Low-Intensity Treatments for Common Mental Disorders
Lectures
Week 1
Lecture 1: Introduction & Motivational Interviewing
Lecture 2: Self Help & Problem-Solving Therapy
Week 2
Lecture 3: Low-Intensity Treatments in the context of Psycho-oncology
Week 3
Lecture 4: Low Intensity Behavioural Activation in Depression
Week 4
Lecture 5: Exposure Therapy
Lecture 6: Digital Interventions for Worrying
Week 5
Lecture 7: Low Intensity CBT for Insomnia
Week 6
Lecture 8: Low-Intensity Cognitive Restructuring
Week 7
Lecture 9: Low-Intensity Treatments in a Cross-cultural context
Practice Exam
Lecture 1: Introduction & Motivational Interviewing
Lecture 2: Self-help & Problem-Solving Therapy
Lecture 3: Low-intensity Treatments in Psychosocial Oncology
Lecture 4: Behavioral Activation
Lecture 5: Exposure Therapy
Lecture 6: Digital Interventions
Lecture 7: Sleep & Insomnia
Lecture 8: Cognitive Restructuring
Lecture 9: Global Mental Health & Cultural Adaptation
, Lectures
Week 1
Lecture 1: Introduction & Motivational Interviewing
Flynn HA (2011) = integration of motivational interviewing with cognitive behavioral therapy
in the treatment of depression
- Cognitive behavioral Therapy (CBT) is one of the most common
treatments for depression but many individuals do not fully respond
to treatment
- Aim: explore integration of Motivational Interviewing (MI) to
change CBT outcome
- MI: addressing motivation for treatment, addressing ambivalence &
adherence, readiness to change
- CBT: focused on changing maladaptive thoughts & behaviors
- Rationale: motivational interviewing targets the symptoms of
depression focusing on deficiencies in ambivalence & change
- Integration of MI as treatment-engagement intervention are
effective in substance abuse
- Possible benefits of integration of MI & CBT for depression
- Increased client engagement & motivation
- Improved treatment adherence
- Comprehensive & personal treatment planning
Low-intensity Treatments = lower doses of intervention, fewer or shorter sessions, groups
- Less contact with the therapist (involving self-help interventions)
- More self-direction of the client (higher accountability of the client)
- Modes of delivery: books, online, telephone
- Advantages: More flexible: time & pace, lower cost
- Less of a conventional therapist and more of a “coach”
- Require a different way of working with your patient
- Less guidance
- Often used for prevention & milder symptoms but also works for
severe problems
Content of interventions may not be different!
- Often based on Cognitive Behavioral Therapy (CBT) just delivered
differently
- Shorter duration with other tools
History
- Created in the UK to be more efficient
- It is also cheaper
- NOT because they are better or content related ONLY political &
economical reasons
Main characteristics
1. Efficiency: lower doses of the treatment, less & shorter sessions,
groups
2. Vehicles: use self-help materials for more efficiency
- Not using so much time of the therapist
3. Early access to services: in community, self-referral, prevention
- Less stigmatizing
Stepped care approach = beginning with less intense treatment and stepping up to more intense
1
, treatment
- Evaluate after each step!
- Good for the therapist & the client: More efficient, less stigmatizing
(accessible) & affordable
- Avoid giving treatment that is not needed
- UK: guidelines for treatment is stepped care
1. Primary care: Psychoeducation
2. Low-intensity treatment: Self-help
3. High-intensity treatment: face-to-face CBT
4. Multidisciplinary
5. Inpatient care
Used to close the treatment gap!
- Difference between people who have mental health problems and
those who seek & receive help
Application - Highest need in common mental health disorders such as anxiety &
depression
- Prevention
- Mild symptoms
- Have a broader use
Improving Access to Psychological Therapies (IAPT)
- Implemented in the UK by the NHS
- Delivering LIT for common mental health disorders in about 5 (face
to face) sessions
- Created a new profession: Psychological Wellbeing Practitioners
(PWP)
Cognitive Behavioural Suitable for low-intensity treatments
Therapy ● Proticalized
● Short and to the point
● Practical (with assignments, focused on the here and now)
Modes of Delivery - Self-help materials
- Group therapy
- Online Interventions
- Applications
- Games: good for children as well
- VR: good for exposure therapy
Quality: Always has a structure theory and rationale!
Criteria:
● Readable
● Unambiguous
● Engaging
● Appealing
● User-Friendly
Effectiveness = We are not sure if it works (when a therapist is involved it seems to be
effective) but how well & how much?
- Difficult to evaluate since people who do high intensity will have a
different severity
2
, No convincing evidence of…
● Number of sessions needed
● Difference between complex therapy
● Mode of delivery
● Therapist qualifications
Preference & expectations are most important!
Guided Self-Help vs Face to Face (2010 study)
- Minimal difference (favor between face-to-face and self-help
wavered)
- In 12-month follow up there was no difference
- No dropout difference
Motivational Interviewing = ‘Directive, client-centered, counseling style for eliciting behavior change
by helping clients to explore and resolve ambivalence’
- Take responsibility for your trajectory
Development
- Comes from addiction to motivate clients for behavioral change
- Aim: to increase adherence and clinical outcomes
- From addiction → lifestyle changes
- Not mainly used for anxiety, depression but used when
motivation is getting in the way of treatment
Motivational Interviewing in Practice:
1. Stand-alone treatment in addiction (not in a lot of others)
2. Use at the start for motivation for a different treatment (CBT)
3. Integrate into treatment when motivation is lacking
- Focus on MI when ambivalence or resistance is present
- Requires flexibility of interventions
Rationale:
- Education is not sufficient to investigate behavioral change
(psychoeducation is not enough)
- Moving from good intention → behavior change is a big step
- Ambivalence towards ‘new’ behavior competes and hinders the
implementation of intentions
- Ambivalence creates tension & discomfort leading to
negative affect (anxiety, avoidance, procrastination)
- Tool to resolve ambivalence
- Focus on intrinsic motivation for change
Without motivation, treatment becomes obsolete!
Components/Structure
3
Lectures
Week 1
Lecture 1: Introduction & Motivational Interviewing
Lecture 2: Self Help & Problem-Solving Therapy
Week 2
Lecture 3: Low-Intensity Treatments in the context of Psycho-oncology
Week 3
Lecture 4: Low Intensity Behavioural Activation in Depression
Week 4
Lecture 5: Exposure Therapy
Lecture 6: Digital Interventions for Worrying
Week 5
Lecture 7: Low Intensity CBT for Insomnia
Week 6
Lecture 8: Low-Intensity Cognitive Restructuring
Week 7
Lecture 9: Low-Intensity Treatments in a Cross-cultural context
Practice Exam
Lecture 1: Introduction & Motivational Interviewing
Lecture 2: Self-help & Problem-Solving Therapy
Lecture 3: Low-intensity Treatments in Psychosocial Oncology
Lecture 4: Behavioral Activation
Lecture 5: Exposure Therapy
Lecture 6: Digital Interventions
Lecture 7: Sleep & Insomnia
Lecture 8: Cognitive Restructuring
Lecture 9: Global Mental Health & Cultural Adaptation
, Lectures
Week 1
Lecture 1: Introduction & Motivational Interviewing
Flynn HA (2011) = integration of motivational interviewing with cognitive behavioral therapy
in the treatment of depression
- Cognitive behavioral Therapy (CBT) is one of the most common
treatments for depression but many individuals do not fully respond
to treatment
- Aim: explore integration of Motivational Interviewing (MI) to
change CBT outcome
- MI: addressing motivation for treatment, addressing ambivalence &
adherence, readiness to change
- CBT: focused on changing maladaptive thoughts & behaviors
- Rationale: motivational interviewing targets the symptoms of
depression focusing on deficiencies in ambivalence & change
- Integration of MI as treatment-engagement intervention are
effective in substance abuse
- Possible benefits of integration of MI & CBT for depression
- Increased client engagement & motivation
- Improved treatment adherence
- Comprehensive & personal treatment planning
Low-intensity Treatments = lower doses of intervention, fewer or shorter sessions, groups
- Less contact with the therapist (involving self-help interventions)
- More self-direction of the client (higher accountability of the client)
- Modes of delivery: books, online, telephone
- Advantages: More flexible: time & pace, lower cost
- Less of a conventional therapist and more of a “coach”
- Require a different way of working with your patient
- Less guidance
- Often used for prevention & milder symptoms but also works for
severe problems
Content of interventions may not be different!
- Often based on Cognitive Behavioral Therapy (CBT) just delivered
differently
- Shorter duration with other tools
History
- Created in the UK to be more efficient
- It is also cheaper
- NOT because they are better or content related ONLY political &
economical reasons
Main characteristics
1. Efficiency: lower doses of the treatment, less & shorter sessions,
groups
2. Vehicles: use self-help materials for more efficiency
- Not using so much time of the therapist
3. Early access to services: in community, self-referral, prevention
- Less stigmatizing
Stepped care approach = beginning with less intense treatment and stepping up to more intense
1
, treatment
- Evaluate after each step!
- Good for the therapist & the client: More efficient, less stigmatizing
(accessible) & affordable
- Avoid giving treatment that is not needed
- UK: guidelines for treatment is stepped care
1. Primary care: Psychoeducation
2. Low-intensity treatment: Self-help
3. High-intensity treatment: face-to-face CBT
4. Multidisciplinary
5. Inpatient care
Used to close the treatment gap!
- Difference between people who have mental health problems and
those who seek & receive help
Application - Highest need in common mental health disorders such as anxiety &
depression
- Prevention
- Mild symptoms
- Have a broader use
Improving Access to Psychological Therapies (IAPT)
- Implemented in the UK by the NHS
- Delivering LIT for common mental health disorders in about 5 (face
to face) sessions
- Created a new profession: Psychological Wellbeing Practitioners
(PWP)
Cognitive Behavioural Suitable for low-intensity treatments
Therapy ● Proticalized
● Short and to the point
● Practical (with assignments, focused on the here and now)
Modes of Delivery - Self-help materials
- Group therapy
- Online Interventions
- Applications
- Games: good for children as well
- VR: good for exposure therapy
Quality: Always has a structure theory and rationale!
Criteria:
● Readable
● Unambiguous
● Engaging
● Appealing
● User-Friendly
Effectiveness = We are not sure if it works (when a therapist is involved it seems to be
effective) but how well & how much?
- Difficult to evaluate since people who do high intensity will have a
different severity
2
, No convincing evidence of…
● Number of sessions needed
● Difference between complex therapy
● Mode of delivery
● Therapist qualifications
Preference & expectations are most important!
Guided Self-Help vs Face to Face (2010 study)
- Minimal difference (favor between face-to-face and self-help
wavered)
- In 12-month follow up there was no difference
- No dropout difference
Motivational Interviewing = ‘Directive, client-centered, counseling style for eliciting behavior change
by helping clients to explore and resolve ambivalence’
- Take responsibility for your trajectory
Development
- Comes from addiction to motivate clients for behavioral change
- Aim: to increase adherence and clinical outcomes
- From addiction → lifestyle changes
- Not mainly used for anxiety, depression but used when
motivation is getting in the way of treatment
Motivational Interviewing in Practice:
1. Stand-alone treatment in addiction (not in a lot of others)
2. Use at the start for motivation for a different treatment (CBT)
3. Integrate into treatment when motivation is lacking
- Focus on MI when ambivalence or resistance is present
- Requires flexibility of interventions
Rationale:
- Education is not sufficient to investigate behavioral change
(psychoeducation is not enough)
- Moving from good intention → behavior change is a big step
- Ambivalence towards ‘new’ behavior competes and hinders the
implementation of intentions
- Ambivalence creates tension & discomfort leading to
negative affect (anxiety, avoidance, procrastination)
- Tool to resolve ambivalence
- Focus on intrinsic motivation for change
Without motivation, treatment becomes obsolete!
Components/Structure
3
