“If there is a tension about something, I can solve it”: A qualitative investigation of change processes in a trial of brief problem‐solving interventions for common adolescent mental health problems in India
Open accessAbstract
Objectives: There is limited understanding of change processes and long‐term effects of low‐intensity psychosocial interventions. We investigated these aspects in two brief problem‐solving intervention formats for adolescents with elevated mental health symptoms and associated distress/impairment. Methods: This qualitative study was nested within a school‐based randomized controlled trial in New Delhi, India, which compared two problem‐solving intervention formats: a lay counsellor‐led format supported by printed materials (intervention arm) and printed problem‐solving materials alone (“bibliotherapy” control arm). A total of 32 participants, ranging in age from 14 to 20 years (mean = 16.4 years, SD = 1.9) and comprising 21 males and 11 females, were interviewed across both trial arms at 12‐month follow‐up. Results: Five themes were derived using thematic framework analysis. The “impacts on symptoms and functioning” theme described symptomatic improvements and functional gains. “Processes underlying problem solving” reflected changes in positive beliefs, attitudes and emotions when confronted with problems, and the use of a more effective problem‐solving coping style. “Experiences of problem‐solving materials” covered benefits (e.g. access to relatable stories and readymade solutions) and limitations (e.g. diminishing use over time) of printed problem‐solving handouts. “Role of supporting figures” accounted for the facilitating roles played by counsellors and trusted others. There were also accounts of researchers functioning as de facto counsellors in the bibliotherapy arm. “Recommended modifications for intervention delivery” included more flexible and private ways to access the interventions, greater personalization of the counselling process, more engaging and relevant supporting materials, and suggestions for widening access to the interventions in schools and community settings. Conclusions: We infer from our qualitative analysis that changes in problem‐solving style and problem orientation underpinned long‐term symptomatic and functional improvements. Participants in the counsellor‐led intervention appeared better able to sustain the use of problem‐solving skills and generalize this approach beyond the original presenting problems. We attribute the differences between arms to the influence of direct advice and supportive interactions with counsellors. Practice implications are discussed.
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Previous research provides confidence that brief interventions can help reduce mental health difficulties in children.
“Previous research also provides confidence that brief interventions can help reduce mental health difficulties in children (Malik et al., 2022).”
From Intervention for school anxiety and absenteeism in children (ISAAC): Co-designing a brief parent-focused intervention for emotionally-based school avoidance. (2024) · cites this paper as Malik et al., 2022
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McDonald, B., Michelson, D., & Lester, K. J. (2024) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231222648 · Cited by 9 · see citing works
“Coaching sessions to last 20 – 30 minutes Previous research also provides con fi dence that brief interventions can help reduce mental health dif fi culties in children (Malik et al., 2022).”
BackgroundSelf-citation
- Authors
- Malik, K., Parikh, R., Sahu, R., Sudhir, P., Fairburn, C. G., Patel, V., & Michelson, D.
- Affiliations
- Sangath (IN)
- Program for Appropriate Technology in Health (IN)
- National Institute of Mental Health and Neurosciences (IN)
- University of Oxford (GB)
- Harvard University (US)
- University of Sussex (GB)
- Corresponding author
- Michelson, Daniel
- ORCID
- Venue
- Psychology and Psychotherapy: Theory, Research and Practice
- Publisher
- Wiley
- Published
- 2022-11-09
- Volume
- 96
- Issue
- 1
- Pages
- 189-208
- ISSN
- 1476-0835 (ISSN-L)
- 2044-8341
- PMC
- PMC10099760
- OpenAlex
- W4308644802
- Cited by
- 7
- References
- 12
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 3 · 2022: 1
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychology and Psychotherapy Theory Research and Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Wellcome Trust (106919/Z/15/Z)
- Topics
- Health Sciences › Health Professions › Speech and Hearing › Problem Solving Skills Development
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- problem-solving intervention, adolescent mental health, change processes, bibliotherapy, school-based mental health services, problem orientation, long-term intervention effects, India
- MeSH terms
- Adolescent, Adult, Mental Disorders, Counseling, Female, Humans, India, Male, Mental Health, Problem Solving, Young Adult
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