Enhancing Chronic Illness Outcomes Through Therapeutic Interventions
- Ryan Burns
- Apr 28
- 14 min read
Updated: Apr 30

SCIENCEWORKS BEHAVIORAL HEALTHCARE
March 2025
Executive Summary
Chronic illnesses represent a significant global health burden, affecting approximately 45% of the U.S. population and placing substantial strain on healthcare systems worldwide. While medical interventions remain the cornerstone of treatment, compelling quantitative evidence indicates that psychological therapies can dramatically enhance patient outcomes across multiple domains.
The data is striking: therapeutic interventions have demonstrated reductions in HbA1c levels of 0.5-0.8% in diabetes patients (comparable to many second-line medications), decreases in pain intensity of 25-33% across conditions, improvements in functional capacity of 28-37%, and reductions in depression symptoms of 40-56%. These clinical improvements translate to measurable economic benefits, including decreased emergency department visits (25-73%), reduced hospitalization rates (29-45%), and an average return on investment of $1.68 for every $1 spent on therapeutic interventions.
Table 1: Key Clinical Outcomes of Therapeutic Interventions
Outcome Metric | Average Improvement | Comparison to Control Groups |
HbA1c Reduction | 0.5-0.8% | 0.2-0.3% in controls |
Pain Intensity Reduction | 25-33% | 8-15% in controls |
Functional Capacity Improvement | 28-37% | 10-17% in controls |
Depression Symptom Reduction | 40-56% | 12-31% in controls |
Anxiety Symptom Reduction | 38-47% | 14-22% in controls |
This white paper examines the efficacy of five evidence-based therapeutic approaches—Acceptance and Commitment Therapy (ACT), Behavioral Activation (BA), Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT)—in improving health outcomes, quality of life, and psychological well-being for patients with chronic conditions. The integration of these therapeutic modalities into standard care protocols is not merely beneficial but represents an evidence-based imperative for more comprehensive, cost-effective, and patient-centered chronic illness management.
Introduction
Chronic illnesses—defined as conditions that persist for one year or more, requiring ongoing medical attention and/or limiting activities of daily living—affect approximately 45% of the U.S. population (CDC, 2023). These conditions, including cardiovascular diseases, diabetes, chronic respiratory diseases, and autoimmune disorders, pose significant challenges to patients' physical functioning, emotional well-being, and overall quality of life.
The traditional biomedical approach to chronic illness management has primarily focused on controlling physical symptoms and disease progression. However, this approach often overlooks the profound psychological impact of living with a chronic condition, including:
Adjustment difficulties following diagnosis
Depression and anxiety as comorbidities
Challenges with treatment adherence
Disruption to identity and life roles
Social isolation and relationship strain
Research consistently demonstrates that psychological factors significantly influence how patients cope with and manage chronic conditions (Turner & Kelly, 2022). Consequently, there has been growing interest in integrating psychological therapies into comprehensive treatment plans to address both the physical and psychological dimensions of chronic illness.
This white paper explores how five evidence-based therapeutic approaches can complement medical interventions to improve outcomes for patients with chronic illnesses.
The Psychological Impact of Chronic Illness
Living with a chronic illness extends far beyond managing physical symptoms. Patients often experience:
Psychological distress: Depression is 2-3 times more common in people with chronic physical conditions compared to the general population (Katon, 2011). Anxiety disorders also show higher prevalence rates in chronically ill populations.
Reduced quality of life: Physical limitations, pain, fatigue, and other symptoms can restrict participation in meaningful activities and reduce overall life satisfaction (Megari, 2013).
Identity challenges: Many patients struggle with changes to their self-concept and social identity following diagnosis (Charmaz, 1983).
Treatment burden: Complex medication regimens, lifestyle modifications, and frequent medical appointments can overwhelm patients, leading to reduced treatment adherence (May et al., 2014).
Table 2: Prevalence of Psychological Comorbidities in Chronic Illness
Chronic Condition | Depression Prevalence | Anxiety Prevalence | Comparison to General Population |
Diabetes | 17-27% | 14-25% | 2-3× higher |
Cardiovascular Disease | 15-30% | 20-35% | 2-3× higher |
Chronic Pain | 30-54% | 35-45% | 3-4× higher |
Multiple Sclerosis | 22-54% | 25-41% | 2-3× higher |
Cancer | 20-38% | 19-34% | 2-3× higher |
These psychological challenges can exacerbate physical symptoms, reduce treatment adherence, and ultimately lead to poorer health outcomes. Therapeutic interventions that address these challenges offer potential to break this negative cycle and improve overall disease management.
Evidence-Based Therapeutic Approaches: Quantitative Outcomes
Acceptance and Commitment Therapy (ACT)
Core Principles: ACT focuses on increasing psychological flexibility through mindfulness, acceptance of difficult experiences, and commitment to valued actions rather than futile attempts to control or eliminate symptoms.
Quantitative Evidence for Chronic Illness: ACT has demonstrated significant measurable improvements across multiple chronic conditions:
Table 3: ACT Outcomes Across Chronic Conditions
Condition | Outcome Measure | ACT Group Improvement | Control Group Improvement | Study Details |
Chronic Pain | Pain Acceptance | 65% improvement (d=0.65) | 22% improvement | Meta-analysis, 25 RCTs (Hughes et al., 2017) |
Chronic Pain | Functional Capacity | 32% improvement | 11% improvement | Meta-analysis, 25 RCTs (Hughes et al., 2017) |
Diabetes | HbA1c Reduction | 0.8% reduction | 0.3% reduction | RCT, n=157 (Gregg et al., 2007) |
Diabetes | Self-management | 24% improvement | 9% improvement | RCT, n=157 (Gregg et al., 2007) |
Diabetes | Target Glycemic Control | 2.5× more likely | Baseline | Follow-up study (Shayeghian et al., 2016) |
Multiple Sclerosis | Depression Symptoms | 40% reduction | 12% reduction | Controlled trial (Pakenham et al., 2018) |
Multiple Sclerosis | Quality of Life | 35% improvement | 8% improvement | Controlled trial (Pakenham et al., 2018) |
Application in Chronic Illness Management: ACT helps patients acknowledge the reality of their condition while focusing on living meaningfully despite illness-related limitations. By fostering psychological flexibility, ACT enables patients to pursue valued activities even in the presence of symptoms or disease progression.
Behavioral Activation (BA)
Core Principles: BA focuses on increasing engagement in adaptive activities, decreasing avoidance behaviors, and solving problems that limit access to reinforcement.
Quantitative Evidence for Chronic Illness: BA has demonstrated significant measurable improvements across chronic illness populations:
Table 4: Behavioral Activation Outcomes Across Chronic Conditions
Condition | Outcome Measure | BA Group Improvement | Control Group Improvement | Study Details |
Cardiovascular Disease | Depression Scores | 56.8% reduction | 32.1% reduction | RCT, n=157 post-CABG patients (Freedland et al., 2015) |
Cardiovascular Disease | Cardiac Rehospitalizations | 37% reduction | No significant change | 12-month follow-up (Freedland et al., 2015) |
Chronic Pain | Pain Intensity | 2.1 point reduction (0-10 scale) | 0.8 point reduction | Systematic review, 11 studies (Veehof et al., 2016) |
Chronic Pain | Pain-related Disability | 45% reduction | 22% reduction | Systematic review, 11 studies (Veehof et al., 2016) |
Cancer | Depression Symptoms | 70% reduction | 31% reduction | Controlled trial, n=80 breast cancer survivors (Hopko et al., 2011) |
Cancer | Fatigue Severity | 43% reduction | 15% reduction | Controlled trial, n=80 breast cancer survivors (Hopko et al., 2011) |
Application in Chronic Illness Management: BA helps chronically ill patients counter the tendency to withdraw from activities due to symptoms, fatigue, or depression. By systematically increasing engagement in meaningful activities, BA can break cycles of inactivity, isolation, and mood deterioration that often accompany chronic illness.
Cognitive Behavioral Therapy (CBT)
Core Principles: CBT focuses on identifying and modifying maladaptive thoughts, beliefs, and behaviors that contribute to psychological distress and functional impairment.
Quantitative Evidence for Chronic Illness: CBT has the most extensive research support among psychological interventions:
Table 5: Cognitive Behavioral Therapy Outcomes Across Chronic Conditions
Condition | Outcome Measure | CBT Group Improvement | Control Group Improvement | Study Details |
Chronic Pain | Pain Intensity | 25% reduction (SMD=0.21) | 10% reduction | Meta-analysis, 25 trials, n=4,788 (Williams et al., 2012) |
Chronic Pain | Functional Capacity | 30% improvement (SMD=0.26) | 12% improvement | Meta-analysis, 25 trials, n=4,788 (Williams et al., 2012) |
Chronic Pain | Pain Catastrophizing | 53% reduction (SMD=0.53) | 14% reduction | Meta-analysis, 25 trials, n=4,788 (Williams et al., 2012) |
IBS | Symptom Severity | 61% reduction | 27% reduction | RCT, n=436 (Lackner et al., 2018) |
IBS | Clinical Remission | 41% achieved | 12% achieved | RCT, n=436 (Lackner et al., 2018) |
Chronic Fatigue | Fatigue Severity | 40% reduction | 19% reduction | Systematic review, 14 studies, n=1,648 (Price et al., 2008) |
Chronic Fatigue | Physical Functioning | 37.5% improvement | 15.3% improvement | Systematic review, 14 studies, n=1,648 (Price et al., 2008) |
Chronic Fatigue | Clinically Significant Improvement | 40% of patients | 26% of patients | Systematic review, 14 studies, n=1,648 (Price et al., 2008) |
Insomnia | Sleep Onset Latency | 19 min reduction | 5.5 min reduction | Meta-analysis, 37 RCTs (Wu et al., 2015) |
Insomnia | Total Sleep Time | 17.6 min increase | 6.2 min increase | Meta-analysis, 37 RCTs (Wu et al., 2015) |
Insomnia | Sleep Efficiency | 9.9% improvement | 3.1% improvement | Meta-analysis, 37 RCTs (Wu et al., 2015) |
Insomnia | Remission Rates | 36% achieved | 17% achieved | Meta-analysis, 37 RCTs (Wu et al., 2015) |
Application in Chronic Illness Management: CBT helps patients challenge illness-related thought patterns that may exacerbate distress or interfere with self-management (e.g., catastrophizing, all-or-nothing thinking). It also provides strategies for behavior change to support medication adherence, symptom management, and lifestyle modifications.
Dialectical Behavior Therapy (DBT)
Core Principles: DBT combines acceptance and change strategies, with particular emphasis on emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness skills.
Quantitative Evidence for Chronic Illness: While originally developed for borderline personality disorder, adapted DBT approaches have demonstrated quantifiable benefits:
Table 6: Dialectical Behavior Therapy Outcomes Across Chronic Conditions
Condition | Outcome Measure | DBT Group Improvement | Control Group Improvement | Study Details |
Chronic Pain | Pain Catastrophizing | 45% reduction | 15% reduction | Controlled trial, n=108 (Linton, 2010) |
Chronic Pain | Pain Acceptance | 37% improvement | 14% improvement | Controlled trial, n=108 (Linton, 2010) |
Chronic Pain | Pain-related Disability | 28% reduction | 10% reduction | Controlled trial, n=108 (Linton, 2010) |
Chronic Pain | Emergency Department Visits | 68% reduction | 25% reduction | 12-month follow-up (Linton, 2010) |
End-stage Renal Disease | Depression Scores | 52% reduction | 19% reduction | Pilot RCT, n=45 dialysis patients (Lynch et al., 2018) |
End-stage Renal Disease | Treatment Adherence | 31% improvement | 11% improvement | Pilot RCT, n=45 dialysis patients (Lynch et al., 2018) |
End-stage Renal Disease | Missed Dialysis Sessions | 3.4 to 0.8 per month | 3.2 to 2.7 per month | Pilot RCT, n=45 dialysis patients (Lynch et al., 2018) |
End-stage Renal Disease | Hospitalizations | 45% reduction | 17% reduction | Pilot RCT, n=45 dialysis patients (Lynch et al., 2018) |
Diabetes | HbA1c Reduction | 0.7% reduction | 0.2% reduction | Controlled trial, n=94 (Webb et al., 2017) |
Diabetes | Diabetes Distress | 41% improvement | 17% improvement | Controlled trial, n=94 (Webb et al., 2017) |
Diabetes | Medication Adherence | 35% improvement | 13% improvement | Controlled trial, n=94 (Webb et al., 2017) |
Application in Chronic Illness Management: DBT's emphasis on distress tolerance and emotion regulation is particularly valuable for helping patients cope with the unpredictable nature of many chronic conditions, treatment-related distress, and difficult medical decisions. Interpersonal effectiveness skills can also help patients navigate changing relationships and communicate effectively with healthcare providers.
Mindfulness-Based Cognitive Therapy (MBCT)
Core Principles: MBCT combines mindfulness practices with elements of cognitive therapy, focusing on developing awareness of thoughts, feelings, and bodily sensations without judgment.
Quantitative Evidence for Chronic Illness: MBCT has demonstrated significant measurable improvements across multiple conditions:
Table 7: Mindfulness-Based Cognitive Therapy Outcomes Across Chronic Conditions
Condition | Outcome Measure | MBCT Group Improvement | Control Group Improvement | Study Details |
Chronic Pain | Pain Intensity | 33% reduction (d=0.33) | 15% reduction | Meta-analysis, 38 RCTs, n=3,536 (Hilton et al., 2017) |
Chronic Pain | Physical Functioning | 28.7% improvement | 11.2% improvement | Meta-analysis, 38 RCTs, n=3,536 (Hilton et al., 2017) |
Chronic Pain | Analgesic Medication Use | 38% reduction | 12% reduction | Meta-analysis, 38 RCTs, n=3,536 (Hilton et al., 2017) |
Multiple Sclerosis | Fatigue Impact | 42% reduction | 11% reduction | Controlled trial, n=150 (Grossman et al., 2010) |
Multiple Sclerosis | Depression Symptoms | 47% reduction | 13% reduction | Controlled trial, n=150 (Grossman et al., 2010) |
Multiple Sclerosis | Quality of Life | 31% improvement | 13% improvement | Controlled trial, n=150 (Grossman et al., 2010) |
Cardiovascular Disease | Systolic Blood Pressure | 5.8 mmHg reduction | 1.9 mmHg reduction | Meta-analysis, 12 studies, n=758 (Abbott et al., 2014) |
Cardiovascular Disease | Diastolic Blood Pressure | 6.1 mmHg reduction | 2.1 mmHg reduction | Meta-analysis, 12 studies, n=758 (Abbott et al., 2014) |
Cardiovascular Disease | Depression Scores | 44% reduction | 18% reduction | Meta-analysis, 12 studies, n=758 (Abbott et al., 2014) |
Cardiovascular Disease | Anxiety Symptoms | 38% reduction | 14% reduction | Meta-analysis, 12 studies, n=758 (Abbott et al., 2014) |
Diabetes | Diabetes Distress | 34% reduction | 9% reduction | RCT, n=139 (van Son et al., 2013) |
Diabetes | HbA1c Levels | 0.5% reduction | 0.1% reduction | RCT, n=139 (van Son et al., 2013) |
Diabetes | Perceived Stress | 37% reduction | 13% reduction | RCT, n=139 (van Son et al., 2013) |
Application in Chronic Illness Management: MBCT helps patients develop a different relationship with illness-related thoughts and sensations, reducing rumination and catastrophizing. The mindfulness skills taught in MBCT can also enhance body awareness, potentially improving symptom management and treatment adherence.
Mechanisms of Therapeutic Benefit
The therapeutic approaches described above improve chronic illness outcomes through several key mechanisms:
Enhanced Emotional Regulation
Chronic illness often triggers intense emotional responses, including fear, grief, anger, and frustration. Therapeutic interventions provide patients with skills to regulate these emotions more effectively, preventing them from interfering with self-management behaviors or quality of life.
Research indicates that improved emotional regulation mediates the relationship between psychological interventions and health outcomes in conditions such as diabetes (Tran et al., 2019) and cardiovascular disease (Loucks et al., 2015).
Reduced Symptom Amplification
Psychological factors, particularly catastrophizing and hypervigilance, can amplify the perception of physical symptoms. Therapies that address these cognitive processes can reduce symptom intensity and associated distress.
A systematic review by Edwards et al. (2016) found that reductions in pain catastrophizing mediated improvements in pain outcomes following CBT interventions.
Improved Illness Management Behaviors
Psychological interventions can enhance treatment adherence, lifestyle modifications, and self-monitoring through:
Addressing motivation and barriers to behavior change
Developing problem-solving skills for implementation challenges
Building habits and routines that support health behaviors
A meta-analysis by Gonzalez et al. (2016) found that CBT interventions significantly improved medication adherence across multiple chronic conditions.
Enhanced Coping Resources
Therapy provides patients with a broader range of adaptive coping strategies to manage illness-related challenges. Research by Sirois and Hirsch (2019) indicates that flexibility in coping approach is associated with better adjustment to chronic illness.
Reduced Comorbid Mental Health Conditions
By addressing depression, anxiety, and other psychological comorbidities, therapy can indirectly improve physical health outcomes. Katon et al. (2010) demonstrated that collaborative care addressing depression in diabetes patients led to improvements in both mental health and glycemic control.
Implementation Models for Integrating Therapy in Chronic Illness Care
Several models exist for incorporating psychological therapies into chronic illness care:
Collaborative Care Model
This approach integrates mental health providers into primary care settings, with regular monitoring of patients' psychological status and stepped care protocols.
The IMPACT study, a large trial of collaborative care for depression in older adults with chronic illnesses, found the model improved both depression outcomes and physical functioning (Unützer et al., 2002).
Integrated Specialty Clinics
Specialty clinics (e.g., diabetes centers, pain clinics) can incorporate mental health providers as core team members, offering both individual and group-based interventions.
The Acceptance and Commitment Therapy for Diabetes (ACT-D) program, integrated into standard diabetes care, demonstrated improvements in diabetes self-management and glycemic control (Gregg et al., 2007).
Digital Delivery of Therapeutic Interventions
Digital platforms offering therapy via mobile apps, web-based programs, or telehealth can expand access to psychological interventions for chronic illness patients:
Web-based CBT programs have shown efficacy for managing depression in patients with multiple sclerosis (Fischer et al., 2015).
ACT-based mobile applications have demonstrated benefits for chronic pain management (Kristjánsdóttir et al., 2013).
Remote DBT skills training has shown promising results for patients with comorbid emotional disorders and chronic conditions (McCarthy et al., 2017).
A systematic review by Mehta et al. (2019) found that digital mental health interventions were effective in improving both psychological and physical outcomes across multiple chronic illnesses.
Cost-Effectiveness: Quantitative Economic Impact
The integration of psychological therapies into chronic illness care has demonstrated considerable cost-effectiveness across multiple studies:
Table 8: Economic Outcomes of Therapeutic Interventions for Chronic Conditions
Condition | Intervention | Cost Reduction | Healthcare Utilization Impact | Return on Investment | Study Details |
Irritable Bowel Syndrome | CBT | $1,642 per patient annually | Work absenteeism reduced by 3.1 days/month | $2,831 net savings per patient annually | Cost-effectiveness analysis, n=436 (Lackner et al., 2019) |
Irritable Bowel Syndrome | CBT | ICER: $1,183 per QALY | - | Below $50,000/QALY threshold | Cost-effectiveness analysis (Lackner et al., 2019) |
Diabetes/Cardiovascular | Collaborative Care with CBT | ICER: £13,069 per QALY | ED visits decreased by 34% | Below £20,000/QALY threshold | COINCIDE trial, n=387 (Camacho et al., 2018) |
Diabetes/Cardiovascular | Collaborative Care with CBT | - | Hospitalization rates reduced by 29% | - | COINCIDE trial, n=387 (Camacho et al., 2018) |
Chronic Pain | Mindfulness-based Interventions | $2,527 per patient annually | Workplace productivity increased by 22% | ROI: $1.68 for every $1 spent | Systematic review, 8 economic analyses (Cherkin et al., 2018) |
Chronic Pain | Mindfulness-based Interventions | All ICERs below $20,000/QALY | - | Below cost-effectiveness thresholds | Systematic review (Cherkin et al., 2018) |
The economic benefits of psychological interventions have been quantified in multiple studies:
Table 9: Healthcare Utilization Impact of Therapeutic Interventions
Healthcare Parameter | Range of Improvement | Average Improvement |
Emergency Department Visits | 25-68% reduction | 51% reduction |
Hospital Readmissions | 29-73% reduction | 45% reduction |
Medication Adherence | 22-47% improvement | 35% improvement |
Work Absenteeism | 3.1-8.2 fewer days per month | 5.4 fewer days per month |
Barriers and Challenges to Implementation
Despite their potential benefits, several barriers limit the integration of psychological therapies into chronic illness care:
Healthcare System Barriers
Fragmentation between physical and mental healthcare systems
Inadequate reimbursement models for psychological services
Limited mental health resources in primary care settings
Provider Barriers
Insufficient training in recognizing psychological needs
Time constraints during medical appointments
Limited knowledge of appropriate referral pathways
Patient Barriers
Stigma associated with seeking psychological help
Financial concerns related to therapy costs
Physical limitations that complicate therapy attendance
Addressing Implementation Barriers
Successful integration of psychological therapies requires a multi-faceted approach:
Workforce development: Training healthcare providers to recognize psychological needs and utilize brief interventions within medical appointments.
Healthcare policy changes: Advocating for reimbursement models that support integrated care and recognize the value of psychological interventions.
Stepped care approaches: Implementing tiered intervention models that match treatment intensity to patient needs and preferences.
Cultural adaptation: Tailoring therapeutic approaches to diverse patient populations, considering cultural attitudes toward mental health and chronic illness.
Digital solutions: Leveraging technology to expand access to psychological interventions, particularly for patients with mobility limitations or in rural areas.
Recommendations for Clinical Practice
Based on the evidence reviewed, the following recommendations are proposed for integrating psychological therapies into chronic illness care:
Routine screening for psychological distress should be conducted with all chronic illness patients using validated measures.
Matched care approaches should consider patient preferences, illness characteristics, and specific psychological needs when selecting therapeutic modalities.
Early intervention should be emphasized, offering psychological support at diagnosis or early in the disease course rather than waiting for significant distress to develop.
Group-based formats should be considered where appropriate, as they can provide both therapeutic benefit and peer support while optimizing resources.
Family involvement should be incorporated when possible, as family dynamics significantly influence adjustment to chronic illness.
Regular assessment of both psychological and physical outcomes should guide treatment planning and modifications.
Clinician training in basic psychological principles and interventions should be expanded across healthcare disciplines involved in chronic illness care.
Conclusion: The Quantitative Case for Integration
The substantial body of quantitative evidence presented in this white paper overwhelmingly supports the integration of psychological therapies into comprehensive care plans for patients with chronic illnesses. The data demonstrates that therapeutic interventions consistently produce clinically significant improvements across multiple domains:
Table 10: Summary of Key Clinical and Economic Outcomes
Outcome Domain | Range of Improvement | Comparison to Usual Care |
Disease-specific Biomarkers | HbA1c reductions: 0.5-0.8% | 0.1-0.3% in controls |
Disease-specific Biomarkers | Blood pressure: 5.8-6.1 mmHg | 1.9-2.1 mmHg in controls |
Symptom Burden | Pain intensity: 25-33% reduction | 8-15% reduction in controls |
Symptom Burden | Fatigue: 40-43% decrease | 11-19% decrease in controls |
Functional Capacity | Physical functioning: 28-37% improvement | 10-17% improvement in controls |
Psychological Outcomes | Depression: 40-56% reduction | 12-31% reduction in controls |
Psychological Outcomes | Anxiety: 38-47% reduction | 14-22% reduction in controls |
Healthcare Utilization | Emergency visits: 25-68% decrease | Not significant in most controls |
Healthcare Utilization | Hospitalizations: 29-73% decrease | Not significant in most controls |
Cost-effectiveness | ICERs below established thresholds | - |
Cost-effectiveness | ROI averaging $1.68 for every $1 spent | - |
ACT, BA, CBT, DBT, and MBCT offer distinct but complementary approaches to addressing the psychological challenges that accompany chronic conditions. The magnitude of improvement achieved through these interventions often equals or exceeds that of many pharmacological treatments, without the risk of adverse side effects.
Successfully implementing these approaches requires overcoming systemic, provider, and patient-level barriers through policy changes, workforce development, and innovative delivery models. With quantifiable benefits across clinical, functional, and economic domains, the integration of psychological therapies into chronic illness care represents not merely a promising option but an evidence-based imperative for advancing more effective, efficient, and patient-centered healthcare.
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