Self‐Help Plus ( SH +): a new WHO stress management package

Epping‐Jordan, JoAnne E.; Harris, Russ; Brown, Felicity L.; Carswell, Kenneth; Foley, Claudette; García‐Moreno, Claudia; Kogan, Cary; van Ommeren, Mark

doi:10.1002/wps.20355

Cited by 151Digital Mental Health InterventionsMental Health Treatment and AccessMindfulness and Compassion Interventions

Self‐Help Plus ( SH +): a new WHO stress management package

Open access

Epping‐Jordan, JoAnne E., Harris, Russ, Brown, Felicity L., Carswell, Kenneth, Foley, Claudette, García‐Moreno, Claudia, Kogan, Cary, van Ommeren, Mark·2016·World Psychiatry

DOI 10.1002/wps.20355PMC PMC5032500

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Abstract

Consistent with its recommendations for stress management interventions1, the World Health Organization (WHO) has developed a new psychological intervention for managing stress and coping with adversity. This new intervention is intended to be relevant for coping with any type of adversity, including chronic poverty, endemic community and gender-based violence, long-term armed conflict, and displacement. It is especially targeted towards places with enormous needs but limited humanitarian access, such as Syria and South Sudan. Following exposure to adversity, rates of diverse mental health problems and non-pathological distress increase. At the same time, most people affected by adversity do not have access to effective mental health and psychosocial support2. Without mental health specialists on the ground, either for direct service delivery or for training and supervising non-specialists3, 4, new approaches need to be established that can be delivered without an extensive workforce for mental health. SH+ was developed to address these needs. It does not require much time from experts for implementation: instead, it uses a guided self-help format and is delivered through a pre-recorded audio course, complemented with bibliotherapy. The potential of using a course to access hard-to-reach populations has been demonstrated previously5. Evidence for bibliotherapy is also promising6. Furthermore, research has found that guided self-help programs produce better results than "pure" (unguided) self-help, and the effects produced by guided self-help are surprisingly similar to face-to-face psychological treatment7. SH+ was designed to be relevant for large segments of adversity-affected populations: it is intended to be transdiagnostic, easily adaptable to different cultures and languages, and both meaningful and safe for people with and without mental disorders. The program was developed with experts in psychological care and global mental health, and colleagues in the humanitarian field. It underwent extensive peer-review, with 43 external experts reviewing the intervention. The SH+ package has two components: a pre-recorded course and a self-help book. Pre-recorded audio material (locally adapted) is delivered across five 2-hour sessions and in groups of 20 to 30 people. The audio material imparts key information about stress management and guides participants through individual exercises and small group discussions. A written facilitator guide helps briefly trained non-specialist facilitators to conduct the course using these audio materials. To augment the course materials, an illustrated self-help book reviews all essential content and concepts. The book – inspired by an existing illustrated self-help guide8 – contains more than 400 illustrations and conveys key points with minimal text. It was written to be useful both as a standalone product and as a key resource for those participating in the course. The format of SH+ is innovative in that it seeks to ensure that key intervention components are delivered as intended through the use of pre-recorded audio, without the burden of extensive training and supervision. This mode of delivery holds promise for helping hard-to-reach populations: the package may be introduced in areas where a conventionally delivered mental health intervention would not be feasible (e.g., remote areas, or areas where humanitarian access is limited). SH+ is based on acceptance and commitment therapy (ACT), a form of cognitive-behavioral therapy, with distinct features9. ACT is based on the concept that ongoing attempts to suppress unwanted thoughts and feelings can paradoxically make these problems worse. Instead, it emphasizes learning new ways to accommodate difficult thoughts and feelings – primarily through mindfulness approaches – without letting them dominate, while guiding people to take proactive steps towards living in a way that is consistent with their values. ACT has been shown to be useful for a range of mental health issues10 and has been used successfully in a guided self-help format11. Components of the SH+ package are currently being piloted in Syria, with Syrian refugees in Turkey, and with South Sudanese refugees in northern Uganda. Initial feedback has been positive. Funding has been secured for a full-scale randomized controlled trial to evaluate the SH+ course in Uganda later this year. Following evaluation and any necessary revisions, the SH+ package may become part of WHO's growing collection of low-intensity psychological interventions. Thinking Healthy (for perinatal depression)12 and Problem Management Plus (PM+; delivered in face-to-face sessions)4 are the first two of this collection. Over the next five years, the WHO will design and rigorously test additional psychological interventions for different age groups and using varying delivery models. Mental health specialists will always be essential for supervision and for management of those for whom these in

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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
Early responses from testing SH+ in Syria, among Syrian refugees in Turkey, and among South Sudanese refugees in northern Uganda were favorable.
“Components of the SH 1 package are currently being piloted in Syria, with Syrian refugees in Turkey, and with South Sudanese refugees in northern Uganda. Initial feedback has been positive.”
Quote in the paperNot a substantial claim
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
A majority of adversity-affected individuals cannot obtain effective mental health and psychosocial support.
“At the same time, most people affected by adversity do not have access to effective mental health and psychosocial support 2 .”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [2] Tol WA, Barbui C, Galappatti A et al. Lancet 2011;378:1581-91. source
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
Prior work has shown that a course format can reach populations that are hard to access.
“The potential of using a course to access hard-to-reach populations has been demonstrated previously 5 .”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [5] Cuijpers P , Mu ~ noz RF , Clarke GN et al. Clin Psychol Rev 2009;29:449-58. source
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
In many places, there are insufficient mental health specialists to provide services directly or to train and supervise non-specialists.
“Without mental health specialists on the ground, either for direct service delivery or for training and supervising nonspecialists 3,4”
Quote in the paperSubstantial claim0 of 2 sources checked
- cites [3] World Health Organization and United Nations High Commissioner for Refugees. mhGAP Humanitarian Intervention Guide (mhGAP-HIG). Geneva: World Health Organization, 2015.
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- cites [4] Dawson KS, Bryant RA, Harper M et al. World Psychiatry 2015;14:354-7. source
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
Guided self-help produces effects comparable to those of in-person psychological treatment.
“the effects produced by guided self-help are surprisingly similar to face-to-face psychological treatment 7 .”
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- cites [7] World Health Organization. WHO mhGAP guideline update. Geneva: World Health Organization, 2015.
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
ACT has demonstrated usefulness across various mental health conditions.
“ACT has been shown to be useful for a range of mental health issues 10”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [10] A-Tjak JGL, Davis ML, Morina N et al. Psychother Psychosom 2015;84:30-6. source
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
Guided self-help yields superior outcomes compared with unguided self-help.
“research has found that guided self-help programs produce better results than 'pure' (unguided) self-help”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [7] World Health Organization. WHO mhGAP guideline update. Geneva: World Health Organization, 2015.
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
ACT has been applied successfully within guided self-help.
“has been used successfully in a guided self-help format 11 .”
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- cites [11] Fledderus M, Bohlmeijer ET, Pieterse ME et al. Psychol Med 2012;42:48595. source
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
The SH+ program draws on acceptance and commitment therapy (ACT).
“SH 1 is based on acceptance and commitment therapy (ACT), a form of cognitive-behavioral therapy, with distinct features 9 .”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [9] Hayes SC, Pistorello J, Levin M. Couns Psychol 2012;40:976-1002. source
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
Evidence for bibliotherapy is promising.
“Evidence for bibliotherapy is also promising 6 .”
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- cites [6] den Boer PC, Wiersma D, Van den Bosch RJ. Psychol Med 2004;34:959-71. source
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
The intervention was extensively peer-reviewed by 43 external experts.
“It underwent extensive peer-review, with 43 external experts reviewing the intervention.”
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§ Self-Help Plus (SH 1 ): a new WHO stress management package · p. 1
ACT holds that trying to suppress unwanted thoughts and feelings can paradoxically worsen them.
“ACT is based on the concept that ongoing attempts to suppress unwanted thoughts and feelings can paradoxically make these problems worse.”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [9] Hayes SC, Pistorello J, Levin M. Couns Psychol 2012;40:976-1002. source
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2 of 2

The paper relies on this without support.
After adversity, the prevalence of various mental health problems and non-pathological distress rises.
“Following exposure to adversity, rates of diverse mental health problems and non-pathological distress increase.”

1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

SH+ is a low-intensity psychological intervention for stress management and overcoming a variety of adversities.
“SH+ is a low-intensity psychological intervention for stress management and overcoming a variety of adversities (15) and is informed by various meta-analyses of its therapeutic ingredients.”
From Translation, adaptation, and initial evaluation of a guided self-help intervention to reduce psychological distress among nurses during COVID-19 in China (2023) · cites this paper as [15]
SH1 is a guided self-help program made up of five audio sessions and a manual with illustrations.
“SH1 is a guided self-help intervention consisting of five audio-recorded sessions and an illustrated self-help manual 3 .”
From Feasibility of a guided self-help intervention to reduce psychological distress in South Sudanese refugee women in Uganda (2018) · cites this paper as [3]
SH1 is intended to reduce psychological distress in individuals with various common mental disorders and subthreshold symptoms.
“It aims to reduce psychological distress in people with a range of common mental disorders and subthreshold symptoms.”
From Feasibility of a guided self-help intervention to reduce psychological distress in South Sudanese refugee women in Uganda (2018) · cites this paper as [3]
SH1 can be delivered to large groups of 20 to 30 participants and can be facilitated by lay helpers who have minimal training.
“It can be provided to large groups (20 to 30 participants) and facilitated by lay helpers with minimal training.”
From Feasibility of a guided self-help intervention to reduce psychological distress in South Sudanese refugee women in Uganda (2018) · cites this paper as [3]

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DEN BOER, P. C. A. M., WIERSMA, D., & VAN DEN BOSCH, R. J. (2004) · Psychological Medicine · doi:10.1017/s003329170300179x · Cited by 220 · see citing works
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Fledderus, M., Bohlmeijer, E. T., Pieterse, M. E., & Schreurs, K. M. G. (2012) · Psychological Medicine · doi:10.1017/s0033291711001206 · Cited by 209 · see citing works
Management of Acute Stress, PTSD, and Bereavement: WHO Recommendations
Tol, W. A., Barbui, C., & van Ommeren, M. (2013) · JAMA · doi:10.1001/jama.2013.166723 · Cited by 115 · see citing works
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World Health Organization and United Nations High Commissioner for Refugees., 2015, mhGAP Humanitarian Intervention Guide (mhGAP‐HIG)
World Health Organization, 2015, WHO mhGAP guideline update
Harris R, 2013, The illustrated happiness trap
World Health Organization, 2015, Thinking Healthy: a manual for psychosocial management of perinatal depression (WHO generic field‐trial version 1.0)

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Background
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Self-citation
Effectiveness of a stepped-care programme of internet-based psychological interventions for healthcare workers with psychological distress: Study protocol for the RESPOND healthcare workers randomised controlled trial
Mediavilla, R., McGreevy, K. R., Félez-Nóbrega, M., Monistrol-Mula, A., Bravo‐Ortiz, M. F., Bayón, C., Vega, B. R., Nicaise, P., Delaire, A., Sijbrandij, M., et al. (2022) · Digital Health · doi:10.1177/20552076221129084 · Cited by 27 · see citing works
“Doing What Matters in Times of Stress (DWM) (25) and, secondly, PM+, an individual intervention based on CBT (27).”
Method
Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries
Purgato, M., Prina, E., Ceccarelli, C., Cadorin, C., Abdulmalik, J. O., Amaddeo, F., Arcari, L., Churchill, R., Jordans, M. J., Lund, C., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014722.pub2 · Cited by 27 · see citing works
Recent approaches to provision of mental healthcare in refugee populations
Koesters, M., Barbui, C., & Purgato, M. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000428 · Cited by 25 · see citing works
How does context influence the delivery of mental health interventions for asylum seekers and refugees in low- and middle-income countries? A qualitative systematic review
Jannesari, S., Lotito, C., Turrini, G., Oram, S., & Barbui, C. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00501-y · Cited by 24 · see citing works
“SH+ is a novel five session psychosocial intervention developed by the World Health Organisation [30].”
Background
Sustainable Technology for Adolescents and youth to Reduce Stress ( STARS ): a WHO transdiagnostic chatbot for distressed youth
Hall, J., Jordan, S., van Ommeren, M., Au, T. M., Sway, R. A., Crawford, J., Ghalayani, H., Hamdani, S. U., Luitel, N. P., Malik, A., et al. (2022) · World Psychiatry · doi:10.1002/wps.20947 · Cited by 21 · see citing works
Self-citation
Cost-effectiveness of the Self-Help Plus Intervention for Adult Syrian Refugees Hosted in Turkey
Park, A., Waldmann, T., Kösters, M., Tedeschi, F., Nosè, M., Ostuzzi, G., Purgato, M., Turrini, G., Valimaki, M. A., Lantta, T., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.11489 · Cited by 25 · see citing works
Self-citation
Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda
Brown, F. L., Carswell, K., Augustinavicius, J., Adaku, A., Leku, M. R., White, R. G., Ventevogel, P., Kogan, C. S., Garcia‐Moreno, C., Bryant, R. A., et al. (2018) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2018.17 · Cited by 24 · see citing works
Self-citation
Humanitarian space and well-being: effectiveness of training on a psychosocial intervention for host community-refugee interaction
Chemali, Z. N., Borba, C. P. C., Johnson, K. A., Hock, R. S., Parnarouskis, L., Henderson, D. C., & Fricchione, G. L. (2017) · Medicine Conflict & Survival · doi:10.1080/13623699.2017.1323303 · Cited by 22 · see citing works
Global mental health and psychotherapy: Importance of task-shifting and a systematic approach to adaptation
Bolton, P. A. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814932-4.00001-x · Cited by 22 · see citing works
Effectiveness of a stepped‐care programme of WHO psychological interventions in a population of migrants: results from the RESPOND randomized controlled trial
Purgato, M., Tedeschi, F., Turrini, G., Cadorin, C., Compri, B., Muriago, G., Ostuzzi, G., Pinucci, I., Prina, E., Serra, R., et al. (2025) · World Psychiatry · doi:10.1002/wps.21281 · Cited by 24 · see citing works
“…characteristics are barriers to implementation, the World Health Organization (WHO) has de-World veloped a stress management intervention named Self Help Plus (SH+) 7 , and a brief intervention based on cognitive-behavioral and problem-solving strategies called Problem Management Plus (PM+) 8 .”
Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial
Purgato, M., Turrini, G., Tedeschi, F., Serra, R., Tarsitani, L., Compri, B., Muriago, G., Cadorin, C., Ostuzzi, G., Nicaise, P., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1100546 · Cited by 17 · see citing works
Scalable interventions for refugees
Bryant, R. A. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.59 · Cited by 23 · see citing works
“One example of this approach is the WHO’s Self-Help Plus program, which was initially trialled by delivering it to groups of 20–30 people by a facilitator who assisted participants as they worked through an illustration-based self-help manual (Epping-Jordan et al., 2016).”
Method
Contextual behavioral science and global mental health: synergies and opportunities
White, R. G., Gregg, J., Batten, S., Hayes, L. L., & Kasujja, R. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.07.001 · Cited by 22 · see citing works
“This intervention has been piloted amongst Sudanese Refugees living in Northern Uganda, with the intention of adapting it for use amongst Syrian Refugees in the Middle-East (Epping-Jordan et al., 2016).”
Background
Evaluating the feasibility of a group psychosocial intervention for migrant and host community women in Ecuador and Panamá: protocol for a multi-site feasibility cluster trial
Greene, M. C., Bonz, A. G., Cristobal, M., Vega, C., Andersen, L. S., Angulo, A., Armijos, A., Guevara, M. E., Benavides, L., de la Cruz, A., et al. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01085-1 · Cited by 21 · see citing works
“Therapy (ACT), a type of cognitive behavioral therapy that incorporates mindfulness approaches to develop skills for managing difficult thoughts and feelings [27, 28].”
Background
A randomized controlled trial assessing the efficacy of a self-administered psycho-educational intervention for patients with cancer
Körner, A., Roberts, N., Steele, R. J., Brosseau, D. C., & Rosberger, Z. (2019) · Patient Education and Counseling · doi:10.1016/j.pec.2018.12.002 · Cited by 19 · see citing works
Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations
Lakin, D. P., García-Moreno, C., & Roesch, E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19052916 · Cited by 18 · see citing works
“The World Health Organization (WHO) developed an ACT-based guided self-help intervention as part of its scalable psychotherapy initiative [46], Self-Help Plus (SH+) [54].”
MethodSelf-citation
Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial
Turrini, G., Purgato, M., Tedeschi, F., Acartürk, C., Anttila, M., Au, T. M., Carswell, K., Churchill, R. C., Cuijpers, P. J., Friedrich, F., et al. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000269 · Cited by 16 · see citing works
“In this context, the World Health Organization (WHO) developed Self-Help Plus (SH + ), a low-intensity self-help stress management programme aimed at reducing stress and improving overall wellbeing in people exposed to adversities (Epping-Jordan et al., 2016).”
BackgroundSelf-citation
Developing the Group Facilitation Assessment of Competencies Tool for Group-Based Mental Health and Psychosocial Support Interventions in Humanitarian and Low-Resource Settings
Pedersen, G. A., Sangraula, M., Shrestha, P., Lakshmin, P., Schafer, A., Ghimire, R., Luitel, N. P., Jordans, M. J. D., & Kohrt, B. A. (2021) · Journal on Education in Emergencies · doi:10.33682/u4t0-acde · Cited by 18 · see citing works
“Self-Help Plus, designed based on acceptance and commitment therapy principles for people with high levels of stress and psychological distress, particularly those living in humanitarian settings (Brown et al. 2018; Epping-Jordan et al. 2016; Tol et al. 2018; Tol et al. 2020).”
Background
Prevention and promotion effects of Self Help Plus: secondary analysis of cluster randomised controlled trial data among South Sudanese refugee women in Uganda
Augustinavicius, J., Purgato, M., Tedeschi, F., Musci, R. J., Leku, M. R., Carswell, K., Lakin, D. P., van Ommeren, M., Cuijpers, P. J., Sijbrandij, M., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2020-048043 · Cited by 17 · see citing works
Self-citation
A Chatbot-Based Version of the World Health Organization–Validated Self-Help Plus Intervention for Stress Management: Co-Design and Usability Testing
Fietta, V., Rizzi, S., Luca, C. D., Gios, L., Pavesi, M. C., Gabrielli, S., Monaro, M., & Forti, S. (2024) · JMIR Human Factors · doi:10.2196/64614 · Cited by 15 · see citing works
“The SH+ package has been incorporated into the expanding array of low-intensity psychological interventions endorsed by the World Health Organization (WHO) [21].”
Influential
Risk factors for mental disorder development in asylum seekers and refugees resettled in Western Europe and Turkey: Participant-level analysis of two large prevention studies
Barbui, C., Tedeschi, F., Acartürk, C., Anttila, M., Au, T. M., Baumgartner, J. S., Carswell, K., Churchill, R. C., Cuijpers, P. J., Karyotaki, E., et al. (2022) · International Journal of Social Psychiatry · doi:10.1177/00207640221132430 · Cited by 16 · see citing works
“Aiming to test the effect of Self Help Plus (SH+), a low intensity, group-based, self-help psychological intervention recently developed by the WHO (Epping-Jordan et al., 2016; WHO, 2021a), in reducing the frequency of mental disorders, we conducted two large randomized prevention trials in asylum seekers and refugees…”
MethodSelf-citation
Acceptance and Commitment Therapy in a Low-Income Country in Sub-Saharan Africa: A Call for Further Research
Geda, Y. E., Krell‐Roesch, J., Fisseha, Y., Tefera, A., Beyero, T., Rosenbaum, D., Szabo, T. G., Araya, M., & Hayes, S. C. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.732800 · Cited by 13 · see citing works
“In a feasibility study from Uganda published in 2018 (65), 25 South Sudanese refugee women underwent an ACT-based stress management intervention called Self-Help Plus (SH+), consisting of two components: a pre-recorded course and a selfhelp book (67).”
Background
Evaluating a Psychological First Aid Training Intervention (Preparing Me) to Support the Mental Health and Wellbeing of Chinese Healthcare Workers During Healthcare Emergencies: Protocol for a Randomized Controlled Feasibility Trial
Wang, L., Norman, I. J., Xiao, T., Li, Y., Li, X., & Leamy, M. C. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.809679 · Cited by 13 · see citing works
“Some further argue that Self-Help Plus and stress management approaches may be ideal for stress and BO reduction (14), yet those appears to be insufficient of empowering them to address patients’ need.”
Background
Preventing the mental health consequences of war in refugee populations
Barbui, C., Purgato, M., Acartürk, C., Churchill, R. C., Cuijpers, P. J., Koesters, M., Sijbrandij, M., Valimaki, M. A., Wancata, J., & White, R. G. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000154 · Cited by 13 · see citing works
“…a preventative effect on the development of mental disorders has recently been demonstrated for Self Help Plus (SH+), a WHO self-help psychological intervention that can be delivered to up to 30 people at once by briefly trained non-specialist facilitators (Epping-Jordan et al., 2016; WHO, 2021a).”
Background
Brief CBT-based psychological interventions to improve mental health outcomes in refugee populations: a systematic review and meta-analysis
Daniel, N., Liu, X., Thomas, E. T., Eraneva-Dibb, E., Ahmad, A.-M., & Heneghan, C. J. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2389702 · Cited by 14 · see citing works
Human centered design of AI-powered Digital Therapeutics for stress prevention: Perspectives from multi-stakeholders' workshops about the SHIVA solution
Bolpagni, M., Pardini, S., & Gabrielli, S. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100775 · Cited by 13 · see citing works
Implementing Integrative Adapt Therapy with Rohingya refugees in Malaysia: a training-implementation model involving lay counsellors
Tay, A. K., Miah, M. A. A., Khan, S. T., Badrudduza, M., Alam, R., Balasundaram, S., Rees, S. J., Morgan, K., & Silove, D. M. (2019) · Intervention · doi:10.4103/intv.intv_45_19 · Cited by 11 · see citing works
“Problem-solving is the most frequently used evidencebased technique in existing scalable psychological approaches such as Problem Management Plus (Dawson et al., 2015), Self-Help Plus (Epping-Jordan et al., 2016) and the Common Elements Treatment Approach (CETA) (Murray et al., 2014).”
Method
Psychometric Validation of a Combined Assessment for Anxiety and Depression in Primary Care in Mozambique (CAD-MZ)
Belus, J. M., Muanido, A., Cumbe, V., Manaca, M. N., & Wagenaar, B. H. (2021) · Assessment · doi:10.1177/10731911211032285 · Cited by 11 · see citing works
“In Mozambique, an LMIC with a population close to 30 million people, with a recent history of civil war, political instability (USAID, 2020), and high rates of infectious disease (Institute for Health Metrics and Evaluation, 2017), there are only 215 primary care facilities that offer mental health services (World Hea…”
BackgroundInfluential
Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India
Shrivastava, R., Singh, A., Khan, A., Choubey, S., Haney, J. R., Karyotaki, E., Tugnawat, D. K., Bhan, A., & Naslund, J. A. (2023) · SSM - Mental Health · doi:10.1016/j.ssmmh.2023.100230 · Cited by 11 · see citing works
A low-cost digital first aid tool to reduce psychological distress in refugees: A multi-country randomized controlled trial of self-help online in the first months after the invasion of Ukraine
Noha, A.-M. A., Asanov, I., & Buenstorf, G. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.117442 · Cited by 11 · see citing works
Self-help plus for refugees and asylum seekers; study protocol for a series of individual participant data meta-analyses
Karyotaki, E., Sijbrandij, M., Purgato, M., Acarturk, C., Lakin, D., Bailey, D., Peckham, E., Uygun, E., Tedeschi, F., Wancata, J., et al. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1930690 · Cited by 9 · see citing works
“…is based on acceptance and commitment therapy (ACT), a form of cognitive behavioural therapy that incorporates mindfulness and other acceptance-based practices to help people adaptively cope with distress and commit to actions that are aligned with their values (Epping-Jordan et al., 2016).”
BackgroundSelf-citation
Evaluating a stepped care model of psychological support for adults affected by adversity: study protocol for a randomised controlled trial in Jordan
Keyan, D., Habashneh, R., Akhtar, A., El-Dardery, H., Faroun, M., Abualhaija, A., Aqel, I. S., Dardas, L. A., & Bryant, R. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-078091 · Cited by 8 · see citing works
Translation, adaptation, and initial evaluation of a guided self-help intervention to reduce psychological distress among nurses during COVID-19 in China
Tian, T., Sun, J., Jiang, Y., Guo, Q., Huang, Z., Wang, D., Rahman, A., Li, X., & Yang, L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1168117 · Cited by 8 · see citing works
Views and experiences of migrants and stakeholders involved in social and health care for migrants in Italy during the COVID-19 pandemic: a qualitative study
Lotito, C., Turrini, G., Purgato, M., Bryant, R. A., Félez-Nóbrega, M., Haro, J. M., Lorant, V., McDaid, D., Mediavilla, R., Melchior, M., et al. (2023) · BMC Psychology · doi:10.1186/s40359-023-01208-0 · Cited by 8 · see citing works
“DWM is a component of the Self Help Plus (SH+) intervention [21], which is based on acceptance and commitment therapy (ACT) and consists of a pre-recorded audio course delivered by briefly trained facilitators in a group setting and complemented with an illustrated self-help book.”
Method
Self-help or silenced voices? An ethnographically informed warning
Torre, C. (2020) · The Lancet Global Health · doi:10.1016/s2214-109x(20)30106-6 · Cited by 8 · see citing works
The Effect of Intervention Approaches of Emotion Regulation and Learning Strategies on Students’ Learning and Mental Health
Charbonnier, É., Vigouroux, S. L., Puechlong, C., Montalescot, L., Goncalves, A., Baussard, L., Gisclard, B., Philippe, A. G., & Lespiau, F. (2023) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580231159962 · Cited by 8 · see citing works
Facilitators and barriers to participation and scale-up of a non-specialist delivered psychological intervention for adolescents in low-resourced settings: a process evaluation
Terp, A. M., Habashneh, R., Brown, F. L., Abualhaija, A., Aqel, I. S., Ghatasheh, M., Bryant, R. A., Jordans, M. J. D., Malik, A., Mittendorfer‐Rutz, E., et al. (2025) · BMC Public Health · doi:10.1186/s12889-025-21914-1 · Cited by 7 · see citing works
“These findings led to the development of several low-intensity and transdiagnostic interventions delivered by non-specialists e.g. (Group) Problem Management Plus (PM+) [15, 16], which have shown promise among adults [17–20].”
Self-citation
Preventing common mental health problems in war-affected populations: the role of digital interventions
Frankova, I., & Sijbrandij, M. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1586030 · Cited by 14 · see citing works
Positive appraisal style predicts long-term stress resilience and mediates the effect of a pro-resilience intervention
Petri‐Romão, P., Mediavilla, R., Restrepo, A., Puhlmann, L. M. C., Zerban, M., Ahrens, K. F., Barbui, C., Basten, U., Bayón, C., Chmitorz, A., et al. (2025) · Nature Communications · doi:10.1038/s41467-025-65147-7 · Cited by 15 · see citing works
“This is encouraging as it seems to support the view that the level of exposure does not influence the found longitudinal relationship.”
Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study
Abrahams, N., Chirwa, E. D., Mhlongo, S., Seedat, S., MYERS, B. J., Peer, N., Kengne, A. P., Garcia‐Moreno, C., Lombard, C. J., & Jewkes, R. K. (2023) · Archives of Women s Mental Health · doi:10.1007/s00737-023-01312-5 · Cited by 7 · see citing works
Implementing a Non-Specialist Delivered Psychological Intervention for Young Adolescents in a Protracted Refugee Setting: a Qualitative Process Evaluation in Lebanon
Ali, R., Brown, F. L., Stevenson, K., Jordans, M. J. D., Taha, K., Amine, M. E., Steen, F., Meksassi, B., Elias, J., Aoun, M., et al. (2023) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-023-09870-3 · Cited by 14 · see citing works
“11, 12 More recently, WHO developed the Early Adolescent Skills for Emotions (EASE) intervention, a transdiagnostic intervention for young adolescents which aims to mitigate the symptoms of internalizing disorders such as depression and anxiety.”
BackgroundSelf-citation
Healthcare workers’ perspectives on trauma and mental health access for Rohingya refugees in Cox’s Bazar
Green, L., Kaljee, L., Chowdhury, S. A., McHale, T., Mishori, R., Fateen, D., & Sheth, N. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1458680 · Cited by 6 · see citing works
A virtual intervention to support educator well-being and students’ mental health in conflict-affected Ukraine: A non-randomized controlled trial
Powell, T. M., Портницька, Н. Ф., Тичина, І. М., Savychenko, О., Макаренко, О. М., Shyriaieva, T., Cherniavska, K., Muller, J., & Carney, R. (2025) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2025.10014 · Cited by 8 · see citing works
“Rooted in principles of cognitive behavioral therapy (CBT), SH+ aimsto helpindividualslearn alternative waysto manage challenging thoughts and feelings (Epping-Jordan et al. , 2016).”
Highlighting Complementary Benefits of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) Interventions Delivered Alongside Broader Community MHPSS Programming in Zummar, Ninewa Governorate of Iraq
Musotsi, P., Koyiet, P. N., Khoshaba, N. B., Ali, A. H., Elias, F., Abdulmaleek, M. W., Simiyu, K., & Rosenkranz, E. (2022) · Intervention · doi:10.4103/intv.intv_7_22 · Cited by 6 · see citing works
What medical students want from Mental Health Self-Help Resources: A focus group study
Edwin, J., Cornwall, J., & Plooy, K. D. (2024) · Mental Health & Prevention · doi:10.1016/j.mhp.2024.200353 · Cited by 8 · see citing works
Early Identification of Post-Traumatic Stress Disorder in Trauma Patients: Development of a Multivariable Risk Prediction Model
Kravets, V. G., McDonald, M., DeRosa, J., Hernández-Irizarry, R., Parker, R. M., Lamis, D. A., Powers, A. D., & Schenker, M. L. (2022) · The American Surgeon · doi:10.1177/00031348221121549 · Cited by 7 · see citing works
“41 All of these interventions are directed towards decreasing the burden of mental health disease in a cost-effective manner for low resource settings.”
Background
BAMBOO for Refugees—A Culturally Sensitive Positive Psychology Intervention: A Protocol for a Pilot Randomized Controlled Trial
Hendriks, T., de Jong, J. T. V. M., Hassankhan, A., & van Woerkom, M. (2024) · International Journal of Applied Positive Psychology · doi:10.1007/s41042-023-00139-w · Cited by 6 · see citing works
Social validity of acceptance-based workplace mental health training for use in a low resource setting. A qualitative study with Ugandan mental health providers
Musanje, K., Flaxman, P. E., McIntosh, R., & Kasujja, R. (2024) · PLOS mental health. · doi:10.1371/journal.pmen.0000127 · Cited by 5 · see citing works
“To be scalable, such interventions ideally need to be transdiagnostic, so that they can simultaneously address the range of common mental health challenges found in the LAMICs’ workforce [13].”
BackgroundMethod
LLM-Enriched Finite-State Chatbots for Mental Health Support: A Case Study on Self-Help+
Sanna, L., Bolpagni, M., Fietta, V., Gavioli, G., Franzin, M., Dragoni, M., & Gabrielli, S. (2025) · Lecture notes in computer science · doi:10.1007/978-3-031-95838-0_38 · Cited by 5 · see citing works
Scaling up mental health service provision through multisectoral integration: A qualitative analysis of factors shaping delivery and uptake among South Sudanese refugees and healthcare workers in Uganda
Ndlovu, J. N., Ouizzane, S., Leku, M. R., Kalani, K. O., Sentongo, H., Nyangwen, B., Upadhaya, N., Skovdal, M., Augustinavicius, J., & Tol, W. A. (2024) · Implementation Research and Practice · doi:10.1177/26334895241288574 · Cited by 5 · see citing works
Assessing local service providers’ needs for scaling up MHPSS interventions for Ukrainian refugees: Insights from Poland, Slovakia, and Romania
Purgato, M., Bartucz, M. B., Turrini, G., Compri, B., Prina, E., Patania, F., Kucukozkan, E., Zubachova, A., Mňahončak, M., Čavojská, K., et al. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.113 · Cited by 7 · see citing works
Why Social Work Methodologies Are So Important in Delivering Mental Health and Psychosocial Support Interventions for Refugees in Humanitarian Settings
Ventevogel, P., & Whitney, C. (2022) · Essential clinical social work series · doi:10.1007/978-3-031-12600-0_13 · Cited by 8 · see citing works
Psychological stress self-help interventions for healthcare workers in the context of COVID-19 in China: A randomized controlled trial protocol
Luo, R., Guo, P., Shang, M., Cai, Y., Huang, J., He, Y., Mo, P. K. H., Wu, A. M. S., Xu, R. D., Li, J., et al. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100541 · Cited by 5 · see citing works
Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial
Roos, R., Witteveen, A. B., Ayuso-Mateos, J. L., Barbui, C., Bryant, R. A., Felez-Nobrega, M., Figueiredo, N., Kalisch, R., Haro, J. M., McDaid, D., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05288-5 · Cited by 5 · see citing works
“The first step is a digitalized guided self-help web application (web app) of Doing What Matters in times of stress (DWM), an illustrated self-help book that is part of Self-Help Plus (SH + ) [24].”
Background
Effectiveness of Self-Help Plus in its digital version in reducing anxiety and post-traumatic symptomatology among nursing home workers during the COVID-19 pandemic: secondary analysis of randomised controlled trial data
Purgato, M., Tedeschi, F., Riello, M., Zaccoletti, D., Mediavilla, R., Ayuso‐Mateos, J. L., MacTaggart, D., Barbui, C., & Rusconi, E. (2025) · BMJ Mental Health · doi:10.1136/bmjment-2024-301379 · Cited by 5 · see citing works
“13 SH+ is a low-intensity, guided self-help intervention for managing stress and coping with adversity.”
Effectiveness of a WHO self-help psychological intervention to alleviate stress among healthcare workers in the context of COVID-19 in China: a randomised controlled trial
Li, J., Luo, R., Guo, P., Zhang, D., Mo, P. K. H., Wu, A. M. S., Xin, M., Shang, M., Cai, Y., Wang, X., et al. (2024) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796024000106 · Cited by 6 · see citing works
“SH + was developed by the WHO and collaborators working in mental health and psychosocial support in humanitarian settings (Epping-Jordan et al. , 2016).”
Method
Development of a Polymeric Optical Fiber Sensor for Stress Estimation: A Comparative Analysis Between Physiological Sensors
Gaitán-Padilla, M., Múnera, M., Pontes, M. J., et al. (2024) · IEEE Sensors Journal · doi:10.1109/jsen.2024.3435399 · Cited by 4 · see citing works
“T HE effects of stress on physical and mental health have been evaluated because it has been growing in the statistics of the World Health Organization (WHO), as well as the importance of stress management to avoid diseases related to the autonomous nervous system (ANS) [1].”
Background
The Problem Management Plus psychosocial intervention for distressed and functionally impaired asylum seekers and refugees: the PROSPER feasibility RCT
Dowrick, C. F., Rosala‐Hallas, A., Rawlinson, R., Khan, N., Winrow, E., Chiumento, A., Burnside, G., Aslam, R. W., Billows, L., Eriksson-Lee, M., et al. (2022) · Public Health Research · doi:10.3310/nzxa0081 · Cited by 4 · see citing works
Self-help plus and problem management plus – a qualitative study to assess acceptability and feasibility with rape and GBV survivors in South Africa
Willan, S., Khoza, Z., Mngadi, S., Nöthling, J., Majola, T., Mabhida, M., Gounden, T., Shabalala, M., Zembe, A., Gigaba, G., et al. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100503 · Cited by 3 · see citing works
Combining a guided self-help and brief alcohol intervention to improve mental health and reduce substance use among refugee men in Uganda: a cluster-randomized feasibility trial
Greene, M. C., Andersen, L. S., Leku, M. R., Au, T. M., Akellot, J., Upadhaya, N., Odokonyero, R. F., White, R. G., Ventevogel, P., García‐Moreno, C., et al. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.103 · Cited by 3 · see citing works
Self-citation
Quality of life in unaccompanied young refugees: the role of traumatic events, post-migration stressors and mental distress
Garbade, M., Kappler, S., Eglinsky, J., Kindler, H., Rosner, R., Sachser, C., & Pfeiffer, E. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06975-1 · Cited by 5 · see citing works
“For example, in addition to the dissemination of evidence-based psychological interventions for UYRs (e.g., TF-CBT [57] or “Mein Weg” [58]), further offerings such as low-thresh-old stress management workshops (e.g. Self-Help+ [59]) should be widely provided.”
How to distinguish promotion, prevention and treatment trials in public mental health? Study protocol for the development of the VErona-LUgano Tool (VELUT)
Purgato, M., Albanese, E., Papola, D., Prina, E., Tedeschi, F., Gross, A. L., Sijbrandij, M., Acartürk, C., Annoni, A. M., Silva, M., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-082652 · Cited by 3 · see citing works
“32 Consequently, experimental studies have been conducted to test the efficacy of SH+ in different populations for both prevention 24 33 34 and treatment of mental disorders.”
Background
Beyond effectiveness in eHealth trials: Process evaluation of a stepped-care programme to support healthcare workers with psychological distress (RESPOND-HCWs)
Mediavilla, R., García-Vázquez, B., McGreevy, K. R., Underhill, J., Bayón, C., Bravo‐Ortiz, M. F., Muñoz‐Sanjosé, A., Haro, J. M., Monistrol-Mula, A., Nicaise, P., et al. (2024) · Digital Health · doi:10.1177/20552076241287678 · Cited by 4 · see citing works
“17 It was adapted into a guided self-help web application consisting of ﬁ ve modules that included strategies based on acceptance and commitment therapy, mindfulness techniques and audio recordings that further explained and reinforced the use of the techniques.”
Method
Empirically supported treatments for all: Realizing equitable coverage of care for trauma survivors globally
Patel, A., Jayawickreme, N., Visquerra, V., Dixon, K. E., & Patel, V. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104757 · Cited by 3 · see citing works
Effectiveness of barber-facilitated “Doing What Matters in Times of Stress” intervention among urban literate youths in Western Kenya: A cluster randomised trial
Musotsi, P., Koyiet, P. N., Musimbi, H., Simiyu, K., Chemorei, E., Koskei, P., Evangelidou, S., & Nangukhula, M. (2025) · PLOS Global Public Health · doi:10.1371/journal.pgph.0004712 · Cited by 3 · see citing works
Participants' experiences of mental health during a COVID-19 tailored ACT-based behavioural weight management intervention: a qualitative study
Jones, R. A. P., Richards, R., Palat, R., Hughes, C. A., Hill, A. J., Vincent, A., Griffin, S. J., Ahern, A. L., & Duschinsky, R. (2022) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2022.2123093 · Cited by 3 · see citing works
“…interventions are increasingly being provided remotely as “guided selfhelp”—these are interventions that are predominantly self-directed with periodic support from a trained practitioner (Cavanagh et al., 2014; Epping-Jordan et al., 2016; Purgato et al., 2019; World Health Organization, 2015).”
Background
History of the International Society for the Study of Women's Sexual Health (ISSWSH)
Goldstein, S. W. (2018) · doi:10.1002/9781119266136.ch1 · Cited by 3 · see citing works
A stress-reduction eHealth intervention for healthcare workers in primary care settings: an implementation study
García-Vázquez, B., Muñoz‐Sanjosé, A., Fernández-López, A., Pérez-de-Ciriza, I., Nocete-Navarro, L., Almaraz-Garzón, E., Martín-Palacios, M. T., Novella, B., Bravo‐Ortiz, M. F., Ayuso‐Mateos, J. L., et al. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1600059 · Cited by 4 · see citing works
“They saw DWM as a simple and applicable tool and were particularly keen on some of its elements –namely the modules of personal values and kindness, or mindfulness practices.”
Influential
A systematic review on predictors of treatment outcome among forcibly displaced adults receiving psychological and/or psychosocial interventions
Kurath, J., Keyan, D., Akhtar, A., Martins, W. V., Komenda, B., Maurer, V., Turgut, K., Bryant, R. A., & Morina, N. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102619 · Cited by 4 · see citing works
Parenting on the border: Study protocol for a randomized controlled trial of a trauma-informed, edutainment-enhanced intervention to improve parenting and mental health among migrant and displaced caregivers in Thailand
Sim, A. L., Puffer, E. S., Eagling‐Peche, S., Lwin, K. Z., Meléndez‐Torres, G. J., Vyas, S., Jirapramukpitak, T., Lachman, J. M., Soe, S. T., Moo, T., et al. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100516 · Cited by 3 · see citing works

Authors: Epping‐Jordan, J. E., Harris, R., Brown, F. L., Carswell, K., Foley, C., García‐Moreno, C., Kogan, C., & van Ommeren, M.
Affiliations: WHO Consultant Seattle WA USA
WHO Consultant Melbourne Australia
Harvard University (US)
World Health Organization (CH)
University of Ottawa (CA)
World Health Organization Geneva Switzerland
ORCID: Brown, Felicity L.
Carswell, Kenneth
García‐Moreno, Claudia
Kogan, Cary
Venue: World Psychiatry
Publisher: Wiley
Published: 2016-09-22
Volume: 15
Issue: 3
Pages: 295-296
ISSN: 1723-8617 (ISSN-L)
2051-5545
DOI: 10.1002/wps.20355
PMC: PMC5032500
OpenAlex: W2521400234
Semantic Scholar: 7a22f2c18d4f565343c482db875d6852c431574a
Cited by: 151
References: 8
Citations by year: 2026: 15 · 2025: 31 · 2024: 23 · 2023: 19 · 2022: 25 · 2021: 12 · 2020: 8 · 2019: 6 · 2018: 8 · 2017: 2 · 2016: 2
FWCI: 9.25
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: World Psychiatry (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: World Health Organization
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords: stress management, guided self-help, bibliotherapy, adversity, audio course, transdiagnostic treatment, community violence, armed conflict, displacement, chronic poverty, global mental health, South Sudan conflict, non-communicable diseases, mental health promotion

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Self‐Help Plus ( SH +): a new WHO stress management package

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