Psychological Interventions

• Intervention

  1. Any action intended to interfere with and stop or modify a process, as in treatment undertaken to halt, manage, or alter the course of the pathological process of a disease or disorder.

  2. Action on the part of a psychotherapist to deal with the issues and problems of a client. The selection of the intervention is guided by the nature of the problem, the orientation of the therapist, the setting, and the willingness and ability of the client to proceed with the treatment.

  5. In research design, an experimental manipulation.
• The point of an intervention is to produce change – attempting to solve a problem. They have come to you for help and have things they need resolving.
• Theory


  Can be used to help decide what factors are most important to focus on to help solve the problem. Helps see what things they want to target.
• Theory is important because it gives us a basis for how a process occurs (e.g. how a condition may develop), can be used as a framework to stop a similar condition occurring.
• Interventions need to be evaluated to see whether they produce the expected change – did they work? A group level, overall group- see if there was change in the expected direction.
• RCT (randomised controlled trial)


  Compare the intervention against something else (no intervention, usual care, another active intervention) to see whether the intervention is better or worse in terms of patient outcomes
• Quasi-experimental


  Before and after studies also useful designs
• Change4Life


  • Public Health England (PHE) campaign launched in 2009
  • Social marketing programme aimed at reducing childhood obesity
  • Targeted parents and primary school children
  • Has been extended over the last 10 years
  • Media based – TV ads, website, smartphone app
  • Materials distributed within schools
• Problem


  • 61% of adults and 28% of children were obese
  • Overweight and obesity is associated with a higher risk of Type II diabetes, heart disease, and certain cancers
  • Obesity-related health problems cost the NHS >£5billion every year
• Intervention

  • Public health campaign on adverts, radio etc.
  • Encourage people to be more active, and eat and drink more healthily (education and advice; including of calorie information on menus; food packaging labelling systems)
  • Sugar tax: calorie count on menus
  • To reduce weight, and therefore reduce associated health problems (and reduce NHS treatment costs)
• Evaluation

  • Is it effective?
  • Difficult to evaluate public health campaigns – hard to find a control group not exposed to the intervention once it has been rolled out
  • Before and after studies possible (measure key variables before and after implementation), but difficult to control for potential confounding factors
  • Croker et al (2012) – randomised controlled trial of Change4Life campaign – found increased awareness, but little change in attitudes or behaviour
  • Wrieden & Levy (2016) – quasi-experimental study – short-term behaviour change found ("smart swaps") but may not be sustainable long-term
  • Can reach lots of people at the same time
• Quasi-experimental study

  • Not a randomised controlled trial – not possible
  • Could still compare 2 groups
• A higher percentage of families in the intervention group had made healthy swaps compared to the comparison group
• But can this be maintained over time? Habits, Costs, Time pressure
• Behavioural Activation


  • A form of Cognitive Behavioural Therapy (CBT) which focuses more directly on the behavioural aspects of a condition
  • The aim of BA is to reverse the cycle of depression by increasing engagement in valued activities, which increases our chances of deriving pleasure and a sense of achievement from life
  • Used in the NHS as a way of treating depression, but can be used for other mental and physical health conditions
  • Can be very effective at treating depression for many people
  • Simplicity is its major advantage over many other treatments. Simpler treatments can be taught more quickly and cheaply and are more likely to be delivered with greater fidelity than more complex treatments
  • Poor concentration is a common symptom of depression, so simplifying treatment may also help sufferers to apply the techniques long enough to experience the benefits
  • Another advantage of BA is the absence of side effects, which is a common concern with medications
  • Specialist and more expensive treatments can be reserved for people who really need them, which is important for minimising costs in health services with finite resources
• Problem


  • Clinical depression is a recurrent, debilitating condition with a global prevalence of 16%
  • In the UK, annual costs of depression and anxiety are around £17bn
• Intervention


  Behavioural activation is a relatively simple intervention – easy for patients to understand and operationalise
• Evaluation


  • How do we know whether BA is effective?
  • Compare it against something else and measure patient outcomes
  • Randomised controlled trial of BA vs CBT – COBRA trial (Rhodes et al)
  • Advantages: more targeted- easier to change specific behaviours, people may feel happier being honest about their problems/motivations in an individual setting
  • Disadvantages: less cost effective- one therapy per person, other factors may impact outcome of intervention
• No difference was found between the groups (both BA and CBT were equally effective)
• Equally effective – is this a bad thing?
• Depends on your hypothesis...
• COBRA trial authors wanted to that BA could be delivered by healthcare professionals and was equally as effective as CBT – so this is a good result!