Psychological Interventions

Question 1

What is the brief history of psychological interventions?

Answer 1

9th C: Al Razi, persian polymath

18th C: Demon possession: punitive action

18th C: Asylums and moral care

20th C: Sigmund Freud: talking cure

21st C: Conversations

Question 2

What are the major intervention types in Global Mental Health?

Answer 2

Psychoeducation: Sometimes active element of study. First step in stepped care.

Social Interventions

Brief interventions: CBT and IPT: by non-specialists.

Question 3

What is IPT and how does the therapy aim to work?

Answer 3

Interpersonal Therapy:
Depression leads to disrupted Interpersonal Difficulties leads to Loss leads to Depression.

Interpersonal Difficulties refer to: transitions in the role, Disputes, and bereavement.

The Aim: To reduce depressive symptoms and increase social functioning

By: Assessing symptoms. onset and continuation, sessions for resolution, and patients encouraged to engage to change patterns.

Question 4

What is CBT?

Answer 4

Aim: To break down problems into manageable parts and change them.

Trigger will set off hot cross bun model of: Feelings, thoughts, emotions and physical sensations.

Steps: Make behaviour changes, breakdown problems into smaller ones via hot cross model, analyse components, support changing them.

Question 5

What is the evidence for Psychological interventions?

Answer 5

That they are on par with pharmacological interventions for symptom reduction.

Moderate size at best:

CBT is under NICE guidelines for Depressive symptoms

CBT and MBCT effective in preventing relapse

Question 6

Why should we focus on Psychological interventions?

Answer 6

Because they are as good as pharmacological and carry a smaller risk of harm.

Also most feasible in LMIC due to medical training to administer and supply chain issues.

Question 7

What is the goal of GMH and what aspects do we need to be aware of?

Answer 7

Acceptability, Affordability, Equity, Feasibility, Effectiveness.

To reduce the treatment gap.

Question 8

What is a useful Framework to use to adapt interventions locally?

Answer 8

Identity cultural contexts, measure them, consider how they may guide research.

Question 9

What balance does cultural adaption need to strike and what are the criticisms of this?

Answer 9

Local context and feasibility

Criticism: Meta-analysis is positive, however, done in HIC, also lack evidence of top-down processes being sufficient for local priorities