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: Will be open access, but for now contact WHO at 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 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).
Information provided by Edith van ‘t Hof on 27 March 2024. She was involved in manual development at WHO.