Curated Space for Psychological Interventions

Problem Management Plus (PM+)

**Summary description:** Problem Management Plus (PM+) is a brief five-session WHO intervention for adults from communities exposed to adversities suffering from psychological distress (e.g. anxiety and depression symptoms). The intervention has been successfully delivered by non-specialists in low, middle income and high income countries. **Access to the intervention manual: ** Full Open Access **Access to training:** Please contact WHO using the following email [Psych_interventions@who.int](Psych_interventions@who.int ). **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** Problem management, behavioural activation, stress reduction and strengthening social support. **Intervention format:** In PM+, people are seen on an individual basis for five weekly sessions (usually face-to-face, but remote versions have also been implemented). Sessions are 90 minutes long with independent practice of strategies between sessions encouraged. There is also an evidence-based group version called Group Management Plus (Group PM+). **Target population:** Adults impaired by psychological distress **Significant effects found on symptoms of:** psychological distress, depression, anxiety, functional impairment, post-traumatic stress, self-identified problems. While some small effects on PTSD symptoms were found, these varied between studies. This is not a trauma focused intervention and other more relevant interventions exist for PTSD. **Key innovative or differentiating features of this intervention:** PM+ is open access and available in many languages, this means it can be adapted for different settings. The intervention has been implemented in a number of settings. **Summary of Evidence:** Several fully powered RCTs have been conducted with PM+ It has been found to be effective in reducing psychological distress and self-identified problems and increasing functioning in women exposed to gender-based violence in Kenya; decreases in anxiety, depression, post-traumatic stress, improvements in functional impairment, self-identified problems, in communities exposed to adversities in Pakistan being implemented by both non professionals and professionals. With Syrian refugees in the Netherlands is has shown to reduce symptoms of depression, anxiety, PTSD and self-identified problems. **Different populations where the intervention has been used:** Communities exposed to adversities; Refugees and asylum seekers in middle and high income settings; People with medical conditions; Women exposed to GBV, health workers in HIC. **Restrictions or requirements for its use:** PM+ is not suitable for people who have a severe impairment related to a mental, neurological or substance use disorder, or are at imminent risk of suicide (e.g. people with a plan to end their life in the near future) **Requirements / qualifications for trainers and supervisors:** Ideally this should be a mental health professional thoroughly trained in cognitive behaviour therapy (CBT). See the PM+ manual for more information. **Examples of implementation outside of RCT contexts:** PM+ has been tested effectively as part of a stepped care package for health workers in Spain and was delivered remotely. PM+ is implemented in many different settings. For example, after a capacity building project by TdH and WHO, PM+ was implemented in Ethiopia, Syria and Honduras (see three case studies). Partners in Health have been adapting and implementing PM+ in (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503941/pdf/nihms-1745255.pdf) Rwanda, Peru, Mexico and Malawi. Information provided by Edith van ‘t Hof on 27 March 2024. She was involved in manual development at WHO.

Title: Helping Children Cope with Grief During a War 1

Summary: is an interactive web-based leaflet, developed to help people understand how children of different ages experience loss and grief; how to talk to them about it, and how to help them cope with the death of a loved one during war and displacement. It is presented as a leaflet that answers many questions a caregiver may have, such as Do children grieve?, Should I tell my children if someone they love has died?, What is the best way to tell them?

Step-by-Step

**Summary description:** Step-by-Step (SbS) is a 5 session intervention proven to improve symptoms of common mental disorders, subjective well-being and self-identified personal problems. It can be offered alongside other mental health interventions, or community programming. SbS can be delivered remotely and at scale and can reach many people across a large geographical area. **Access to the intervention manual:** Contact WHO at Psych_interventions@who.int **Access to training:** Contact WHO at Psych_interventions@who.int **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** SbS provides psychoeducation and training in behavioural activation alongside other therapeutic techniques such as slow breathing, identifying strengths, positive self-talk, increasing social support and relapse prevention. **Intervention format:** SbS was tested in a digital format. It uses a fictional illustrated story of people seeking help for depression, with a trusted character (e.g. a health worker) giving instructions on therapeutic techniques. By reading the story the user of the programme learns the techniques. It encourages service users to practise techniques on their own, in between modules. In the RCTs is was provided as a guided intervention, with five weekly calls of 15 minutes per week. It can also be delivered as an unguided intervention: this might make the intervention less effective, but it will reach more people. **Target population:** Adults with moderate to severe depressive symptoms **Significant effects found on symptoms of:** Psychological distress, depression, anxiety, dysfunctioning, post-traumatic stress, self-identified problems. While some small effects on PTSD symptoms were found, these varied between studies. This is not a trauma focused intervention and other more relevant interventions exist for PTSD. **Key innovative or differentiating features of this intervention:** SbS content will be available from WHO as open access and can be added to any online platform (e.g. an e-learning platform). It could also be used in other media formats such as books or videos. It follows a narrative approach, which will make it possible to tailor it for many different populations. In the RCTs is was given as a guided intervention, with five weekly calls of 15 minutes per week. It can also be delivered as an unguided intervention: this might make the intervention less effective, but it will be able to reach more people. **Summary of Evidence:** SbS has been tested through two large randomized controlled trials in Lebanon. The trials showed the intervention was effective in reducing symptoms of depression and anxiety and improving functioning and well-being, including at three-month follow-up. The trials also showed this intervention could be delivered safely, with procedures developed to ensure support to people at imminent risk of suicide. A randomized controlled trial with an adapted version of SbS with Chinese students showed it is effective in reducing depressive symptoms in the short term and improving psychological well-being in a longer term. **Different populations where the intervention has been used:** Communities exposed to adversities; Refugees and asylum seekers in middle and high income settings; LMICC; student populations **Restrictions or requirements for its use:** SbS is not suitable for people who have a severe impairment related to a mental, neurological or substance use disorder, or are at imminent risk of suicide (e.g. people with a plan to end their life in the near future) Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions or guided self-help. See the SbS manual (available on request from WHO) for more information. **Requirements / qualifications for trainers and supervisors:** Ideally this should be a mental health professional thoroughly trained in cognitive behaviour therapy (CBT). See the PM+ manual for more information. **Examples of adaptations and different formats:** Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions or guided self-help. See the SbS manual (available on request from WHO) for more information. **Examples of implementation outside of RCT contexts:** Adapted SbS was also proven to be an acceptable intervention for Filipino overseas workers in China. Other versions of SbS are being piloted, such as a version dedlviered by What’s App in India. After the two RCTs, Step-by-Step was scaled up as a national service in Lebanon and made available to anyone in the country. A process evaluation interviewing key stakeholders and people who completed the programme said it was relevant, acceptable and beneficial. Information provided by Edith van ‘t Hof on 29 March 2024. She was involved in manual development at WHO.

NETfacts

**Summary description:** NETfacts is an intervention that integrates NET/FORNET indiviudal treatment with a community based intervention that involves all community members. **Access to the intervention manual:** Contact the NET Institute https://www.net-institute.org/ **Access to training:** Contact the NET Institute https://www.net-institute.org/ **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** Cotextualisation of the trauma memory, meaning making, collective memory **Intervention format:** NETfacts is a 5-6 session community intervention using culturally inherent communication methods to feed back composite narratives (anonymised and merged descriptions about the individual experience of a traumatic event) derived from indiviudal NET and FORNET sessions **Target population:** Traumatised communities **Significant effects found on symptoms of:** Reduction of rape myth acceptance, reduction of victimization and perpetration (via rape myths) (alongside reduction of trauma related mental health problem addressed with NET/FORNET). **Key innovative or differentiating features of this intervention:** Integration of direct intervention with community members based on composite narratives from NET/FORNET indiviudal treatments **Summary of Evidence:** Find it [here](https://www.pnas.org/doi/abs/10.1073/pnas.2204698119). **Different populations where the intervention has been used:** Rraumatised communities in DR Congo **Restrictions or requirements for its use:** The intervention was tested in adults 16+ yrs. **Requirements / qualifications for trainers and supervisors:** n.a. (status mid 2024) **Examples of implementation outside of RCT contexts:** n.a. (status mid 2024) Information provided by Anke Köbach on 21 August 2024. She is co-author of the intervention.

Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET)

**Summary description:** FORNET follows the principles of NET but incorporates the narration of perpetrated violent acts (symbolised as sticks on the lifeline). Parallel group sessions support the clients to abstain from violence and build new bonds based on pro-social rules. **Access to the intervention manual:** Contact the NET Institute https://www.net-institute.org/ **Access to training:** Contact the NET Institute https://www.net-institute.org/ **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** Contextualisation of the trauma memory, meaning making, social support (buddy), role plays to abstain from violence **Intervention format:** 6 individual and 6 group sessions each 90 min **Target population:** Traumtized individuals who have been actively involved in violence (as perpetrators) **Significant effects found on symptoms of:** Reduction of PTSD, apptetitive aggression, current violent behavior, substance dependence, increase in social acknowledgement **Key innovative or differentiating features of this intervention:** In FORNET, excess violence perpetration is treated in the same logic as traumatic event. Groups sessions apply CBT techniques from addiction treatment. **Different populations where the intervention has been used:** Traumatized offenders in post-conflict and LMIC settings, refugees in high income settings, other **Restrictions or requirements for its use:** Co-morbid psychotic disorders, other severe neurological disease **Requirements / qualifications for trainers and supervisors:** Being able to read and write, excellent communication skills, strong empathic skills **Examples of implementation outside of RCT contexts:** FORNET is used in all sorts of clinical practice for instance as a module for forensic or trauma rehabilitation centers with clients who suffer from PTSD and other mental disorders, or in specialized clinics for refugees with trauma related symptoms Information provided by Anke Köbach on 14 June 2024. She is author/developer of the intervention.

Common Elements Treatment Approach (CETA) System of Care

**Summary description:** CETA is an evidenced based, transdiagnostic system of care based on cognitive behavioral therapy that provides a) a multi-problem assessment, b) a triage system, c) safety planning/suicide prevention, d) flexible treatment options from wellness and prevention through moderate and severe mental and behavioral health conditions, e) option for M&E, measurement-based care results. CETA has proven to be effective in reducing mental health problems (e.g., depression, anxiety, post-traumatic stress, etc.), intimate partner violence, and substance misuse. **Access to the intervention manual:** The manual is sent out when there is interest for review and feedback. Groups who sign up for training get it prior to training for printing, and then have access to ongong manuals. **Access to training:** The manual is sent out when there is interest for review and feedback. Groups who sign up for training get it prior to training for printing, and then have access to ongong manuals. **Intended users/ Implementers:** Non-specialist providers refers to lay-workers, MHPSS practitioners etc. please specify any other groups; We also train MH professionals, volunteers, PCPs, nurses…etc. We have criteria that lay out who might work best in different systems. **Therapeutic strategies:** Engagement and psychoeducation, cognitive coping and restructuring, behavioral activation, confronting fears and trauma memories (gradual exposure), harm reduction strategies and motivational interviewing techniques, problem solving, anxiety management, and caregiver skills. **Intervention format:** For CETA, a) the assessment can be done in person, via tele-health, in groups or individual, via technology...etc. b) people are seen individually and/or in groups for 1-12 sessions on a weekly (or bi-weekly) basis either in-person or remotely depending on their level of need (i.e, precision-based care). Sessions last for 20-60+ minutes and include a weekly client monitoring form to assess changes in mental and behavioral health symptoms. Practice of skills in between sessions is strongly encouraged. CETA Psychosocial Support (CPSS) program is a shorter intervention adapted from CETA and can be delivered individually or in groups for mild symptoms, secondary prevention, screening and referrals. If someone needs full MH treatment (moderate to severe MH issues), the average number of sessions is 8. **Target population:** Adults and children with mild to severe mental and behavioral health conditions **Significant effects found on symptoms of:** The CETA intervention has shown significant outcomes in depression, anxiety, functional impairment, suicide/safety, PTS, substance use and violence. Our assessment has gone through validation in numerous countries and found to be able to effectively replace large batteries. **Key innovative or differentiating features of this intervention:** CETA is a flexible transdiagnostic approach that spans the life course and can be adapted and integrated within different settings, including health systems, schools, community day settings, shelters, and virtually. It is unique in that it is the only end-to-end system of care that is evidence-based. CETA is also unique in its address of so many different mental/behavioral health problems. **Summary of Evidence:** Several clinical RCTs have been conducted with CETA and found effective in reducing depression, PTS, impaired functioning, anxiety, substance use, IPV, and aggression.Trials have been done in: a) Mae Sot, Thailand with adult Burmese refugees showing decreased PTS, depression, and dysfunction, b) In Iraq with adults exposed to systematic violence showing reduced PTSD, c) Zambia - adults (couples) along with one child in the house; outcomes focused on substance use and IPV, also showed reduction in depression, PTS, anxiety,etc. d) Zambia adults affected by HIV and alcohol, e) Zambia with AYA reduction of broad internalizing and externalizing symptoms, f) Ukraine - veterans and IDP for full CETA, g) Ukraine - CPSS (psychosocial treatment for veterans and IDPs), h) border of Ethiopia and Somali with children in refugee camp showing reduced internalizing, externalizing, and posttraumatic stress symptoms and improved well-being. **Different populations where the intervention has been used:** Populations exposed to violent traumatic events, refugees and displaced adults, men and women with interpersonal violence and using substances, health workers, people living with HIV/Diabetes/TF and other physical health issues, perinatal women and their family members, and communities in LMIC and HIC settings. **Restrictions or requirements for its use:** Given that CETA addresses things like suicide and PTSD, we require proper training by a CETA trainer, and ongoing supervision/support to competency to assure safety to all those poulations that are recipients. **Requirements / qualifications for trainers and supervisors:** Supervisors are certified at the provider level first, while at the same time being coached to supervise. They need to demonstrate appropriate supervisory skills and are certified. CETA trainers need to be certified as both a provider and supervisor, and then are selected to go through a train-the-trainer program. At this point they know the CETA system of care, and can coach in small groups....the TTT focuses on how do you train in a larger group, and a lot of implementation science and training management (how to decide/review trainees, consultation with groups on implementation, training logistics, scheduling of element-training, setting up supervision groups, how to teach others to provide and supervise CETA, how to interpret the assessment, etc.) We are flexible on this. At a bare minimum for supervisors, they have to demonstrate the ability to provide CETA well and with fidelity, as well as show leadership and teaching abilities that supervisors need. For trainers, they need to be certified as a provider and supervisor - and demonstrate an ability to speak and lead a large group, teach differnet levels and types of trainees, think flexibly about how to schedule training of different elements, read an audience, organizational skills...etc. Then they need to do a Train-the-trainer, and complete 1-2 co-trainings witha certified CETA trainers. **Examples of implementation outside of RCT contexts:** CETA has been adapted and implemented in many countries including, Brazil, Chile, Germany, India, Kazakhstan, Lebanon, Lesotho, Liberia, Malawi, Mexico, Moldova,Mozambique, Myanmar, Namibia, Papua New Guniea, Peru, Sierra Leone, South Africa, Syria, Thailand, United States, Uganda, Ukraine, Zambia. Information provided by Laura Murray on 14 June 2024. She is the author/developer.

The Friendship Bench Model

**Summary description:** The Friendship Bench model employs a unique approach to address mental health challenges. It consists of sessions of culturally adapted problem soliving therapy for common mental health disorders delivered by a trained lay counsellor on a bench in a discreet area. Following this one-on-one structured talk therapy, clients are introduced to a peer-led support group called Circle Kubatana Tose (CKT), which translates to ‘holding hands together.’ In these groups, individuals connect with others who have also sat on the Friendship Bench, received PST, and gained empowerment to solve their own problems. The safe space for open dialogue fosters a sense of belonging and reduces stigma associated with mental health issues and personal sharing. **Access to the intervention manual:** Contact Dixon Chibanda at dixon.chibanda@friendshipbench.io **Access to training:** Contact Dixon Chibanda/Ethel Manda at dixon.chibanda@friendshipbench.io/ ethel.manda@friendshipbench.io **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** Problem solving, behaviour activation, social connectedness **Intervention format:** The Friendship Bench intervention comprised 6 sessions of individual problem-solving therapy delivered by trained, supervised LHWs plus an optional 6-session peer support program. The control group received standard care plus information, education, and support on common mental disorders. **Target population:** Adults (18+) with common mental health disorders **Significant effects found on symptoms of:** Among 573 randomized patients (286 in the intervention group and 287 in the control group), 495 (86.4%)were women, median age was 33 years (interquartile range, 27-41 years), 238 (41.7%) were human immunodeficiency virus positive, and 521 (90.9%) completed follow-up at 6 months. Intervention group participants had fewer symptoms than control group participants on the SSQ-14 (3.81; 95% CI, 3.28 to 4.34 vs 8.90; 95% CI, 8.33 to 9.47; adjusted mean difference, −4.86; 95% CI, −5.63 to −4.10; P < .001; adjusted risk ratio [ARR], 0.21; 95% CI, 0.15 to 0.29; P < .001). Intervention group participants also had lower risk of symptoms of depression (13.7%vs 49.9%; ARR, 0.28; 95% CI, 0.22 to 0.34; P < .001). **Key innovative or differentiating features of this intervention:** With over 100 peer-reviewed scientific publications and over 10 years of research, the Friendship Bench stands out as a home grown solution from the Global South to address the treatment gap for mental, neurological and substance use disorders. Our seminal publication of the randomized controlled trial (RCT), in JAMA in 2016 demonstrated an 80% reduction in depression and suicidal ideation and a 60% improvement in quality of life, 6 months after receiving therapy from a trained community grandmother, affectionately referred to as ambuya utano. It is against this publication and numerous others that Friendship Bench has become the most sought-after intervention aimed at addressing the treatment gap for common mental disorders - invited regionally, in the USA, UK, South America and beyond to replicate the model in new settings. We are on a mission to get people out of depression and we envision a friendship bench within a walking distance for all. **Different populations where the intervention has been used:** Adults 18+ **Examples of adaptations and different formats:** In Zimbabwe - Adolescents and young adults (15-24years) Youth Friendship Bench (https://www.tandfonline.com/doi/pdf/10.1080/01612840.2021.1924323 and https://www.tandfonline.com/doi/pdf/10.1080/01612840.2021.1879977), Adults 18+ living positively with HIV (https://doi.org/10.1371/journal.pgph.0001492) and online sessions (https://s3.ca-central-1.amazonaws.com/assets.jmir.org/assets/preprints/preprint-37968-submitted.pdf). Outside Zimbabwe - Mobile application in Kenya (https://www.cambridge.org/core/services/aop-cambridge-core/content/view/BA0F3D4B9ABA077EEFF634A9D951CBD8/S2054425121000030a.pdf/div-class-title-a-community-health-volunteer-delivered-problem-solving-therapy-mobile-application-based-on-the-friendship-bench-inuka-coaching-in-kenya-a-pilot-cohort-study-div.pdf), Adaptation of a Problem-solving Program (Friendship Bench) to Treat Common Mental Disorders Among People Living With HIV and AIDS and on Methadone Maintenance Treatment in Vietnam (http://www.ncbi.nlm.nih.gov/pubmed/35802402). In Africa - Malawi, Zambia and Zanzibar. Adaptation in USA - Washington DC (Help Age) and New Orleans. Adaptation in UK - South of London - LSTMH. Information provided by Dixon Chibanda on 19 August 2024. He is the autor.

Social Emotional and Economic Empowerment Knowlege Through Group Support Psychotherapy (SEEK-GSP)

**Summary description:** The SEEK-GSP (Social, Emotional, and Economic Empowerment Knowledge through Group Support Psychotherapy) program trains lay health workers to recognize and treat mild to moderate depression using Group Support Psychotherapy (GSP). This innovative intervention addresses mild to moderate depression by enhancing emotional and social support, positive coping skills, and income-generating abilities. A key advantage of GSP is its reliance on trained primary health care workers, rather than expert mental health practitioners. These workers train lay health workers to identify and treat depression in rural villages, empowering communities to manage their own mental health needs effectively and sustainably. **Access to the intervention manual:** Contact Etheldreda Nakimuli Mpungu ([www.seek-gsp.org/](www.seek-gsp.org/)). Manual can be purchased on Amazon. **Access to training:** Contact Etheldreda Nakimuli Mpungu ([www.seek-gsp.org/](www.seek-gsp.org/)) **Intended users/ Implementers:** Trained and supervised non-specialist provider. **Intervention format:** SEEKGSP is a structured therapeutic intervention designed to improve mental health outcomes among individuals living with chronic conditions, such as HIV/AIDS. The program consists of eight weekly sessions, each lasting 2 to 3 hours, conducted in sex-specific groups of 10 to 12 participants. Trained lay health workers of the same sex as the participants deliver the intervention using a scripted manual to ensure consistency and effectiveness. **Target population:** Children, men, women and youth with mild to moderate depression **Significant effects found on symptoms of:** GSP treats mild to moderate depression, improves functioning, self-esteem and social support. GSP reduces,stigma and increases participation in income generating activities. GSP significantly reduces hazardous alcohol consumption, and suicide risk. **Key innovative or differentiating features of this intervention:** Highly effective against mild to moderate depression. 99% of GSP participants had achieved remission by 6 months after the end of treatment and remained depression there after for 18 months. Two years after treatment, GSP participants monthly income was double the monthly income of Control Group participants. GSP is highly cost-effective. Only 13 USD is needed to prevent one year of disability-adjusted life year(DALY) due to depression. GSP improved HIV viral suppression among HIV positive individuals through the sequential reduction of depression and improvement in ART adherence. **Different populations where the intervention has been used:** Men women children and youth. **Requirements / qualifications for trainers and supervisors:** Trainers are mental health specialists who have received GSP training and have successfully delivered two GSP treatment cycles and are subscibed to SEEKGSP. **Examples of adaptations and different formats:** We have a child and adolescent format and and an online format for Youth(tele-support psychotherapy). **Examples of implementation outside of RCT contexts:** Nigeria Jalingo (Taraba state): Trained 35 health workers (in-person training) 40 (online). Cameroon: Trained 20 healthworkers (Online). Zambia: 20 health workers(online). Ghana 20 healthwokers (online). These healthworkers have created mental health awareness in communities and provided GSP with virtual mentorship and supervision through SEEKGSP Academy. We do not do ME in these countries, So we cannot quantify the numbers reached. Information provided by Etheldreda Nakimuli Mpungu on 10 July 2024. She is the author.

Narrative Exposure Therapy (NET)

**Summary description:** Narrative Exposure Therapy (NET) for children, adolescents, and adults is an evidence-based, culturally inclusive, trauma-focused, short-term psychotherapeutic intervention that was designed for survivors of multiple and complex trauma. Within a life-span approach, it enables the integration of traumatic memories into the biographical context, activates the person's resources, and allows meaning-making and corrective relationship experiences. **Access to the intervention manual:** Buy it here https://www.hogrefe.com/de/shop/narrative-exposure-therapy-net-for-survivors-of-traumatic-stress-98099.html **Access to training:** Contact the NET Institute https://www.net-institute.org/ **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** Personal interview about traumatic events and childhood experience, chonological construction of the "Lifeline", Narrative Exposure (telling of the life story), contextualization of the trauma memory, meaning making **Intervention format:** 6-12 individual sessions **Target population:** Indiviudals with trauma related disorders (PTSD) **Significant effects found on symptoms of:** the trauma spectrum **Key innovative or differentiating features of this intervention:** The NET approach is distinct from other trauma focused treatments in its explicit focus on recognizing and creating a narrative of what happened, restoring the individual’s sense of autobiography, self-identify and self-esteem, together with the acknowledgement of the human rights abuses that have occurred. **Summary of Evidence:** >30 fully powered RCTs reveal large effects of NET. Siehl, Robjant & Crombach (2019) provide an overview on effects across populations. **Different populations where the intervention has been used:** Refugees / migrants, torture survivors, LMIC, post-conflict, gang members, ex-combatants, soldiers, survivors of gender based violence, individuals with diagnosis for borderline personality disorder, complex trauma, dissociative identity disorder, psychotic symptoms, other severe mental illness, pregnant woman, children with neurodevelopmental disabilities, elderly adults, individuals in insecure living conditions and ongoing violence, children and adolescents, gender diverse and intersectional groups / LGBTQ+, indiviudals with intellectual disabilities, homeless persons or vulnerably housed **Restrictions or requirements for its use:** Acute psychotic episode (pre-medication), other severe neurological disease, acute intoxication (example: substance abuse), acute suicidal ideation, acute danger to others **Requirements / qualifications for trainers and supervisors:** The trainer and supervisor is not currently suffering from PTSD symptoms or other manifest mental health disorders **Examples of implementation outside of RCT contexts:** KIDNET for children, FORNET for traumatized offenders, ElderNET for seniors, NETfacts for communities, high-NET for inpatient care, NET-PC for primary care, amongst others. Information provided by Maggie Schauer on 5 October 2024. She is author if the intervention.

Self-Help Plus (SH+): A group-based stress management course for adults

**Summary description:** Self-Help Plus (SH+) is a 5-session stress management course from WHO designed for groups of up to 30 people. Led by trained, non-specialist facilitators, SH+ uses pre-recorded audio and an illustrated guide, *Doing What Matters in Times of Stress*, to teach essential stress management skills. This program effectively reduces psychological distress and helps prevent mental disorders, making it suitable for adults experiencing stress. SH+ can complement other mental health interventions, serve as an initial step in a stepped care program, or be used as a community-based intervention in broader programs. **Access to the intervention manual: **Full open access **Access to training:** [https://www.who.int/publications/i/item/9789240035119](https://www.who.int/publications/i/item/9789240035119) **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** SH+ is based on Acceptance and Commitment Therapy (ACT), a form of CBT with distinct features. It provides training in five skills used to help people manage stress. These five core skills are – Grounding in stressful situations, Unhooking from difficult thoughts and feelings, Acting on your values, Being kind - related to social support, Making room, a mindfulness exercises. **Intervention format:** SH+ is a large-group self-help intervention that delivers key information through pre-recorded audio, with facilitators guiding discussions and addressing questions. This program is specifically designed for use with hard-to-reach populations. **Target population:** Populations affected by adversity, including refugees and people affected by a humanitarian emergencies **Significant effects found on symptoms of:** Psychological distress, depression, anxiety, functional impairment, post-traumatic stress, self-identified problems. Importantly some RCTs showed that SH+ may help to prevent the development of mental disorders. **Key innovative or differentiating features of this intervention:** SH+ can be delivered to large groups (up to 30 people). The use of pre-recorded materials ensures consistency and means training and supervision may eb shorter compared to other psychological interventions. **Summary of Evidence:** SH+ has been evaluated in three randomized controlled trials (RCTs) across diverse refugee and asylum seeker populations. These studies included South Sudanese refugees in Uganda, Syrian refugees in Türkiye, and refugees from various countries across multiple European nations. Findings demonstrate that SH+ significantly reduces psychological distress, enhances well-being, and may prevent the onset of mental health disorders. The RCTs highlight SH+ as a scalable, accessible intervention that provides measurable mental health benefits, even when delivered by non-specialist facilitators. A meta-analysis of individual participant data found that, at 5-6 months post-randomization, SH+ was significantly more effective than Enhanced Care As Usual (ECAU) in improving depression symptoms, self-identified problems, and overall well-being. Interestingly, no immediate post-intervention difference was found between SH+ and ECAU, though SH+ showed notable benefits for particularly vulnerable participants, such as those unemployed or with lower initial mental well-being. **Different populations where the intervention has been used:** Refugees and asylum seekers in middle and high income settings. **Restrictions or requirements for its use:** SH+ is not suitable for people who have a severe impairment related to a mental, neurological or substance use disorder, or are at imminent risk of suicide (e.g. people with a plan to end their life in the near future). It may be considered as an additional itnervention, when other needsd are fully addressed. Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions or guided self-help. See the SH+ manual and training manual for more information. **Requirements / qualifications for trainers and supervisors:** Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions or guided self-help. See the SH+ manual and training manual for more information. **Examples of implementation outside of RCT contexts:** SH+ has been scaled up in Ukraine as part of the national mental health response and deployed in Türkiye and Northwest Syria as part of earthquake relief efforts. It has also been implemented in northern Uganda as part of community programming under a program called SH+ 360. [https://www.elrha.org/project/scaling-up-self-help-plus-sh-through-humanitarian-partnerships/](https://www.elrha.org/project/scaling-up-self-help-plus-sh-through-humanitarian-partnerships/) [https://www.cambridge.org/core/journals/bjpsych-open/article/sh-360-novel-model-for-scaling-up-a-mental-health-and-psychosocial-support-programme-in-humanitarian-settings/933B5682CE0E94EC5E19A5433D8875A3](https://www.cambridge.org/core/journals/bjpsych-open/article/sh-360-novel-model-for-scaling-up-a-mental-health-and-psychosocial-support-programme-in-humanitarian-settings/933B5682CE0E94EC5E19A5433D8875A3) Information provided Ken Carswell on 26 October 2024. He is WHO focal point for SH+.

Youth Readiness Intervention (YRI)

**Summary description:** Problem Management Plus (PM+) is a brief five-session WHO intervention for adults from communities exposed to adversities suffering from psychological distress (e.g. anxiety and depression symptoms). The intervention has been successfully delivered by non-specialists in low, middle income and high income countries. **Access to the intervention manual: **Full open access **Access to training:** Please send an email to [rpcalab_ssw@bc.edu](rpcalab_ssw@bc.edu) **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** Problem management, behavioural activation, stress reduction and strengthening social support. **Intervention format:** In PM+, people are seen on an individual basis for five weekly sessions (usually face-to-face, but remote versions have also been implemented). Sessions are 90 minutes long with independent practice of strategies between sessions encouraged. There is also an evidence-based group version called Group Management Plus (Group PM+). **Target population:** Adults impaired by psychological distress **Significant effects found on symptoms of:** Psychological distress, depression, anxiety, functional impairment, post-traumatic stress, self-identified problems. While some small effects on PTSD symptoms were found, these varied between studies. This is not a trauma focused intervention and other more relevant interventions exist for PTSD. **Key innovative or differentiating features of this intervention:** PM+ is open access and available in many languages, this means it can be adapted for different settings. The intervention has been implemented in a number of settings. **Summary of Evidence:** Several fully powered RCTs have been conducted with PM+ It has been found to be effective in reducing psychological distress and self-identified problems and increasing functioning in women exposed to gender-based violence in Kenya; decreases in anxiety, depression, post-traumatic stress, improvements in functional impairment, self-identified problems, in communities exposed to adversities in Pakistan being implemented by both non professionals and professionals. With Syrian refugees in the Netherlands is has shown to reduce symptoms of depression, anxiety, PTSD and self-identified problems. **Different populations where the intervention has been used:** Communities exposed to adversities; Refugees and asylum seekers in middle and high income settings; People with medical conditions; Women exposed to GBV, health workers in HIC. **Restrictions or requirements for its use:** PM+ is not suitable for people who have a severe impairment related to a mental, neurological or substance use disorder, or are at imminent risk of suicide (e.g. people with a plan to end their life in the near future). **Requirements / qualifications for trainers and supervisors:** Ideally this should be a mental health professional thoroughly trained in cognitive behaviour therapy (CBT). See the PM+ manual for more information. **Examples of adaptations and different formats:** PM+ has been tested effectively as part of a stepped care package for health workers in Spain and was delivered remotely. **Examples of implementation outside of RCT contexts:** PM+ is implemented in many different settings. For example, after a capacity building project by TdH and WHO, PM+ was implemented in Ethiopia, Syria and Honduras (see three case studies). Partners in Health have been adapting and implementing PM+ in Rwanda,Peru, Mexico and Malawi (For more information click [here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503941/pdf/nihms-1745255.pdf)). Information provided by Edith van ‘t Hof on 27 March 2024. She was involved in manual development at WHO.

Sugira Muryango - Family Strengthening Intervention - ECD (Early Child Development) + VP (Violence Prevention)

**Summary description:** Sugira Muryango is a home-visiting intervention designed to improve responsive parenting, promote play in early child development, and prevent violence in the home. Sugira Muryango’s 12 sessions are delivered weekly to engage male and female caregivers with active coaching on responsive caregiving, improved nutrition, hygiene, help-seeking behaviors, early stimulation, problem-solving, conflict resolution, stress management, and shared decision making. **Access to the intervention manual: ** Access by request from author, please email: Theresa Betancourt, RPCA Lab ([rpcalab_ssw@bc.edu](rpcalab_ssw@bc.edu)) **Access to training:** Access by request from author, please email: Theresa Betancourt, RPCA Lab ([rpcalab_ssw@bc.edu](rpcalab_ssw@bc.edu)) **Intended users/ Implementers:** Trained and supervised non-specialist provider **Intervention format:** It uses a manual curriculum divided into 12 modules, a welcome and closing session, and 3- and 6-month booster session, sequential 60 minute+ home-visiting sessions designed to be delivered by non-specialists. **Target population:** Vulnerable families with a child 0-3. **Key innovative or differentiating features of this intervention:** Sugira Muryango is flexible, in-home intervention for all family types (dual-headed, single-headed, teen mothers, multigenerational households, etc.) and has high male caregiver engagement with 70% of fathers attending all sessions in RCT. Also, building on the success from the RCT, from 2021–2023 the Sugira Muryango program successfully tested a multi-level implementation strategy – the Promoting Lasting Anthropometric Change and Young Children’s Development (PLAY) Collaborative – to create a platform for expansion and sustainment of Sugira Muryango via government social and child protection programs. **Summary of Evidence:** In the RCT, Sugira Muryango has been found to be effective in decreasing child exposure to violent child discipline, reducing victimization to intimate partner violence among mothers, decreasing in mothers & fathers showing depression/ anxiety symptoms, increasing male engagement, caregivers providing more stimulating materials for children in the home (e.g., books), increasing caregiver engagement of playful activities with children, increasing care seeking for diarrhea and fever, increasing safe treatment of drinking water and improving children's motor, communication, problem-solving, and personal-social-skills (ASQ-3) 1 year after intervention delivery. **Different populations where the intervention has been used:** Vulnerable families in Rwanda, Venezuelan migrant families in Colombia, War-impacted families in Sierra Leone, Refugee populations in New England (US) **Restrictions or requirements for its use:** Material User Agreements are required to access the manual. A Licensing Agreement is required to use the intervention. Both are available free of charge. To request access please email: [rpcalab_ssw@bc.edu](rpcalab_ssw@bc.edu) **Requirements / qualifications for trainers and supervisors:** Those interested in using the intervention should work with RPCA to identify experienced interventionists who can train others, or develop a plan to become a trained as a trainor. Information provided by Theresa Betancourt on 8 November 2024. She is the Author, Principal Investigator.

Doing What Matters in Times of Stress: An Illustrated Guide

**Summary description:** Doing What Matters in Times of Stress (DWM) is an illustrated self-help stress management guide that is one part of Self-Help Plus (SH+), a WHO group stress management course and can be used alone or with the accompanying audio exercises.The DWM guide can be delivered as a guided self-help intervention with support from a briefly trained non-specialised helper. It is based on acceptance and commitment therapy (ACT). when delivered as a guided self-help intervention DWM has been shown to reduce psychological distress making it suitable for adults experiencing stress. Evidence suggests that DWM can complement other mental health interventions as an initial step in a stepped care program. **Access to the intervention manual: ** Available online, contact WHO at: psych_interventions@who.int for any further enquiries. **Access to training:** Training manual for providing DWM as guided self-help is available on request from psych_interventions@who.int. manual and training will be published in 2025. **Intended users/ Implementers:** Self-help guide. Can also be delivered as guided self help intervention by trained non-specialist workers. **Therapeutic strategies:** DWM is based on Acceptance and Commitment Therapy (ACT), a form of CBT with distinct features. It provides training in five skills used to help people manage stress. These five core skills are – Grounding in stressful situations, Unhooking from difficult thoughts and feelings, Acting on your values, Being kind (related to social support), and Making room (a mindfulness exercise). **Intervention format:** The DWM guide is a booklet with images and small amounts of text and has accompanying audio recordings to support users to use the techniques described. All materials can be freely downloaded from the WHO website. It has also been adapted for delivery as an online digital application. It can be delivered with guidance from trained non-specialist helpers in different ways. One pilot trial with Syrian refugees provided three calls while other trials (in press) provided up to 15 mins for up to 5 sessions over the telephone. **Target population:** Populations affected by adversity, including refugees and people affected by a humanitarian emergencies. **Significant effects found on symptoms of:** A pilot RCT showed effects when DWM is delivered as a guided self-help intervention for and post-traumatic stress symptoms. **Key innovative or differentiating features of this intervention:** DWM can be delivered either as a self-help or guided self help intervention. When delivered as a guided self-help intervention, the use of a booklet and pre-recorded materials ensures consistency and means training and supervision may be shorter compared to other psychological interventions. The intervention can also be adapted for other means of delivery e.g. presented as an online intervention rather than a printed booklet. **Summary of Evidence:** DWM has been evaluated in one randomised controlled pilot trial in Turkey with Turkish nationals and Syrian refugees. Further trials are in press where DWM was part of stepped care model in Europe with migrant populations. **Different populations where the intervention has been used:** Refugees and asylum seekers. **Restrictions or requirements for its use:** DWM is not suitable for people who have a severe impairment related to a mental, neurological or substance use disorder, or are at imminent risk of suicide (e.g. people with a plan to end their life in the near future). It may be considered as an additional intervention, when other needs are fully addressed. Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions or guided self-help. **Requirements / qualifications for trainers and supervisors:** When delivered as a guided self-help intervention supervisors and trainers of helpers are mental health professionals who are competent and experienced in delivering psychological interventions or guided self-help. **Examples of implementation outside of RCT contexts:** DWM has been adapted to be delivered as an online intervention and made available publicly with a focus on the Ukraine crisis by Vrijie Universitet Amsterdam: https://dwmatters.eu/ Information provided by James Underhill on 5 November 2024. He is the WHO focal point for DWM.

The Center for Mind-Body Medicine (CMBM) Small Group Model

**Summary description:** The Center for Mind-Body Medicine (CMBM) Small Group Model is an approach designed to heal psychological trauma, relieve stress, reduce symptoms of chronic illness, and increase resilience. Working in small groups of 8-10 people, facilitators teach a variety of self-care techniques drawn from the world’s healing traditions as well as modern medicine to help participants learn to move through emotions and experience their own capacity for self-healing. Trained facilitators guide the experience, helping participants discover their own answers. **Access to the intervention manual: ** Access after training. Find more information [here](https://cmbm.org/work-with-us/training/). **Access to training:** Access after training. Find more information [here](https://cmbm.org/work-with-us/training/).. **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** The individual mind-body skills taught consist of different types of meditation including an expressive (active, physical) meditation, biofeedback and autogenic training, guided imagery, genograms, mindful eating, and self-expression through written words and drawings. **Intervention format:** The mind-body skills are taught in groups of 8-10 people for 2 hours once a week for 6-8 weeks. Longer programs may be run for 10-12 weeks. Each group consists of the following: 1. A slow deep breathing meditation; 2. Check-in; 3. Explanation of the mind-body technique and practice of the technique; 4. Sharing the experience of the technique, 5. Closing with a slow deep breathing meditation. **Target population:** Traumatized and chronically stressed individuals. **Significant effects found on symptoms of:** Statistically significant improvements were seen following the mind-body skills groups for: 1. Posttraumatic stress disorder, anger, and sleep disturbance in adults; and 2. posttraumatic stress disorder in adolescents. **Key innovative or differentiating features of this intervention:** This is an innovative comprehensive model of self-care and mutual support. The techniques are taught in a specific order to help achieve physiological and psychological balance by using simple techniques before practicing those that require more focus. The small group setting is very important because it provides safety and social support. **Summary of Evidence:** Two RCTs have been published on this model: with military Veterans (doi: 10.1037/tra0000559) and Kosovar adolescents (doi: 10.4088/jcp.v69n0915). Pilot studies have been published on Palestinian adults (doi:/10.1037/trm0000081), Palestinian youth (doi:/10.1037/trm0000081), depressed adolescents (doi:10.1016/j.pedhc.2020.05.003), and Kosovar adolescents (doi:10.1023/B:JOTS.0000022620.13209.a0) **Different populations where the intervention has been used:** War traumatized populations, Displaced persons, Military veterans, Survivors of mass violence, Survivors of natural disaster, First responders, Incarcerated individuals, Indigenous communities, Healthcare workers, Caregivers, and Community leaders. **Restrictions or requirements for its use:** Anyone can participate in the mind-body skills groups as long as they are able to tolerate being in a group setting and do not have any issues that would lead to them being disruptive. In order to access or use the manual, completion of The Center for Mind-Body Medicine's Professional Training Program in Mind-Body Medicine and the Advanced Training Program in Mind-Body Medicine is required. The manual is provided following completion of the Advanced Training program. **Requirements / qualifications for trainers and supervisors:** No professional degrees or specific levels of education are required for the training. Trainers are required to complete The Center for Mind-Body Medicine's (CMBM) Professional Training Program in Mind-Body Medicine and the Advanced Training Program in Mind-Body Medicine. Supervisors are required to complete the professional and advanced training programs above and in addition must complete the CMBM Certification Program in Mind-Body Medicine, have a recommendation by CMBM faculty, and complete the CMBM Training of Supervisors program, and receive ongoing supervision. **Examples of adaptations and different formats:** Adaptations of this program include: 1. the use of the mind-body skills by individuals as presented in Transforming Trauma: The Path to Hope and Healing by James S. Gordon (ISBN-13‏: ‎978-0062870728); 2. A mind-body medicine curriculum as part of an elective peer counseling course for high school peer counselors as described in a qualitative study (doi:10.1002/pits.22871); 3. A Mind-Body Ambassador Club where high school students participate in a 6-8 week Mind-Body Skills Group and then meet regularly to practice the skills and think creatively how to share them with others in their school; and 4. An Introduction to Mind-Body Skills course offered at Allegany College of Maryland as part of their Integrative Health Department courses. **Examples of implementation outside of RCT contexts:** This program has been implemented in a wide variety of populations in several countries including the following: 1. Since 1999, 600 health and education professionals were trained in Kosovo including a leadership team of 15 people who implemented the program into the 7 community mental health centers. It is estimated that 2 million children and adults have been served. 2. Since 2005, more than 1500 clinicians, educators, and community leaders have been trainined in Gaza. The program has been implemented into the public schools and gender-based violence programs. Trainings and mind-body skills groups continue being conducted during the current war (2024). The program has served more than 410,000 children and adults. Current funding will allow the outreach to serve about 300,000 more. 3. CMBM-Israel was established in 2009 and offers ongoing training and certifcation to Israeli clinicians and educators. Five hundred health and education professionals have been trained. Over 50,000 children and adults have been served. 4. In 2010 after the earthquake in Haiti, CMBM-Haiti was established. Since then the CMBM model has been shared with over 120 local and national organizations. Three hundred clinicians, educators, community leaders, and clergy have been trained and over 250,000 children and adults have been served. 5. In 2017, CMBM held trainings for Syrian refugees in Jordan. 6. In 2018, CMBM expanded its work in Haiti to address population-wide stress as a result of hurricanes Maria and Irma. Three hundred service providers and community leaders have been trained. Forty thousand have participated in Mind-Body Skills Groups and 250,000 children and adults have been served. 7. In 2023, 137 participants were trained in Ukraine and began facilitating mind-body skills groups in their communities. Forty-four of those have been further trained to supervise others in their community and to lead their own trainings. Nearly 3,000 children and adults have been served. 8. In addition to the international programs described above CMBM has also trained and worked with a wide variety of groups in the United States including incarcerated individuals and staff at the Indiana Department of Corrections; Veterans and staff at the Southeast Louisiana Veterans Healthcare System in New Orleans, LA; employees of the Eskenazi Health Care System in Indianapolis, IN; teachers, staff and students in the Broward County Public Schools in Florida; community organizations in Baton Rouge, LA; educators in Las Vegas, NV; the Pine Ridge Indian Reservation in South Dakota; the community leaders in the Sonoma Community Resilience Collaborative in California; Whole Health Coaches and clinical leaders in VISN 8, the largest hospital and clinic system in the Veterans Health Administration, serving 1.5 million U.S. veterans across the southeastern U.S. and the Caribbean; and faculty members, administrators, and students at Allegany College of Maryland. Information provided by Julie Staples on 18 November 2024.

Cognitive Processing Therapy

**Summary description:** Cognitive Processing Therapy (CPT) is a 12-session intervention for adolescents or adults proven to improve symptoms of PTSD and related conditions (depression, anxiety, substance use, suicidal ideation) and to improve functioning. CPT is intended for individuals exposed to traumatic events suffering from PTSD. CPT can be delivered remotely and at scale. CPT has been successfully delivered by non-specialists in low and middle income countries and by specialists in high income countries. **Access to the intervention manual: ** Main manual is published by Guilford; Other manuals can be requested via this site [https://cptforptsd.com/cpt-resources/](https://cptforptsd.com/cpt-resources/) **Access to training:** Access to the LMIC adapted manuals only available after training or just prior to training. **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** CPT provides psychoeducation and training in cognitive restructuring. CPT works to reduce trauma-related avoidance and to teach the client to identify thoughts and emotions and how to question their own beliefs to generate more adaptive and accurate ones. CPT addresses beliefs about the traumatic event and themes affected by trauma (safety, trust, power/control, esteem, intimacy). **Intervention format:** CPT can be delivered in group, individual, or a combined format. In individual CPT people are seen for 12 sessions, at least once a week. CPT can be delivered up to daily. Individual CPT sessions are 50 minutes long with independent practice of strategies between sessions. Group CPT sessions are 90-120 minutes delivered at least once a week, with independent practice of strategies between sessions. Both individual and group CPT have been tested via face-to-face and via video teleconference. **Target population:** Adolescents or Adults exposed to traumatic events with mild to severe post-traumatic stress disorder. **Significant effects found on symptoms of:** Improvements in PTSD, Depression, Anxiety, Traumatic grief, Alcohol use, Illicit drug use, Hopelessness, Suicidal ideation, Guilt, moral injury, Anger, Health concerns, cardiovascular functioning, Eating disorders, Dissociation, Occupational function/economic status, Social/leisure involvement, Intimacy/Sexual concerns. **Key innovative or differentiating features of this intervention:** CPT has demonstrated good cultural adaptability and consistent large to medium effect sizes on PTSD and depression. Outside of the U.S., CPT trials have been conducted in Canada, Australia, Japan, Germany, the Democratic Republic of Congo, Northern Iraq, Southern Iraq, Egypt, and Tanzania. It has been tested outside of specialty care in primary care settings, and new research has tested it delivered via asynchronous texting. Two long-term follow-up studies have been conducted with CPT, one in the US and one in the Democratic Republic of Congo, that have demonstrated long-term (5+ years) maintenance of treatment gains. **Summary of Evidence:** The literature on CPT is quite extensive, and the treatment is recommended as a first-line treatment for individuals with PTSD across several treatment guidelines. There are 40+ published randomized controlled trials (RCTs) of CPT. Exclusion criteria are not extensive, with individuals being excluded from trials for active suicidal intent, active psychosis or mania, and recent medication changes. Inclusion criteria are PTSD (or subthreshold PTSD in some studies). **Different populations where the intervention has been used:** Results from both RCTs and effectiveness studies have demonstrated that CPT works well across a wide range of populations, including community samples, veterans, and service members in outpatient and residential settings, and when delivered in-person, in-home, and via telehealth, CPT has been effective across trauma types, such as interpersonal violence, gender-based violence, torture, childhood abuse and combat, including when traumas are perceived as moral injuries, and when patients have experienced multiple and repeated lifetime traumas. **Restrictions or requirements for its use:** CPT is intended for individuals who have experrienced a traumatic event and who are experiencing mild-severe symptoms and functional impairment. CPT is not intended as a universal program. CPT is not suitable for people at imminent risk of suicide (e.g. people with a plan to end their life in the near future), or with active psychotic symptoms or mania. Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions and who are trained in, and deliver CPT. **Requirements / qualifications for trainers and supervisors:** Supervisors are ideally mental health professionals who are competent and experienced in delivering psychological interventions, and who have learned to deliver CPT with fidelity. Training and consultation are standardized across North America and in other high-resource settings, comprising a 2-day workshop (with an option of an additional day for group CPT training) followed by 6 months of consultation with at least two training cases. Information provided by Debra Kaysen on 4 October 2024.

Early Adolescent Skills for Emotions (EASE)

**Summary description:** Early Adolescent Skills for Emotions (EASE) is an evidence-based group psychological intervention to help 10–15-year-olds affected by internalizing problems (e.g. stress and symptoms of anxiety, depression) in communities exposed to adversity. Published by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF), EASE aims to support adolescents and their caregivers with skills to reduce distress. **Access to the intervention manual: ** Full Open Access **Access to training:** The training manual will be open access and available online in 2025. For now, please contact [EASEtraining@who.int](EASEtraining@who.int) with any inquiries. **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** EASE aims to reduce symptoms of internalizing problems in adolescents through four core empirically supported strategies: psychoeducation, stress management, behavioral activation, and problem-solving. The strategies for caregivers include providing psychoeducation and skills to help their children cope with distress, promoting positive parenting skills such as praise and reducing harsh punishment, enhancing communication skills, and strategies for managing caregivers' own stress. **Intervention format:** The intervention consists of 7 group sessions for adolescents and 3 additional group sessions for their caregivers. It is based on adapted aspects from Cognitive Behavioral Therapy and has been designed to be suitable for delivery by trained and supervised non-specialist helpers. The EASE intervention manual is accompanied by four additional documents to support its delivery. **Target population:** 10–15-year-olds affected by internalizing problems and their caregivers. **Significant effects found on symptoms of:** Psychological distress, including child-reported internalizing problems (Jordan and Pakistan), externalizing problems (Pakistan), and attention problems (Pakistan), and a range of other child- and caregiver-reported psychosocial outcomes (Pakistan). It also reduced psychological distress among caregivers (Jordan) and reduced inconsistent disciplinary parenting (Jordan). **Key innovative or differentiating features of this intervention:** EASE is comprised of seven weekly 90-minute sessions for adolescents, delivered in groups of approximately 8-12. An intervention manual is used to guide helpers to deliver each session. To maximise engagement, the core strategies are shared through a combination of group teaching, discussion, activities, pictures and drawings, and through a story. Each session includes a welcome and review activity of the previous session’s content, followed by sharing or revising a core skill, and ending with setting home practice to engage in between EASE sessions. The sessions are anchored by an illustrated storybook which depicts a character experiencing common difficulties faced by young people, as the character follows their way through the core EASE strategies. Adolescents are also provided with an illustrated workbook for completing their home practice. For both children and caregivers, EASE has been designed to maximised accessibility in contexts where there is low literacy. Caregivers of EASE-attending adolescents are invited to participate in three 90-minute caregiver group sessions, delivered to no more than 12 caregivers a group. The purpose of the caregiver sessions is to enhance existing strengths and promote adaptive parenting practices in order to improve the caregiver-child relationship and equip caregivers with skills to support their child living with distress. The caregiver sessions follow a similar approach to the adolescent sessions – with session welcoming and review, imparting of the core content, and closing through setting home practice - using group teaching, pictures and discussion. Caregivers are kept informed about the EASE skills which their children are receiving, without disclosing confidential or personal content about their child’s participation in the group (and vice versa). The adolescent sessions are structured as follows: - Understanding my Feelings (core strategy: psychoeducation, including emotion identification) - Calming my Body (core strategy: stress management, including slow breathing) - Changing my Actions – part 1, part 2 (core strategy: behavioural activation) - Managing my Problems – part 1, part 2 (core strategy: problem-solving) - Brighter futures (maintenance and relapse prevention) The caregiver sessions are structured as follows: - Understanding sadness, worry and stress (psychoeducation, active listening, quality time, stress management) - Boosting confidence (praise, considering children’s strengths, reducing physical punishment) - Caregiver self-care and brighter futures (caregiver stress management and basic self-care, maintenance and relapse prevention) EASE sessions are delivered by two trained and supervised non-specialist helpers. Training of helpers consists of at least 80 hours of classroom training, followed by two practice groups and weekly routine supervision by a mental health professional. **Summary of Evidence:** EASE has been successfully evaluated in definitive (fully-powered) RCTs among adolescents aged 10 to 15 years and their caregivers in two countries (Jordan and Pakistan). In Jordan, EASE contributed to reduced internalizing problems among adolescents aged 10-14 years. It also reduced distress among caregivers and improved disciplinary parenting. It did not lead to improvements on other psychosocial outcomes such as externalizing problems and attention problems. In Pakistan, EASE contributed to reduced internalizing and externalizing problems among adolescents aged 13-15 years. It also improved adolescents’ attention, problem solving and perceived emotional support, and a number of other psychosocial outcomes. The intervention did not improve caregivers’ quality of life or parenting practices. **Requirements / qualifications for trainers and supervisors:** Desired profile of a trainer • You are a mental health professional who is competent and experienced in all of the strategies included in EASE. • Ideally, you should first complete the EASE classroom training and the additional training day for supervisors before training others on EASE. o Note that trainers may not be the same persons as those who would deliver supervision, but they often are. Participating in the supervisor training allows future EASE trainers to deliver this part of the training. o In the case you have not completed the EASE classroom training, you should have an in-depth understanding of how to facilitate the EASE intervention and be able to competently demonstrate EASE facilitation skills. More experienced trainers may be able to train EASE without direct experience of delivering EASE groups (e.g. they may have supervised EASE). • You should have experience delivering mental health and psychosocial support services to adolescents and caregivers. o Trainers who do not have direct experience in delivering mental health and psychosocial support services should conduct the classroom training together with someone with a background in mental health (e.g. a mental health professional or social worker) who can provide information and training on addressing the imminent risk of suicide and other immediate safety issues (see Chapter 4 of the EASE intervention manual). • You should be experienced and competent in training and delivering EASE or other non-specialist psychological interventions. • You should possess excellent interpersonal and organizational abilities, and should be able to organize role-plays, manage group discussions, provide feedback and present information in a clear and simple manner. • You should share a common language with trainees or be prepared to use interpretation during the training. • Depending on local policies and laws, you should have qualifications (e.g. being a licensed psychologist) to be a trainer in psychological interventions. Desired profile of a supervisor • Ideally, you should first complete the EASE classroom training and the additional training day for supervisors before supervising helpers to deliver EASE. • You should be able to manage safety issues. • You should be a mental health professional trained in cognitive behavioural therapy (CBT), with experience of supervising manualized psychological interventions in a related culture or context. o Supervisors who do not have a mental health background should have experience of running EASE groups and should be supervised by a mental health professional. Information provided by Aiysha Malik, Ashley Nemiro and Anne de Graaff on 30 September 2024. They are the authors and editors of the intervention.

Thinking Healthy Programme

**Summary description:** Thinking Healthy Programme (THP) is a multicomponent cognitive behavioral therapy based intervention that was designed primarily as a task shifted intervention. The standard THP is an evidence-based manualised intervention targeting women with perinatal depression in low socioeconomic settings. It aims to improve health outcomes among mothers and their children through the adaptation and integration of Cognitive Behavior Therapy (CBT) techniques into the routine work of community health workers. Non-specific techniques include active listening, psychoeducation and fostering social support from key family members to support the mother in negotiating the challenges she faces. Owing to its effectiveness and ease of delivery, it was recommended by the World Health Organization as a model intervention and included in the Mental Health GAP Action Programme (mhGAP) for scaling up of mental health services around the world. THP trains non-specialist delivery agents in several evidence-based strategies to improve symptoms of perinatal depression. The intervention programme comprised of a total of sixteen session. **Access to the intervention manual: ** Full Open Access **Access to training:** Full Open Access **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** The CBT techniques include challenging unhelpful thoughts, behavioral activation, and problem solving. It includes cognitive behavioral therapy sessions delivered in a simplified form through pictures, illustrations, and activities. The THP illustrates the use of CBT strategies in three simplified steps. By employing guided discovery technique, LHWs use culturally appropriate figures and illustrations to educate the intervention recipients about maladaptive thinking styles and ways to identify them. Intervention recipients are educated about strategies to replace maladaptive thoughts and use alternative healthy strategies. Thereafter, they are educated about the link between thoughts and actions. They are further taught the use of health calendar to monitor their thoughts and behaviors to practice healthy thinking. **Intervention format:** The intervention programme comprised of a total of sixteen session. After one or two introductory sessions with the LHW, one session of the THP was delivered weekly for four weeks in the last month of pregnancy. These sessions comprise the module 1 of the THP, called the “preparing for the baby”. This was followed by three sessions in the first month postpartum, collectively termed as module 2, “The baby's arrival”. And then monthly sessions for nine months thereafter, comprising three modules preparing mother for early (2nd to 4th month postnatal), middle (5th to 7th month postnatal) and late (8th to 10th month postnatal) infancy. The timing of the sessions could be adapted according to the convenience of the intervention recipient. Each session lasted between 45 to 60 minutes. **Target population:** Perinatal women with depression **Significant effects found on symptoms of:** Moderate to large effect sizes noted for Psychological distress, depression, anxiety, social support and functional impairment. **Key innovative or differentiating features of this intervention:** THPis open access and available in many languages, this means it can be adapted for different settings. The intervention has been implemented in a number of settings. **Summary of Evidence:** The Thinking Healthy Programme (THP) was rigorously evaluated through a high-quality cluster randomized controlled trial involving more than 900 women experiencing perinatal depression in rural Pakistan. The intervention demonstrated substantial effectiveness, yielding an adjusted odds ratio of 0.22 (95% CI: 0.14–0.36), with 77% of participants achieving remission compared to 47% in the enhanced usual care group. **Different populations where the intervention has been used:** Perinatal women with depression **Restrictions or requirements for its use:** THP is not suitable for people who have a severe impairment related to a mental, neurological or substance use disorder, or are at imminent risk of suicide (e.g. people with a plan to end their life in the near future). Moreover, those with learning disability and psychotic symptoms are excluded. **Requirements / qualifications for trainers and supervisors:** Non-specialist health professionals such as community health workers or supervised peers with lived experiences. Ideally this should be a mental health professional thoroughly trained in cognitive behaviour therapy (CBT). See the THP manual for more information. **Examples of implementation outside of RCT contexts:** THP has been tested effectively as part of a stepped care package for health workers in Pakistan. It has also been adapted as a digital app, currently the trial is in process of publication; as a universal intervention in Turkey; adapted to target perinatal anxiety. Trial is in progress to test group preventive version of the THP in Pakistan and Turkey. Trial protcol for the app: [https://link.springer.com/article/10.1186/s13063-023-07581-w](https://link.springer.com/article/10.1186/s13063-023-07581-w) THP has been pilot tested in India, South Africa, Malawi, Peru and Turkey. Relevant publications: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04499-6; https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04499-6; https://pmc.ncbi.nlm.nih.gov/articles/PMC6315282/ Information provided by Ahmed Waqas on 5 December 2024, the co-author of the intervention.

Interpersonal Psychotherapy (IPT)

**Summary description:** Group IPT is a short-term treatment for depression originally developed for use by mental health professionals. It has since been adapted for use by non-specialists and extended to treat other common mental conditions (anxiety, PTSD, etc) in high, middle, and low income countries. IPT addresses interpersonal difficulties and crises that trigger and maintain depression symptoms. By making the clients' aware of the impact of these difficulties on their mood and by enhancing their interpersonal and problem-solving skills with group support, Group IPT alleviates depression. Group IPT is structured around distinct phases and typically spans 8-16 group sessions. **Access to the intervention manual:** Group IPT for Depression is available online with full open access and can get more information [here.](https://academic.oup.com/book/1261) **Access to training:** A generic training schedule and curriculum with participatory training exercises for Group IPT for Depression is available upon request from the WHO. Contact for the WHO manual for Group IPT for Depression: Department of Mental Health and Substance Abuse at WHO (mhgap-info@who.int), Dr Myrna Weissman at the College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University (weissman@nyspi.columbia.edu), or Dr Helen Verdeli at Teachers College, Columbia University (verdeli@tc.columbia.edu). **Intended users/ Implementers:** Trained and supervised non-specialist provider **Therapeutic strategies:** Group IPT focuses on interpersonal triggers of depression including grief following the death of someone significant; disputes (open or hidden); life changes that impact personal relationships and social roles; and loneliness/social isolation. It encourages the members to mobilize social resources, mourn what was lost, and help each other generate options, and identify allies and supports to live more fulfilled lives. **Intervention format:** Group can be delivered in-person and remotely. Its duration varies based on the specific adaptation, but it typically spans several weeks and is structured into four distinct phases: the pre-group, initial, middle, and termination phases. **Target population:** IPT is intended for adults and adolescents who have symptoms of depression (including ante- and postpartum depression), anxiety, PTSD, and transdiagnostic distress. **Significant effects found on symptoms of:** In RCTs Group IPT yielded significant decreases in depressive, anxiety and PTSD symptoms, and improvement in functioning among adults and adolescents. The positive effects of Group IPT have been shown to last for at least 6 months after therapy concludes. **Key innovative or differentiating features of this intervention:** IPT is informed by attachment theory and life events research, emphasizes the emotional impact of separation and loss, as well as the restorative power of social support. At the same time, it offers the flexibility needed for cultural adaptations based on each community's specific expectations for social roles, as well as unique communication codes regarding intimacy and power. Finally, the group format provides a "social laboratory" where group members can help each other enrich their interpersonal and problem-solving skills and create a new supportive community which helps adaptation during adversity. **Different populations where the intervention has been used:** Group IPT is used with men and women living in extreme poverty; affected by HIV/AIDS; internally displaced persons and refugees; and depressed and anxious adolescents. The supervisors need to have fulfilled their attendance, knowledge, and competency requirements as providers. **Requirements / qualifications for trainers and supervisors:** The supervisors need to have fulfilled their attendance, knowledge, and competency requirements as providers. To be competent provider, a specialist or non-specialist need to have attended a training workshop conducted by a vetted IPT trainer, passed an IPT Knowledge Test with at least 80%, attendance weekly supervision sessions over 3 cases, and meeting the required cutoff (75%) of competency assessment by the third case. Group IPT supervisors are encouraged to have a background in mental health. **Examples of adaptations and different formats:** Adaptations of Group IPT include for depressed persons living in extreme poverty, persons with HIV/AIDS, women victims of domestive violence, women with depression and/or PTSD, perinatal depression, internally displaced adolescents in Uganda, and depressed adolescents in Nepal in school-based settings. **Examples of implementation outside of RCT contexts:** Group IPT can be implemented within health and social services, such as, in communities, in non-specialized health-care services, in specialized mental health services, and in independent services provided by organizations. Information provided by Helen Verdeli on 2y November 2024. She is the lead author of Group IPT for Depression.