. For example, genetical abnormalities have been implicated in the aetiology of mental health disorders (Sullivan, Neale, Kendle, 2000), coupled with the ‘additive’ effects of negative life events and environmental factors (Guze, 1989) which all negatively affect psychological functioning (Van Os, Kenis, Rutten, 2010). In terms of psychological experiences, much literature indicates that reasoning abilities, thinking styles and behaviour are critical in the aetiology and maintenance of mental health conditions (Kinderman, 2005). However, some authors have argued that psychological factors are the ‘symptoms’ of gene or gene-environment interactions (Guze, 1989; Pilgrim, 2002). On the other hand, it has been suggested that rather than being ‘symptoms’ disturbances in psychological processes caused by biological and social vulnerabilities and environment and life events are the final stage in a chain of events which may lead to mental health disorders (Kinderman, 2013). For example, in a large-scale eloquent study, including 32,827 participants, Kinderman et al. (2013) showed that psychological processes determined the ‘causal impact of biological, social and circumstantial risk factors on mental health’. Thus, psychological processes or ‘experiences’ (as term in our framework) far from being symptoms of gene-environment interactions may serve as the gateway to mental ill health or wellbeing This suggests that interventions at the level of ‘psychological processes’ (experiences) has great potential to reduce mental health difficulties, which in and of themselves are one of the leading causes of chronic disability (WHO, 2011) and costed an estimated $2,500 billion worldwide in 2010 (Boom, 2011).
 
In addition to psychological experiences being implicated in the causality of mental health conditions, we are beginning to understand the role that early psychological experiences may have in pathways to chronic physical ill-health. For example, Von Korff, Scott (2009) showed that >=3 childhood adversities were independently related to onset of diabetes in adulthood. The authors also showed that negative psychological experiences in childhood were associated with onset of asthma in a dose dependent way. More recently, Scott, Lim, Al-Hamzawi et al., (2015) have shown that negative psychological experiences in childhood is strongly associated with adult onset heart disease.
 
To recapitulate evidence suggests that psychological experiences can play in critical role in the causality of mental health and physical health disorders. Epidemiological studies have also shown that common mental disorders [zf1] and physical disease are strongly inter-connected, highly co-morbid and share critical pathways to ill health and disease (O’Neil et al. 2015; Druss, Walker, 2011[zf2] ). For example, in a study of 245,404 participants from 60 countries across the world, an average of between 9.3-23% of participants with one or more chronic physical condition had co-morbid depression (Moussavi et al., 2007).  This is significantly higher than depression rates in people without a chronic physical disease (p>0.0001). Moreover, even after adjustment for health conditions and socioeconomic factors, depression had the largest effect on worsening mean health scores. The authors conclude that participants with one or more chronic condition and co-morbid depression had the poorest health of all of the disease states. 
 
Cardiovascular disease, type 2 diabetes mellitus, cancer and chronic respiratory diseases are often referred to as the ‘big four’ chronic conditions, because in combination, they account for more deaths than any other. However, if one considers the global burden of chronic conditions in terms of disability rather than mortality, major depression is the second leading cause of disability (O’neil, Jacka, Quirk, Cocker and Taylor and Berk, 2015) preceded only by cardiovascular disease. In terms of disability, ‘the big four’ only account for only (54%) of all related disability adjusted life years (DALYs). Although, relative to physical health conditions, mental disorders are associated with greater disability, they are much less likely to receive treatment and this holds true across the world (Von Korff MR, Scott KM, Gureje, 2009).
 
Prevalence rates for major depression are higher for people with physical illness relative to those without. For example, 29% for people with hypotension, 22% for people with myocardial infarction, 33% for people with cancer and 27% for people with diabetes (World Health Organization, 2003).[zf3]  The World Mental Health Survey showed odds ratios across countries for the relationship between heart disease and mental health conditions were; 2:1 for depression; 2:2 for anxiety; and 1.4 for alcohol dependence. The relationship between heart disease and mental health conditions (the two biggest contributors to the global economic burden of chronic disease) appears to be reciprocal. For example, major depression has been shown to increase the risk of the development of cardiovascular disease (Gasse, Laursen, Baune, 2014). For example, strong relationships have been reported between early onset common mental health disorders and heart disease in adulthood (Gasse, Laursen, Baune, 2014). Conversely, having a physical illness is one of the strongest predictors of depression (O’Neil et al. 2015; Wilhelm K, Mitchell P, Slade T, 2003). In their meta-analysis, Roest, Martens, DeJonge, Denollet (2010) revealed anxiety disorders also increase the risk for cardio-vascular disease and cardiac related death. The relationship between mental health conditions and chronic conditions remains strong across a plethora of chronic conditions. For instance, type 2 diabetes mellitus, has been shown to increase the risk for depression (Rotella and Mannucci, 2013), anxiety (Wandell, Ljunggren, Wahlström, Carlsson, 2014) as well as schizophrenia, bipolar disorder and post-traumatic stress disorder. Meta-analyses have also shown a strong relationship between diabetes and cognitive impairment (Vancampfort D, Correll CU, Galling B, et al, 2016). Respiratory diseases and cancer have been linked with depression (Caruso R, GiuliaNanni M, Riba MB, Sabato S, Grassi, 2017). In the World Mental Health Survey, mood, anxiety, and substance dependency were shown to preceded a diagnosis of asthma (Scott, Lim, Al-Hamzawi, 2015).
 
These common mood disorders appear to share an underlying diathesis whereby mechanisms that predispose individuals to depression and anxiety for example, contribute to the development of a range of chronic physical health conditions across the life span. A greater understanding of this common underpinning diathesis is needed to better develop preventive interventions and well as treatments. Our original GENIAl model lays the foundations from which these underpinning mechanisms can be better understood (Kemp et a al. 2017). What is clear, is that interventions that fail to appreciate the role the causal role of psychological experience in physical and mental health as well as the reciprocal relationship between physical and mental health miss substantial opportunities in the prevention and the amelioration of chronic conditions. Moreover, the biases in treatment towards physical illness in the health service is inefficient given that high degree of co-morbidity with mental health conditions because we know that mental ill health affects adherence to treatments and prognosis. DiMatteo, Leeper and Croghan (2000) showed that people with depression were three times less likely to adhere to treatment regimens that people without depression. This commissioning bias also ignores the evidence that health-related quality of life is significantly lower for depressed patients than for people with physical health conditions for example, asthma, arthritis, and diabetes [Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, et al. (2007)].
 
Targeting psychological experiences may help to prevent or ameliorate the impact of chronic conditions and mental health conditions: Given the role of negative psychological experiences in creating vulnerabilities to chronic conditions and mental health disorders it follows that interventions that target psychological experience have the potential to prevent or ameliorate the impact of the mental and/or physical health conditions.
 
There is considerable evidence that psychological therapies can both improve quality of life for people with chronic conditions as well as improving health outcomes (Galway, Black, Cantwell, Cardwell, Mills, Donnelly, 2013; Happell, Davies and Scott, 2012; Hutchison, Breckon, 2011; Rehse B, Pukrop, 2003; Simpson, Booth, Lawrence, Byrne, Mair, Mercer, 2014; Stinson, Wilson, Gill, Yamada, Holt, 2009; Trautmann, Lackschewitz, Kröner-Herwig, 2006; Van Beugen S, Ferwerda M, Hoeve D, Rovers MM, Spillekom-Van Koulil S, Van Middendorp, 2014). However, Harkness, Macdonald, Valderas, Conventry, Gask and Bower, 2010)  carried out a meta-analysis which included 49 studies exploring the effectiveness of psycho-social interventions for people with type 1 and type 2 diabetes and overall found no benefit.
Cognitive Behavioural Therapy (CBT) is the most widely research psychological therapy (Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, 2006). Hundreds of controlled studies have demonstrated the benefits of CBT when applied to a range of diagnostic groups including mental health disorders such as anxiety, depression, schizophrenia (Hollon, S. D., Munoz, R. F., Barlow, D. H., Beardslee, W. R., Bell, C. C., & Bernal 2002, Barlow 2002; Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., & Orbach. 2002). CBT has also been shown to be effective for people with physical health conditions such as chronic pain, headache, cancer (Moorey, S., & Greer 2002; Holroyd, 2002, Morin, C. M., Hauri, P. J., Espie, C. A., Spielman, A. J., Buysse, D. J., & Bootzin. 1999) to name a few. A systematic review exploring internet-administered CBT for people with health problems also provided positive findings and the effects were comparable with face-to-face therapy for pain reduction and headache (Cuijpers, van Straten and Andersson, 2008).
Behaviour therapy has also been shown to be beneficial in the treamtnet of mental health problems. For example, in their meta-analysis, Cuijpers, van Straten and Wamerdam (2007a) included16 randomised studies exploring the effectiveness of behavioural activation for people with depression. They showed clear indications that the intervention was effective. A subsequent meta-analysis by the same authors (Cuijpers, van Straten and Wamerdam, 2007) included the findings of 13 randomized controlled studies to explore the effectiveness of problem-solving therapy for 1133 people with depression. They reported high levels of heterogeneity in the data which could not be further explained by subgroup analysis, the authors conclude that problem solving therapy has varying effects on depression but that there was no doubt that in some instances it could be effective.
In their systematic review, Robinson, Russell and Dysch (2019) explored the effectiveness of third-waves therapies for adults with long term neurological conditions. The term ‘third wave’ refers to the third development of psychotherapy and represents an extension of CBT (Hayes, 2004). Unlike Cognitive Behavioural Therapy, third waves therapies are less concerned with modifying thoughts but rather with changing the individuals relationship to their thoughts and psychological experiences. In this study, the third wave therapies included were Compassion Focused Therapy; Acceptance and Commitment Therapy; and Mindfulness-Based Cognitive Therapy or Mindfulness-Based Stress Reduction. The findings showed that, across 19 studies, there was a significant reduction in emotional distress. The authors concluded that third waves therapies showed promise in treating transdiagnostic difficulties within neurological conditions. In this context, the authors used the term transdiagnostic to refer to the psychological processes that are common across neurological conditions, such as rumination, low mood etc. In their systematic review of three studies exploring the effectiveness of mindfulness based interventions for patients with multiple sclerosis, Simpson, Booth, Byrne and Mercer, (2014) reported significant benefits relating to quality of life, mental health and selected physical health measures. These effects were sustained at the three and six month follow up period.
In a recent rapid systematic review, Anderson and Ozakinci (2018) explored the effectiveness of a variety of psychological interventions on quality of life, health related quality of life and/or wellbeing including only studies with ‘high scientific vigour’. This meant the inclusion of 6 randomised controlled trials with a treatment as usual control. Of the 6 studies, two were classified as short (0–3 months), two as medium- (3–12 months), and two as  long- term (12 months or more). Of the short studies, Baptist, Ross, Yany, Song, Clark (2013) carried out a six week health education-led self-regulation interventions for people with asthma and  Smeulders, Van Haastregt, Ambergen, Uszko-Lencer, Janssen- Boyce, Gorgels (2010) evaluated a six-week, nurse led, structured self-management programme for patients with chronic heart failure. This programme was also co-facilitated by a patient mentor. Of the medium duration studies, Escobar, Gara, Diaz-Martinez, Interian, Warman (2007) evaluated a 10-week, therapist led, cognitive behavioural group to patients with medically unexplained conditions. Somer, Blumenthal, Guilak, Kraus, Schmitt, Babyak (2012), reported an intervention for patients with osteoarthritis. In this study there were three treatment groups which spanned 24 weeks and was run by two clinical psychologists under the supervision of an experienced senior clinical psychologist. One group had ‘Pain Coping Skills Training’, one had ‘Behavioural Weight Management’ training and the other had both interventions. Of the long duration studies Blank, Hennessy, Eisenberg (2014) reported an intervention for patients with HIV who were offered weekly community based, nurse-led, psycho-education and symptom management sessions over a 12-month period. Also included was problem focused counselling programme for patients head or neck cancer which took place bi-monthly for 12 months. Overall, the findings indicated significant improvements to at least one component of quality of life immediately after the all of the interventions. Interestingly, one of the short duration interventions for people with asthma (Baptist et al. 2013), the medium duration interventions for people with osteoarthritis (Somer et al. 2012) and the long-term interventions for people with HIV (Blank et al. 2014) demonstrated significantly improved quality of life 12 months post intervention. This suggests that psychological interventions can have prolonged effects on the lives of people with chronic conditions (albeit in half of the studies) and that this effect is not dependent on treatment duration.
 [zf1]ADD WHAT DO WE MEAN BY COMMON MENTAL HEALTH CONDITIONS
 
 [zf2]Check this is an epidemiological study
 [zf3]World Health Organization, 2003.  Investing in Mental Health. Geneva: WHO}