Lecture 1: Low Intensity Treatments
What are low-intensity treatments? Why use them?
Compared to traditional psychological treatments:
o Lower dose of the intervention (fewer sessions)
o Less contact with a therapist
o More self-direction of the client
o Modes of delivery: e.g. books, online, telephone
o Flexibility: time and pace
The content of the intervention is not necessarily different
For a therapist this all requires a different way of working than in traditional face-to-face
treatments
They are focused on: Efficiency by requiring a lower dose of the treatment, less/shorter
sessions and group therapies
They make use of: Vehicles in the form of self-help material (also for more efficiency)
They aim at: Early access to services through services in the community, self-referral &
prevention measures (all focused on reaching more people with less stigma, stepped-care)
Low-intensity treatments
and receive help for symptoms.
Low-intensity treatments make treatment accessible & affordable.
Expectations & preferences of the client are important in the choice of what type of low
intensity treatment to give
Highest need of low intensity treatments is in common mental disorders such as anxiety
and depression through prevention & treating mild symptoms: But low intensity treatments
have a much broader use
Cognitive behavioral therapy
CBT is very suitable for low intensity treatments, because it is:
o Protocolized
o Short and to the point
o Practical (with assignments, in the here and now)
Organization of care
Health care delivery of low-intensity treatments should be:
o Freely available for the general population (e.g. self-help books, online treatments,
mobile applications)
o True to a treatment (with minimal guidance or face-to-face)
o An possible addition to face-to-face treatment
o A first step in a stepped care model
o Based on collaborative care
The therapist their skills should/can include:
o Able to halde different ways of communication dependent on the mode of delivery
(email, telephone, chat)
o A role towards coaching: motivation, education, monitoring, feedback
o Having another background: (trained) nurses, GPs, psychologists, lay person
o Having basic knowledge of therapeutic techniques (and supervision is important)
Modes of delivery: Websites, books, apps, games etc.
Self-help material should be:
, o Readable
o Unambiguous
o Engaging
o Appealing
o User-friendly
Are low-intensity treatments effective?
Yes, the treatments are effective when a therapist is involved. The effects seem similar to
face-to-face treatments
There is no convincing evidence that the following lead to higher effectiveness:
o Number of sessions
o More complex therapy
o Mode of delivery
o Therapist qualifications
Patient preference and expectations should be leading
Conclusions of the article on guided self-help effectiveness vs face-to-face therapy
inimal difference between face-to-face and guided self-help interventions (d=0.02
to the benefit of self-help)
o At 12 months follow-up there was no difference
There was no difference in drop-out
So guided self-help and face-to-face treatments are equally effective and implementation is
a next step
Motivational Interviewing
= Directive, client centered, counseling style for eliciting behavior change by helping clients
(ambivalence towards changing vs not changing),
Rationale of MI:
o Education is often not to sufficient to instigate behavior change
o From good intentions to behavior change is a big step
o Ambival intentions, i.e.
wanting and not wanting to change whereas the reasons for change are
incompatible
T negative
affect such as anxiety, avoidance, and procrastination
motivation for change. The client is encouraged the take responsibility
for the decisions that are made. They are the ones who decide to
change or not & how.
Development of MI:
o Comes from the field of addiction to motivate clients for behavioral change
o Aim is to increase treatment adherence (to the behavior change) and clinical
outcomes
o Moved to other fields more recently such as lifestyle, psychological problems such
as anxiety, depression, eating disorders
MI in practice is used as:
1. A stand alone treatment (e.g.for addiction)
2. At the start of treatment (e.g. CBT)
3. Integrated in the intake or treatment
More focus on MI when ambivalence or resistance is present
, Requires some flexibility of the interventions
Motivational Interviewing involves:
1. SPIRIT of the therapist (attitude) = Therapist attitude is to create an open, receptive and
affirmative, environment
Collaboration (vs confrontation) characterized by encouragement
Autonomy (vs authority): responsibility is with the client
Compassion: prioritize the interest of the client and their perspective
based on perceptions, values and aims that already exist
2. Communication skills
Open questions: to encourage the client to think about what is going on
Affirmation: positive reinforcement to build confidence
Reflective listening: understanding what the client feels and reflect. This to show
understanding and empathy
Summarize: Extensive reflection that can be used strategically to give direction
(hopefully in the direction of change)
3. Process (doing the interview)
Engagement
o Work on the therapeutic alliance
where trust and mutual respect
are key
o
questioning, give solutions, show
authority
Focus
o Search direction: What are the
worries, goals, priorities, problem
that a person wants help with?
o The client is autonomous in
determining the focus Rooftop
Assessment, screening, providing information
Evocation
o Talk about change to explore the importance of behavior change and the
confidence in the outcome and to strengthen intentions to change.
o Techniques:
Change talk: Pay attention to language that describes discomfort of
the current situation or the advantages of change & make this
concrete.
Intention to change: Pay attention to commitment language
Rolling with resistance: If a client denies the problem, let them know
that the
This gives some space to explore t
To do: avoid argumentation, listen reflectively, develop
discrepancy
Balance scale: Aims to create discrepancy between current behavior
and the goals and values that someone has (this is the desired
situation)
