Rebooting Psychotherapy Research and Practice to Reduce the Burden of Mental Illness.

Psychological interventions to treat mental health issues have developed remarkably in the past few decades. Yet this progress often neglects a central goal-namely, to reduce the burden of mental illness and related conditions. The need for psychological services is enormous, and only a small proportion of individuals in need actually receive treatment. Individual psychotherapy, the dominant model of treatment delivery, is not likely to be able to meet this need. Despite advances, mental health professionals are not likely to reduce the prevalence, incidence, and burden of mental illness without a major shift in intervention research and clinical practice. A portfolio of models of delivery will be needed. We illustrate various models of delivery to convey opportunities provided by technology, special settings and nontraditional service providers, self-help interventions, and the media. Decreasing the burden of mental illness also will depend on integrating prevention and treatment, developing assessment and a national database for monitoring mental illness and its burdens, considering contextual issues that influence delivery of treatment, and addressing potential tensions within the mental health professions. Finally, opportunities for multidisciplinary collaborations are discussed as key considerations for reducing the burden of mental illness.

Interventions and Models of Their Delivery to Reduce the Burden of Mental Illness: Reply to Commentaries.

Our article in the January issue of Perspectives on Psychological Science (Kazdin & Blase, 2011) recommended developing a portfolio of models to deliver psychotherapeutic interventions with the goals of reaching a larger and more diverse segment of the population in need of mental health services and reducing the burden of mental illness. The commentaries offer several novel extensions to advance the goals. Among the topics raised in the commentaries are the role of moderating influences, the importance of a public health model for intervention research and application, the need to organize and manage our knowledge base and current treatments more effectively, the potential utility of priming-based interventions, the importance of cost measures, and novel applications to extend treatment broadly to veterans in need of services. The commentaries stimulated additional points to address the original goals including the utility of identifying interventions (e.g., lifestyle changes) that can reach many people in need and that can have broad outcome effects on mental and physical health, the importance of "disruptive innovations" (i.e., innovations that qualitatively change the nature of what and how services are delivered) from a business perspective, and the need for improved assessment to track the burden of mental illness in an ongoing way and to evaluate subgroups not being reached with our current interventions.

Self-reported ADHD and adjustment in college: cross-sectional and longitudinal findings.

OBJECTIVE: To examine the association between self-reported ADHD and college adjustment. PARTICIPANTS: Study 1 included nearly 3400 undergraduates attending a public and private university. Study 2 included 846 students who participated during freshman and sophomore year. METHOD: Students completed a web-based survey that assessed diagnostic status and adjustment in multiple domains. RESULTS: Relative to other students, those with self-reported ADHD had lower GPAs and reported more academic concerns, depressive symptoms, social concerns, emotional instability, and substance use. Overall, however, most were making satisfactory adjustments in these domains. Benefits of medication treatment were not found. Freshman year ADHD predicted lower GPA, increased academic concerns and alcohol use, and smoking initiation. CONCLUSION: Students with ADHD struggled relative to peers but most were adjusting reasonably well across multiple domains. Future research should move beyond the use of self-reported diagnosis and more carefully examine the impact of medication treatment in this population.