Psychosocial Treatments

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Psychosocial treatments are non-pharmacologic interventions that are designed to decrease the severity of symptoms, avoid hospitalisation, improve psychosocial functioning (e.g. work and social relationships) and improve overall mental wellbeing.

Psychosocial treatments are the preferred first-line treatment for mild-to-moderate mental disorders. For mental disorders that require treatment with medication, it is important to also deliver psychosocial treatment.

There are many different types of psychosocial treatment. Some treatments are brief and can be delivered at all levels of health service including primary care. A few of these are outlined here.

For more detail refer to the freely available mhGAP Intervention Guide or phone app, and the excellent book, Where There is No Psychiatrist (2018). The WHO guide titled Problem Management Plus (PM+) (2018) has much more detail. Download details for these are in the introduction to this guide.

Psychoeducation

This should be done with every patient. Use the information leaflets in this book to help you explain the mental disorder to an individual and family. Discuss the following:

  • the condition and what the expected course and outcome are
  • what treatments are available
  • duration of treatment
  • importance of sticking with treatment
  • potential side-effects of treatment and what to do if these are experienced
  • involvement of other members of the health team or community services

Relaxation Techniques

There are many types of relaxation exercises and all are good for people who are stressed. This breathing technique is just one:

  • Lie down in a room that is quiet and where you will not be disturbed.
  • Close your eyes. Concentrate your mind on your breathing rhythm.
  • Now, concentrate on breathing slow, regular, steady breaths through the nose, taking a deep breath in.
  • Then let go of the breath slowly.
  • Try to spend at least 10 min a day doing this exercise.

Counselling & Problem-solving

Counselling is usually fairly short and aims to help people to be clearer about their problems – and by being clearer, to come up with their own answers. It is often used to help people cope with recent events they have found difficult. It is beneficial for mild anxiety and depression amongst others. Counselling involves providing a non-judgemental listening ear to help the person to identify and solve problems. A specific type of counselling is Problem Solving therapy (see box below)

  1. Explain the problem solving approach e.g. "People with difficulties like yours can be helped by looking at the way in which they handle stress and deal with problems. I would like to discuss some of your problems and think of ways in which you can try and deal with them”
  2. Identify the problems that cause the person distress e.g. relationship, employment, financial, physical health, sexual problems; bereavement.
  3. Prioritize the problems e.g. List them in order
  4. Select the problem to be addressed. Target a problem which has a potential solution in the short-term. Remember that the aim of the treatment is to teach the person problem-solving skills, not to try and solve all their problems
  5. Think about all possible solutions to the problem. If many options are available, focus on those which are most practical given the person’s social situation
  6. Select the most appropriate solution. Plan on how to carry out the solution. Set specific targets which are achievable.
  7. Implement the solution
  8. Review sessions (if feasible). Evaluate how well the person managed in completing tasks. If progress has not been made, identify barriers, discuss ways to address these, and set new goals

Identify supportive family members and involve them as much as possible and appropriate

Cognitive-Behavioural Therapy (CBT)

CBT is a very popular and evidence-based therapy for many different problems. The aim is to change the way people think, feel and behave.

Interpersonal Therapy (IPT)

IPT is a form of psychotherapy that focuses on the person’s relationships with other people, and major changes in their life e.g. marriage, illness etc.