Psychological interventions Flashcards
What is the predominance of psychological interventions in global mental health?
> Core component of stepped care models
> Often first line of treatment for most common mental health problems
> They’re at the heart of task-shared models
> Brief structured interventions (CBT, IPT) are effective when delivered by non-specialists healthcare workers
Who first developed structured psychotherapeutic approaches?
Al-Razi (9th century)
- Persian polymath
- chief psychiatrist at Baghdad Psychiatric Hospital
What was developed in the 18th century, after the era of punitive action to treat mental illness?
Asyslum system in Western Europe
- “moral” approaches to treatment
When did Sigmund Freud develop psychotherapy as ‘talking cure’?
20th century
What is the nature of psychosocial interventions in the context of global mental health?
Non-pharmacological
What are the three types of psychosocial interventions in global mental health?
- Psychoeducation
- Social interventions (towards holistic approaches)
- Brief interventions (e.g. CBT, IPT)
What is the principle of psychoeducation?
The provision of information to individuals and families to maximise help-seeking and recovery
What are brief interventions in global mental health?
Talking therapies (e.g. CBT, IPT) - which have been found to be effective when delivered by non-specialist workers who have received training
In which contexts are psychosocial interventions used in global mental health?
- Stepped care models
- RCTs
What is the principle of interpersonal therapy (IPT)?
> Recent integrative psychosocial intervention
> Focuses on interaction of:
- mood
- interpersonal difficulties
- subjective loss
-> basis for interpersonal psychotherapy formulation
What makes interpersonal therapy (IPT) integrative?
Combines thinking of medical model (e.g. explicit diagnosis)
AND dynamic ideas of reciprocal and repeating patterns of relationships
AND vulnerability arising from broken attachments
- e.g. focus on interpersonal relationships
What is the aim of interpersonal therapy (IPT)?
To reduce depressive symptoms and to improve social functioning
-> break harmful patterns
What is the process of interpersonal therapy (IPT)?
- Assessment of symptoms and difficulties
- Sessions that work towards resolutions
- Encourage patients to engage in ways that support change
What are the 4 main steps of CBT?
- Make behavioural changes that have positive effect on how patient feels
- Break down problems into categories: feelings, thoughts, physical sensations, actions
- Analyse these components and determine their effects relative to patient’s experience
- Support patient in changing unhelpful thoughts and behaviours
What are the aims of CBT?
- Help people to deal with problems that feel overwhelming
- by breaking them down into smaller parts - Teach people how to apply the skills learnt during treatment to daily life post-treatment
What does the evidence suggest about the effectiveness of psychological interventions?
> They’re as effective as pharmacological treatments in addressing depressive symptoms
- CBT recommended by NICE guidelines in reliving symptoms of major depression
- CBT and MBCT found effective in preventing relapse
> However effect size tend to be moderate at best
- e.g. meta-analysis of RCTs among people with somatic illness (CBT on depressive symptoms vs. control)
-> small pooled effect size for acute treatment
(probably due to lack of sufficiently high-quality trials)
Why focus on psychological therapies in the context of global mental health?
- Evidence of effectiveness as first line of intervention in many conditions
- Evidence base of similar effect to that of pharmacological treatments with lower risk of harm / side effects
Why are psychological interventions most feasible in the context of LMIC health systems, compared to pharmacological treatments?
> Pharma -> need for lengthy medical training
- requires substantial additional funding
> Inconsistency and unreliability of supply chains for essential medications
- improvement would require long-term investment
What made psychological interventions an important component of global mental health?
Psychological treatments = interactive process
- inherently flexible
- adaptable to local context
-> recommended as part of mhGAP
-> adopted by many LMIC governments
=> to close the treatment gap
What is the overall aim of psychological interventions in the context of global mental health?
Reduce the treatment gap
What are the five key considerations for the selection of interventions?
- Effectiveness
- reduced symptoms, improved outcomes - Feasibility
- resource availability in particular settings - Equity
- availability of intervention - Affordability
- costs to individuals, families, health system - Acceptability
- to local service users, families and the community
What are the two key considerations in an intervention for a sustained and substantive engagement with local stakeholders?
- Is the intervention socioculturally acceptable?
2. Is it relevant in a particular context?
What is the framework process for the adaptation and localisation of psychological interventions?
- Identify cultural contexts
- Measure cultural constructs
- Consider how this knowledge might guide research
What are the elements to balance for the adaptation of psychological interventions?
Adaptation = delicate balance between
- fit with local context
- fidelity to evidence-based models
What makes a manual for psychological interventions useful in the context of global mental health?
Most useful manuals for psy. interventions will be
- empirically grounded
- BUT allow flexibility to fit client’s context
When are cultural adaptations warranted (necessary)?
When there are community-specific cultural contexts which influence risk or resilience
What are the findings on culturally adapted interventions?
- Meta-analysis suggests adaptation is effective
- Findings are unclear in context of LMIC settings
- Lack of evidence of top-down processes measuring and treating the right problems (= local priority)
