What is an intervention?
- any action intended to interfere with and stop/modify a process, as in treatment undertaken to halt, manage, or alter the course of the pathological process of a disease/ disorder.
- 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.
- in research design, anexperimental manipulation.
Describe why interventions are important
- they aim to produce change and attempt to solve a problem.
- theory can be used to help decide what factors are most important to focus on to help solve the problem.
- interventions need to be evaluated to see whether they produce the expected change.
Describe why theories are important.
- they give us a basis for how a process occurs (e.g., how a condition might develop).
- this allows us to follow this so we can potentially use this to stop the condition/ problem occurring.
- helps us identify key variables which might be to target during an intervention, to help patient improvement.
Describe and example of a public health intervention (Change4Life).
- 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:
- 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)
Evaluate an example of a public health intervention (Change4Life).
- Hard to find evidence to support intervention.
What are the advantages of public health campaigns?
- Can reach a wide range of people of all ages.
- Can make a change in society.
- Spreads awareness / education.
- Can reach lots of people very quickly (social media).
- Can lead to a healthier lifestyle.
What are the disadvantages of public health campaigns?
- Difficult to measure effectiveness of interventions.
- Targets the general population with an assumption but not a minority or subset of people that it doesn’t work for or adversely effects.
- Easy to be ignored.
- Over-fixation of calories on labels can increase the risk of eating disorders.
Describe an example of a individual intervention: Behavioural Activation (Depression).
- Problem: clinical depression = a recurrent, debilitating condition with a global prevalence of 16%.
- In the UK, annual costs of depression and anxiety are around £17bn.
- Intervention: an simple intervention that is easy for patients to understand and operationalise.
- Evaluation: - in order to assess whether BA is effective, you need to compare it against and something else and measure patient outcomes.
What is behavioural activation?
- A form of CBT which focuses more directly on the behavioural aspects of a condition.
- Used in the NHS as a way of treating depression, but can be used for other mental health conditions.
Describe the Cycle of Depression
-Experience ——–> Emotional distress——> Avoidance———->Reduced opportunity for positive experiences ——-> Problems persist then cycles back to experience.
- A negative cycle.
Describe how Behavioural Activation influences the Cycle of Depression.
- BA analyses the person’s problem.
- There is a shared understanding and addressing of the “problem” behaviours that keep the person in the depressive cycle.
- There is a shared identification of meaningful, goal-oriented behaviours.
- Instead of avoidance, the BA will provide the depressive individual with a positive coping strategy.
- Instead of Reduced opportunity for positive experiences, BA would allow the individual to have an increased opportunity for positive experiences.
- Instead of problems persisting, BA allows the problems to hopefully get better.
What are the advantages of Individual-level interventions?
-More targeted and specialised towards a particular person.
- Can be adapted to help the individual in the best way for them
- People may feel happier being honest about their problems/motivations in an individual setting
What are the disadvantages of individual-level interventions?
- Expensive – therapist costs and more sessions required.
- May have to wait a long time for treatment.
- May not be suitable for people with intellectual disability.
- Clinician-patient interaction may affect outcome.
- Other factors might impact on outcome other than intervention.
How might the Change4Life intervention be trying to help people change their behaviour?
- Actionable bite-sized chunks – fun recipes, activities that target children.
- Can sign up for “healthy steps” emails to motivate parents to receive advice.
- May spark change for children, but not adults
Offers recipes – show how to use healthy ingredients to make meals. - Encourages more active lifestyle as a family
Fun, Disney-inspired games to motivate children to move more. - Healthy snacks as alternatives to high fat/sugar/salt.
- Mostly education – teaching people what healthy snacks are, what the problems are with fatty/sugary foods.
- Some elements of behaviour change – choosing healthier snacks.
- Quiz for kids to choose an appropriate exercise activity – more targeted – fun activities to choose from.
- Encouraging families to change together – modelling behaviour – may increase motivation.
Describe the COBRA Trial.
Behavioural Activation:
- Positive reinforcement
- Functional analysis of patients problem – shared understanding of behaviours that interfere with more meaningful behaviours.
- Self-monitoring of behaviour
- Identify “depressive” behaviours
- New goal-oriented behaviours
- Scheduling
- Addressing avoidance and rumination
CBT:
- Alter expression of depression by correcting negative beliefs, maladaptive information processing and behavioural patterns.
- Agree with patient a problem list and goals, shared understanding of CBT model and BCTs.
- Identify and modify negative automatic thoughts, maladaptive beliefs and underlying core beliefs.
- Identify and manage stressors (to reduce future recurrence).
- Activity and mastery behaviours
Explain what a Randomised Controlled Trial (RCT).
- 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.
- RCTs not always possible – quasi-experimental, before and after studies also useful designs.
Evaluate the effectiveness Change4Life Campaign.
- 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.
Wrieden et al (Change4Life) Study
- Was a Quasi-Experimental study.
- Not a randomised controlled trial as it’s not possible.
- But you could still compare 2 groups.
- Intervention group: Families in England who had signed up to Smart Swaps.
Received a Smart Swaps sign-up pack – info on items containing fat and sugar, and info on alternatives.
- Comparison group: Families in Wales – no sign-up facility available.
No additional information, but would have been aware of campaign (could have signed up in the past). - The data was collected via an app once per week for 3 weeks: purchasing of fatty/sugary foods. Any swaps made.
Describe the results of Wieden et al’s study (Change4Life).
- A higher percentage of families in the intervention group had made healthy swaps compared to the comparison group.
- However, variables such as habits, costs and time pressure could influence the the strength of the healthy swaps (may be difficult to maintain this over time).
Describe the COBRA Trial (Depression).
- 440 participants randomised.
- These participants were adults, 18 yrs and above with a Clinical diagnosis of Major Depressive Disorder.
- 221 depressive participants went through Behavioural Activation.
- 219 depressive participants went through CBT.
- Both groups were followed up, assessed and compared at 6, 12 and 18 months.
- Results: No difference was found between the groups (both equally effective).
