Scaling Up Psychotherapy

treatment gap

1. difference in people who have a disorder and the proportion who receives care

2. only about a third receive adequate treatment

reasons for treatment gap

• treatment is provided on a one-to-one basis

• treatment administered by a highly trained professional

• sessions held at a clinic, private office or health care facility

new models of delivery to extend the reach of evidence-based practice

• Task shifting

• Best-buy interventions

• Disruptive innovations

• Interventions in everyday settings

• Entertainment education

• Use of social media

• Use of technologies

• Community partnership model

task shifting

Redistributing work to a broad range of individuals with less training and fewer qualifications

Best-buy interventions

selected based on cost-effective, feasible, and appropriate to implement in setting

Disruptive innovations

distinct change from what is being done currently

Interventions in everyday setting

Reach people where they’re at

Entertainment education

embed information in television or radio

Use of social media

Bring interventions to people online

Use of technologies

internet-based or app-based treatment delivery

Community partnership model

partner with community organizations to develop action plans

technology in treatment

• psychoeducational or self-help format

• digital treatments

• digital assessment

• digital training and dissemination

psychoeducational or self-help format

• Collection of “tools” designed to be educational

• Presented as “lessons”, rather than “sessions”

digital treatments

• retain structure and components of the original treatment

  • user may select components of intervention that are most relevant

• periods of time set aside by user for intervention

• may have some degree of personalization based on demographic group or presenting psychopathology

  • developments in machine learning will make greater personalization possible

digital assessment

• Questionnaires can be automatically scored and interpreted → information transmitted to clinician

• Can self-monitor thoughts, mood, activities using smartphone

• Can track non self-report phenomena, such as sleep, physical activity, speech, device usage, etc.

• Potential for “real-time” intervention

digital training and dissemination

• clinical training websites with videos and demonstrations

• reach more users and lower costs

• standardized training provided

current results on uses of technology in treatment

• digital interventions are popular and reach a lot of ppl

  • HOWEVER low completion rates if done without support

• online clinics can produce clinically relevant change on a large scale

• supported interventions have a greater impact than unsupported ones

  • difference vary, not always large

• with support, outcomes for digital interventions are similar to face-to-face interventions

future research on uses of technology in treatment

• Does the functionality of the intervention impact its efficacy?

• How can interventions be tailored to the nature of the psychopathology?

• How do we evaluate the efficacy of digital interventions?

• How much support is necessary for improved outcomes?

types of single session interventions

• Pre-therapy or waitlist intervention to provide psychoeducation and/or to increase motivation for treatment

• Delivered after an assessment and combined with therapeutic resources

• Delivered online with or without suppor

advantages of single session interventions

• Brief = less expensive

• Scalable, especially if implemented online

• Reach people without financial resources or with other barriers to seeking traditional treatment

experiment design of Schleider et al., 2022 - Nation(US)-wide RCT of online single-session interventions for adolescent depression

• Compared growth mindset (GM-SSI) and behavioural activation (BA-SSI) to control

• Primary outcomes: hopelessness and agency post-treatment and depressive symptoms at 3 months

• 13-16 y/os randomized to one of three conditions

  • most reported elevated depression

• GM-SSI: neuroplasticity, growth mindsets to persevere, personality can change

• BA-SSI: values assessment, activity action plan, benefits/obstacles

• Control condition: supportive SSI that encourages emotion expression but does not teach behavioural skills

results of schleider

GM-SSI and BA-SSI compared to control

• 3 months in

  • Decreases in depression

• post treatment

  • Decreases in hopelessness

  • increases in agency

implications of schleider

• Small effect, but large implications considering how many youth could be reached by intervention

• Confirms effect size and replicability from previous uncontrolled studies

• Acceptability and efficacy of interventions for a diverse sample (80% of participants identified as sexual minority)