Remarkable progress has been made in developing psychosocial interventions for a broad range of psychiatric disorders for children, adolescents, and adults. In addition many efforts are well underway ...to address the research-practice gap, which refers to the dissemination evidence-based treatments from controlled settings to clinical care. The present article focuses on the treatment gap, which refers to the discrepancy in the proportion of the population in need of services and the proportion that actually receives them. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services receive no treatment. Although there are many reasons, the dominant model of delivering psychosocial interventions in both research and clinical practice makes it difficult to scale treatment to reach the large swaths of individuals in need. That model includes one-to-one, in person treatment, with a trained mental health professional, and provided in clinical setting (e.g., clinic, private practice office, health-care facility). The article discusses the development of delivery models that would permit reaching more individuals in need, highlights criteria for developing such models, and illustrates novel models already available. The article proposes that our next challenge is to reach individuals in need with the many excellent interventions we have developed but through a diversified set of delivery models.
•Most individuals in need of mental health services receive no treatment.•The dominant model of delivering treatments will need to be complemented by models that can be scaled to reach larger numbers of individuals.•Criteria for models of delivery and illustrations of models are provided.•A key priority will be to deliver are well studied treatments in new ways.
Currently, in the United States and worldwide, the vast majority of children and adolescents in need of mental health services receive no treatment. Although there are many barriers, a key barrier is ...the dominant model of delivering psychosocial interventions. That model includes one‐to‐one, in‐person treatment, with a trained mental health professional, provided in clinical setting (e.g., clinic, private practice office, health‐care facility). That model greatly limits the scale and reach of psychosocial interventions. The article discusses many novel models of delivering interventions that permit scaling treatment to encompass children and adolescents who are not likely to receive services. Special attention is accorded the use of social media, socially assistive robots, and social networks that not only convey the ability to scale interventions but also encompass interventions that depart from the usual forms of intervention that currently dominate psychosocial treatment research.
Read the Commentary on this article at doi: 10.1111/jcpp.13034
Single-case designs refer to a methodological approach that can be used to investigate the effectiveness of treatment with the individual client. The designs permit scientifically valid inferences to ...be drawn about the effects of treatment and hence offer advantages over alternative strategies such as the uncontrolled case study or open study that are used with the individual case. The present article discusses the key features of the methodology, illustrates specific designs and how inferences are drawn, and discusses critical issues (feasibility, generality of results, ethical issues) in the use of the designs. Essential features of the design, including ongoing assessment and drawing on the underlying thinking and logic of the designs can improve the clinical care for individual clients, even when the rigors of experimentation are not feasible or desirable. Lamentably, single-case methods are rarely trained among researchers or practitioners in psychology or related mental health professions. The designs could play a special role by improving individual care and therapeutic change, apart from the strength of the methodology as a purely research tool.
•The present article discusses the key features of the single-case methodology, illustrates specific designs and how inferences are drawn, and discusses critical issues (feasibility, generality of results, ethical issues) in the use of the designs.•Essential features of the design, including ongoing assessment and drawing on the underlying thinking and logic of the designs can improve the clinical care for individual clients.•Lamentably, single-case methods are rarely trained among researchers or practitioners in psychology or related mental health professions.•The designs could play a special role by improving individual care and therapeutic change, apart from the strength of the methodology as a purely research tool.
The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public ...interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research-practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice.
There has been enormous progress in psychotherapy research. This has culminated in recognition of several treatments that have strong evidence in their behalf. Even so, after decades of psychotherapy ...research, we cannot provide an evidence-based explanation for how or why even our most well studied interventions produce change, that is, the mechanism(s) through which treatments operate. This chapter presents central requirements for demonstrating mediators and mechanisms of change and reviews current data-analytic and designs approaches and why they fall short of meeting these requirements. The role of the therapeutic alliance in psychotherapy and cognitive changes in cognitive therapy for depression are highlighted to illustrate key issues. Promising lines of work to identify mediators and mechanisms, ways of bringing to bear multiple types of evidence, recommendations to make progress in understanding how therapy works, and conceptual and research challenges in evaluating mediators and mechanisms are also presented.
Tactics of Scientific Research (Sidman, 1960) provides a visionary treatise on single‐case designs, their scientific underpinnings, and their critical role in understanding behavior. Since the ...foundational base was provided, single‐case designs have proliferated especially in areas of application where they have been used to evaluate interventions with an extraordinary range of clients, settings, and target foci. This article highlights core features of single‐case experimental designs, how key and ancillary features of the designs have evolved, the special strengths of the designs, and challenges that have impeded their integration in many areas where their contributions are sorely needed. The article ends by placing the methodological approach in the context of other research traditions. In this way, the discussion moves from the specific designs toward foundations and philosophy of science issues in keeping with the strengths of the person and book we are honoring.
The high prevalence rates of mental disorders worldwide and the paucity of services constitute a mental health crisis. The vast majority of people in low-, middle-, and high-income countries do not ...receive any intervention for their symptoms of mental disorders, despite enormous advances in developing evidence-based psychosocial treatments and medications. The article proposes greater utilization of interventions in everyday life as an addition to the more traditional and commonly used mental-health interventions. The article delineates criteria to help identify what such interventions ought to include to permit accessibility, scalability, and reach to special populations. Physical activity, contact with nature, and yoga are examples to illustrate the class of everyday interventions that have evidence attesting to their impact on mental health and symptoms of psychopathology. The challenge is to integrate such interventions in mental health practices to better promote these at the population level and to monitor the impact. Many components of what is needed are in place but are not coordinated in an effective way to have widespread impact on mental health.
Public Significance Statement
Most individuals with mental disorders receive no treatment. This article focuses on activities in everyday life that can improve mental health, decrease psychiatric symptoms, and surmount many of the barriers that impede obtaining treatment. The activities are posed to promote a class of interventions known to improve mental health, are readily available, and overcome many of the barriers to receiving mental health services.
Coifman and Gunstad (2024) raise cogent points about childhood and adolescence as a place to begin to help close the mental health treatment gap, note the potential of applications (apps) as a ...modality of intervention given the pervasiveness of smartphones, and highlight a large-scale intervention study to convey that treatments can be scaled in outcome research. I expand the range of interventions we might consider, pose a best-buy approach to decide how and where to begin to address the treatment gap, and underscore that mental health problems in children, adolescents, and adults are on the rise. We still have no evidence that we can close the treatment gap and that to do so will require a marriage of multiple disciplines, interventions, and agencies to effect change.
What is the public health significance of this article?
The focus is on the treatment gap, namely, the large discrepancy between the prevalence of mental disorders and the proportion of individuals ...who receive care. The vast majority of individuals in need of services receive no care at all. This article underscores the importance of developing treatments that can be scaled as well as reach those individuals least likely to receive services. Novel interventions and models of delivery are proposed to redirect intervention research and narrow the treatment gap.
Psychological interventions to treat mental health issues have developed remarkably in the past few decades. Yet this progress often neglects a central goal—namely, to reduce the burden of mental ...illness and related conditions. The need for psychological services is enormous, and only a small proportion of individuals in need actually receive treatment. Individual psychotherapy, the dominant model of treatment delivery, is not likely to be able to meet this need. Despite advances, mental health professionals are not likely to reduce the prevalence, incidence, and burden of mental illness without a major shift in intervention research and clinical practice. A portfolio of models of delivery will be needed. We illustrate various models of delivery to convey opportunities provided by technology, special settings and nontraditional service providers, self-help interventions, and the media. Decreasing the burden of mental illness also will depend on integrating prevention and treatment, developing assessment and a national database for monitoring mental illness and its burdens, considering contextual issues that influence delivery of treatment, and addressing potential tensions within the mental health professions. Finally, opportunities for multidisciplinary collaborations are discussed as key considerations for reducing the burden of mental illness.
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