Sangath, New Delhi, India.
Jindal School of Psychology and Counselling, O.P. Jindal Global University, Sonipat, India.
Psychol Psychother. 2023 Mar;96(1):189-208. doi: 10.1111/papt.12433. Epub 2022 Nov 9.
There is limited understanding of change processes and long-term effects of low-intensity psychosocial interventions. We investigated these aspects in two brief problem-solving intervention formats for adolescents with elevated mental health symptoms and associated distress/impairment.
This qualitative study was nested within a school-based randomized controlled trial in New Delhi, India, which compared two problem-solving intervention formats: a lay counsellor-led format supported by printed materials (intervention arm) and printed problem-solving materials alone ("bibliotherapy" control arm). A total of 32 participants, ranging in age from 14 to 20 years (mean = 16.4 years, SD = 1.9) and comprising 21 males and 11 females, were interviewed across both trial arms at 12-month follow-up.
Five themes were derived using thematic framework analysis. The "impacts on symptoms and functioning" theme described symptomatic improvements and functional gains. "Processes underlying problem solving" reflected changes in positive beliefs, attitudes and emotions when confronted with problems, and the use of a more effective problem-solving coping style. "Experiences of problem-solving materials" covered benefits (e.g. access to relatable stories and readymade solutions) and limitations (e.g. diminishing use over time) of printed problem-solving handouts. "Role of supporting figures" accounted for the facilitating roles played by counsellors and trusted others. There were also accounts of researchers functioning as de facto counsellors in the bibliotherapy arm. "Recommended modifications for intervention delivery" included more flexible and private ways to access the interventions, greater personalization of the counselling process, more engaging and relevant supporting materials, and suggestions for widening access to the interventions in schools and community settings.
We infer from our qualitative analysis that changes in problem-solving style and problem orientation underpinned long-term symptomatic and functional improvements. Participants in the counsellor-led intervention appeared better able to sustain the use of problem-solving skills and generalize this approach beyond the original presenting problems. We attribute the differences between arms to the influence of direct advice and supportive interactions with counsellors. Practice implications are discussed.
对于低强度心理社会干预的变化过程和长期效果，我们的了解有限。我们针对两种针对心理健康症状升高且伴有痛苦/障碍的青少年的简短问题解决干预形式，调查了这些方面。
这项定性研究嵌套在印度新德里的一项基于学校的随机对照试验中，该试验比较了两种问题解决干预形式：一种是由印刷材料支持的由非专业辅导员主导的形式（干预组），另一种是仅使用印刷问题解决材料的“图书疗法”对照组。共有 32 名参与者，年龄在 14 至 20 岁之间（平均 16.4 岁，SD=1.9），包括 21 名男性和 11 名女性，在 12 个月随访时分别在两个试验臂中接受了访谈。
使用主题框架分析得出了五个主题。“对症状和功能的影响”主题描述了症状的改善和功能的提高。“问题解决背后的过程”反映了在面对问题时积极信念、态度和情绪的变化，以及更有效的问题解决应对方式的使用。“问题解决材料的体验”涵盖了印刷问题解决讲义的好处（例如，获得相关故事和现成的解决方案）和局限性（例如，随着时间的推移使用减少）。“支持人物的角色”说明了辅导员和可信赖的其他人所发挥的促进作用。也有研究人员在图书疗法组中充当事实上的辅导员的报告。“干预交付的推荐修改”包括更灵活和私人的方式来获取干预措施，对咨询过程进行更大程度的个性化，使用更吸引人且相关的支持材料，并提出扩大干预措施在学校和社区环境中的获取途径的建议。
我们从定性分析中推断，问题解决方式和问题取向的变化是长期症状和功能改善的基础。在辅导员主导的干预中，参与者似乎能够更好地维持问题解决技能的使用，并将这种方法推广到最初的问题之外。我们将手臂之间的差异归因于与辅导员的直接建议和支持性互动的影响。讨论了实践意义。
