Low intensity psychological intervention for common mental disorders

Abstract

In recent years, there is a trend toward the integration of low-intensity psychological interventions into service provision as a way of increasing access to psychological treatments for common mental illnesses in primary health settings worldwide. In view of the structural constraints and cultural barriers of the existing mental health system, such as long waiting period for follow-up, stigma for mental illnesses, and deviation from traditional weekly in-person sessions, it is believed that low-intensity psychological interventions can be a feasible alternative to provide mental health prevention and/or treatment services to the community. This thesis presents three models of low-intensity psychological interventions, namely stepped care approach, transdiagnostic approach, and self-help approach. Stepped care model is considered as a cost effective service delivery model, which provides evidence-based psychological interventions in a hierarchy of low-intensity treatments such as self-help treatments to high-intensity treatments involving individual therapy provided by clinical psychologists, at both the individual and community levels. A meta-analytic review (Study 1) was conducted to evaluate the efficacy and cost-effectiveness of stepped care prevention and treatment for depressive and/or anxiety disorders. There is a shifting perspective away from a disorder-specific intervention approach towards a transdiagnostic intervention approach. Transdiagnostic intervention is a treatment protocol that addresses the commonalities in cognitive and behavioral factors shared across common mental disorders. The application of transdiagnostic self-help cognitive behavioral therapy for insomnia (CBT-I) on comorbid insomnia and depression was examined through a meta-analysis (Study 2) and a secondary analysis of a randomized controlled trial (Study 3). Self-help intervention is recommended as the least restrictive entry step of the stepped care model. Psychological interventions delivered by Internet and smartphone application serve to increase the access to mental health care, and potentially reduce cost and waiting time. A smartphone application “proACT-S” was developed as an alternative delivery modality. The preliminary treatment efficacy and feasibility were evaluated in an open-trial (Study 4). Results of Study 1 provisionally suggest that stepped care was effective in treating anxiety symptoms, but not preventing anxiety and depression, or treating depression, when compared with care-as-usual. In Study 2, the comparisons between self-help CBT-I and waiting-list/routine care/no treatment/ psychoeducation demonstrated significant differences in favor of the former in alleviating both depressive symptoms and insomnia symptoms. In Study 3, the results revealed that the Internet-based self-help CBT-I, especially with minimal therapist support, could help alleviate the severity of depressive and insomnia symptoms in Chinese adult population. In Study 4, the results suggest that “proACT-S” was effective in mitigating insomnia symptoms, depressive and anxiety symptoms, and improving quality of life. In addition, participants reported high level of treatment acceptability and usability as well as satisfactory treatment adherence. In conclusion, the results across the four studies provide important foundations in addressing the unmet mental health needs through low-intensity psychological interventions in regions with scarce resources.