Elsevier, Asian Journal of Psychiatry, Volume 22, 1 August 2016
Cognitive Behaviour Therapy has been demonstrated to be an effective intervention in outpatient and inpatient settings for a wide range of presenting mental health problems including depression, Obsessive Compulsive Disorder, Post traumatic Stress Disorder, Social Anxiety Disorder, Panic Disorder and Somatorform Disorder. There is likely to be an unmet need for this therapeutic approach in most Low and Middle Income Countries (LMIC). However, the training of therapists to deliver this intervention has historically been a lengthy and expensive process, with already highly trained staff such as psychiatrists and psychologists undertaking additional training of up to one year duration in order to develop expertise in this area. This paper proposes that a model where training, supervision, leadership and service evaluation is provided by a small number of highly trained staff to front-line non-specialist staff who will then deliver manualised therapy. These front-line staff may also be conceptualised as part of a stepped care model where self-help and manualised therapy approaches are used in the first instance. Where patient functioning does not improve there is then the possibility of being stepped-up for treatment by a more specialised and highly trained therapist. This approach may help in meeting the huge mental health treatment gap in LMIC. This paper also suggests that lessons learnt from the dissemination of behaviourally informed parenting interventions internationally can be applied to the dissemination of this therapeutic approach.
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Article; CBT; Cognitive Behavioral Therapy; Cognitive Therapy; Conceptual Framework; Cultural Anthropology; Depression; Developing Countries; Developing Country; Economics; Europe; Evidence Based Medicine; Health Care Access; Health Care Delivery; Health Program; Health Services Accessibility; Hospital Care; Hospital Patient; Human; Humans; LMIC; Medical Specialist; Mental Disease; Mental Health Service; Mental Health Services; North America; Obsessive Compulsive Disorder; Organization And Management; Outpatient Care; Panic; Paramedical Education; Posttraumatic Stress Disorder; Priority Journal; Program Development; Psychiatrist; Psychologist; Psychotherapist; Social Phobia; Socioeconomics; Standards; Strategic Framework; Global