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Global Mental Health > Psychological interventions > Flashcards

Psychological interventions Flashcards

1
Q

What is the predominance of psychological interventions in global mental health?

A

> 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

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2
Q

Who first developed structured psychotherapeutic approaches?

A

Al-Razi (9th century)
- Persian polymath

  • chief psychiatrist at Baghdad Psychiatric Hospital
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3
Q

What was developed in the 18th century, after the era of punitive action to treat mental illness?

A

Asyslum system in Western Europe

  • “moral” approaches to treatment
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4
Q

When did Sigmund Freud develop psychotherapy as ‘talking cure’?

A

20th century

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5
Q

What is the nature of psychosocial interventions in the context of global mental health?

A

Non-pharmacological

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6
Q

What are the three types of psychosocial interventions in global mental health?

A
  1. Psychoeducation
  2. Social interventions (towards holistic approaches)
  3. Brief interventions (e.g. CBT, IPT)
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7
Q

What is the principle of psychoeducation?

A

The provision of information to individuals and families to maximise help-seeking and recovery

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8
Q

What are brief interventions in global mental health?

A 
Talking therapies (e.g. CBT, IPT)
- which have been found to be effective when delivered by non-specialist workers who have received training
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9
Q

In which contexts are psychosocial interventions used in global mental health?

A
  • Stepped care models

- RCTs

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10
Q

What is the principle of interpersonal therapy (IPT)?

A

> Recent integrative psychosocial intervention

> Focuses on interaction of:

  • mood
  • interpersonal difficulties
  • subjective loss

-> basis for interpersonal psychotherapy formulation

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11
Q

What makes interpersonal therapy (IPT) integrative?

A

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
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12
Q

What is the aim of interpersonal therapy (IPT)?

A

To reduce depressive symptoms and to improve social functioning

-> break harmful patterns

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13
Q

What is the process of interpersonal therapy (IPT)?

A
  1. Assessment of symptoms and difficulties
  2. Sessions that work towards resolutions
  3. Encourage patients to engage in ways that support change
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14
Q

What are the 4 main steps of CBT?

A
  1. Make behavioural changes that have positive effect on how patient feels
  2. Break down problems into categories: feelings, thoughts, physical sensations, actions
  3. Analyse these components and determine their effects relative to patient’s experience
  4. Support patient in changing unhelpful thoughts and behaviours
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15
Q

What are the aims of CBT?

A
  1. Help people to deal with problems that feel overwhelming
    - by breaking them down into smaller parts
  2. Teach people how to apply the skills learnt during treatment to daily life post-treatment
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16
Q

What does the evidence suggest about the effectiveness of psychological interventions?

A

> 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)

17
Q

Why focus on psychological therapies in the context of global mental health?

A
  1. Evidence of effectiveness as first line of intervention in many conditions
  2. Evidence base of similar effect to that of pharmacological treatments with lower risk of harm / side effects
18
Q

Why are psychological interventions most feasible in the context of LMIC health systems, compared to pharmacological treatments?

A

> 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

19
Q

What made psychological interventions an important component of global mental health?

A

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

20
Q

What is the overall aim of psychological interventions in the context of global mental health?

A

Reduce the treatment gap

21
Q

What are the five key considerations for the selection of interventions?

A
  1. Effectiveness
    - reduced symptoms, improved outcomes
  2. Feasibility
    - resource availability in particular settings
  3. Equity
    - availability of intervention
  4. Affordability
    - costs to individuals, families, health system
  5. Acceptability
    - to local service users, families and the community
22
Q

What are the two key considerations in an intervention for a sustained and substantive engagement with local stakeholders?

A
  1. Is the intervention socioculturally acceptable?

2. Is it relevant in a particular context?

23
Q

What is the framework process for the adaptation and localisation of psychological interventions?

A
  1. Identify cultural contexts
  2. Measure cultural constructs
  3. Consider how this knowledge might guide research
24
Q

What are the elements to balance for the adaptation of psychological interventions?

A

Adaptation = delicate balance between

  • fit with local context
  • fidelity to evidence-based models
25
Q

What makes a manual for psychological interventions useful in the context of global mental health?

A

Most useful manuals for psy. interventions will be

  • empirically grounded
  • BUT allow flexibility to fit client’s context
26
Q

When are cultural adaptations warranted (necessary)?

A

When there are community-specific cultural contexts which influence risk or resilience

27
Q

What are the findings on culturally adapted interventions?

A
  • 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)

Global Mental Health (14 decks)

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