Flynn HA (2011)
= integration of motivational interviewing with cognitive behavioural therapy in the treatment of depression
● C
ognitive behavioural 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 exchange CBT outcome
● MI:addressing motivation for treatment, addressingambivalence & adherence, readiness to change
○ The client is seen as an expert + thoughts are never seen as irrational
● CBT:focused on changing maladaptive thoughts & behaviours
○ The counsellor is seen as an expert
● similarities: collaboration, supporting and self-efficacy
● R
ationale: motivational interviewing fits the symptomsof 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
, WHAT ARE LOW INTENSITY TREATMENTS
Compared totraditional psychological treatments:
● Lower dose of the intervention, fewer or shorter sessions, groups (5 sessions)
● Less contact with a therapist: involving self-help interventions. (5- 10 timesmaximum)
● More self-direction of the client (client does more on themselves → more self- help)
● Modes of delivery: e.g., books, online, telephone (not only face to face to therapist)
● Advantages: Moreflexible: time & pace
● 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 alsoworks for severe problems
HOWEVER:
● T he content of the intervention isnot necessarilydifferent(content same, different duration, notone specific
intervention,same interventions different delivery)
● Often based on Cognitive Behavioral Therapy (CBT) just delivered differently
● For a therapist this all requiresa different wayof working than in traditional face-to-face treatments
● Shorter duration with other tools
Cognitive Behavioral Therapy
● A
ssumes individual’s interpretation of events leads to development and maintenance of psychological
disorders
● Treatment itself: use of techniques to change dysfunctional patterns of cognition and behaviour
● CBT is used forlow intensity treatments (=LICBT)as well ashigh intensity treatments (HICBT)
Verysuitablefor low intensity treatments because:
1. Protocolized (clear, steps, easy translation to low intensity & self- help material)
2. Short and to the point
3. Practical (with assignments, in here and now)
This is certainlynot the only treatmenttype suitablefor low-intensity–treatments!
LICBT= Low intensity cognitive behavioural treatment
● Evolved from HICBT (=high intensity cognitive behavioral therapy)
● Effective for mild to moderate common mental health problems
● Cost-effective
● Stepped care to support LICBT
● Key Principles: Efficiency (high volume approach), therapy vehicles, early access to service
● Assumes domains of symptoms interact with each other
SimilarityLICBT and HICBT:
1. Present- focused
2. Views difficulties in terms of interacting clusters of symptoms
3. Based on scientific approach
4. Collaborative (between practitioner and client) & Structured
, DistinctionLICBT and HICBT:
Different forms oftherapy delivery:
Efficiency High volume approachin LICB:
1- Lower dose of the treatment
2- Less and shorter sessions
3- Groups
Vehicles Use of
1- Self-help material
2- Computerised CBT programs
3- Psychoeducational Groups: Large Format Groups
for more efficiency AND not using so much time of the therapist.
E arly Access to Patients needs to access service early on the development of mental health difficulties
Services ð At that point, relatively small amount of therapeutic input may significantly shift the
trajectory of the client’s problems
ð At later time problems may be chronic => reduces client’s ability to respond quickly
to low intensity approach)
ð Thereby central to LICBT: mechanisms which increase early access such as: (1)self
-referral systems(2) promotion of services withincommunities(3) Prevention
Patients ot only for mild, moderate problems also severe but patients need to be able to work on
N
their problems by themselves
Low-intensity treatments: some HISTORY
K:political and economical argumentsfor low-intensity treatments and the need for efficient use of resources to
U
lift the burden of common mental disorders
=>goal: efficiency!(cost-effective therapy, shortage of therapists, more accessible healthcare, CHEAPER)
Stepped care approach
● L ow-intensity treatments vs high-intensity treatments (=traditional face-to-face treatments) comes from a
stepped care approach.
● L ICBT practitioners are situated within a broader mental healthcare network to allow non-responding clients to
be directed to other treatments => stepped care approach to coordinate different services
● Start with less intense treatments and step-up to more intense if needed (steps increase in intensity and cost!)
So: if patient does not respond to treatment, is stepped up to more intense treatment
● Evaluate after each step!
● Good for the therapist & the client: More efficient, less stigmatizing (accessible) & affordable
○ Avoid giving treatment that is not needed
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