A guided self-help intervention in primary care to improve coping and mental health: an observational study
Rijnders, P., Heene, E., van Dijk, M., van Straten, A., Hutschemaekers, G., & Verbraak, M.J.P.M. (2016).
European Journal for Person Centered Healthcare, 4(2), 281-288

Introduction

The administration of treatments through self-help materials can help to reduce the complexity of psychotherapy and the length and the amount of therapist contact and might therefore reduce costs.

The self-help program is suitable for the treatment in primary care of patients with different mental health problems. This program is based on the idea that maladaptive coping is a transdiagnostic factor for psychopathology.

The treatment intervention: ‘from symptoms to solutions’

This intervention is characterized as follows.

It is structured, simple and brief

The manifestations of mental functioning and mental disorders are explained with the formula: S = L x C. The clarification of this formula helps the patient discover how mental problems (S: symptoms) arise as a consequence of the combination of life events (L) and inadequate coping strategies (C).

The patient uses a manual during the course of treatment. This manual contains information as well as homework assignments. These are typically presented as charts, which the patient has to fill in at home. Through the homework patients reach better understanding of the peculiarities of his or her situation.

It focuses on coping and hence self-efficacy

Coping expresses the behavioural and psychological strategies people employ to master, tolerate or reduce stress. Maladpative coping strategies are associated with psychopathology and are considered to be transdiagnostic. In the program coping strategies are characterized in terms of habitual reaction patterns and seen as the core element. The treatment aims to teach patients a new way to confirm or adapt their coping strategy.

It uses a stepwise approach

The treatment as a whole consists of three steps. These are: 1) shared problem definition and defining targets, 2) behaviour change, and 3) relapse prevention.

It stresses shared decision making

The patient’s problems are sorted out while using an outline. The patient and therapist discuss which components of the problem belong to which portion of the outline. During the discourse, the therapist explains how the elements in the outline are interconnected. As soon as the interconnectedness among S, L and C becomes clear, the patient and therapist discuss which elements of the problem need modification and which strategies will serve to activate new coping behaviour.

It includes monitoring of treatment progress

Objective information about mental functioning of the patient is obtained at the start and during the course of treatment. Ongoing gauging of the features and severity of the symptoms and assessing the coping strategies can serve as a strong tool in mutual decision-making in ongoing therapy. It can also strengthen patient motivation and self-directedness to adhere to the treatment plan as independently as possible.

It uses therapist guidance

A basic condition for the success of a self-help treatment is the support or guidance from a professional.