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NT: Some more radical thinkers and writers have suggested of late that the mental health of the planet is being compromised by a scourge of increasingly narcissistic personality styles, fueled by an emphasis on consumption, quick-fix remedies for societal problems and unsustainable political and societal practices. They tend to suggest that society is in greater need of an overhaul than the treatment options that are available for its remediation and that this is more a political project than a psychotherapeutic one. Some suggest that the prevention of which you speak may be better achieved through the implementation of legislative policies that curb a consumption driven economy, place a renewed emphasis on moral education and development and aim at more sustainable approaches to the full range of challenges that the species is facing. What are your thoughts on the above?

AEK: There are indeed many cultural changes (e.g., family life, pressures on infants and toddlers who often are “interviewed” to be accepted to preferred preschools, greater exposure to violence, economic hardship that exacerbates family stress, and no doubt many other cohort factors that influence stress and mental health. They ways in which untoward influences can be delivered have expanded! For example, in yesteryear, bullying often occurred at school, but children had a reprieve once they arrived at home. Not any more, cyberbullying (e.g., Facebook, tweets, web pages) now can be done 24/7 and all of one’s peers can join in. Not only that, but one can bully another person electronically without revealing one’s identity. These and other such influences do increase cultural pressure on daily functioning.

Additionally, assessment of clinical dysfunction is better than ever before, with large-scale national and international studies on the incidence and prevalence of mental illness. Some of that has led to increased awareness and seemingly increased rates of dysfunction (e.g., autism). Finally, disorders themselves are defined differently. We recognize that many disorders are not present or absent but are “spectrum” disorders.

These influences are likely to increase the real, but also the seeming, rates of clinical dysfunction.

Treatment and prevention, psychosocial techniques and policy, are all relevant and needed. There is no need to pit one (policy) versus another (e.g., psychotherapy). Indeed, the portfolio idea is more relevant now than ever before. In relation to psychotherapy, individual therapy is needed but so much more as a way of delivering services. Expanding models of delivery does not mean that we ought to abandon what we have, but it does begin with a different point of departure.

If one begins with the question, “How can we reduce the burden of mental illness in the US (and world-wide)?” this leads to a range of answers. I have focused on a portfolio of delivery models for treatment and prevention. This does not exclude individual psychotherapy. Yet it does make more salient that we are now not reaching the majority of people in need of services. Indeed, arguably our current model of one-to-one, individual therapy is one that cannot do this. The need now is to expand the ways they can be delivered.

 

Background References

Harwood, T.M., & L’Abate, L. (2010). Self-help in mental health: A critical review. New York: Springer.

Kazdin, A.E., & Blase, S.L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21-37.

Kessler, R.C., & Wang, P.S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115-129.

Lester, R.T., Ritvo, P., Mills, E.J., Kariri, A., Karanja, S., Chung, M.H., . . . Plummer, F.A. (2010). Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): A randomised trial. The Lancet, 376, 1838-1845.

Pennebaker, J.W., & Chung, C.K. (2011). Expressive writing and its links to mental and physical health. In H. S. Friedman (Ed.), Oxford handbook of health psychology (pp. xx forthcoming). New York, NY: Oxford University Press.

Weisz, J.R., & Kazdin, A.E. (Eds.). (2010). Evidence-based psychotherapies for children and adolescents (2nd ed.). New York: Guilford Press.

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