Self-Help Plus (SH+) was developed to meet the challenges of delivering evidence-based psychological interventions in hard to access humanitarian settings where the prevalence of psychological distress is high, but service access is limited.
SH+ is based on acceptance and commitment therapy (ACT), a form of cognitive-behavioural therapy with distinct features6. ACT emphasizes learning new ways to accommodate difficult thoughts and feelings – primarily through mindfulness approaches – and guides people to live in a way that is consistent with their values. ACT has been shown to be useful for a range of mental health issues and has been used successfully in a guided self-help format7.
SH+ combines a pre-recorded audio course and illustrated guide designed for low-literacy populations to create a psychosocial intervention that can be delivered with minimal training. The use of multi-media materials delivered by briefly trained facilitators allows delivery to large groups of people in community settings and ensures fidelity to the techniques. Up to 30 people attend a 2 hour session each week for 5 weeks, where course content is delivered using a loudspeaker with facilitators supporting group discussions, demonstrating exercises and ensuring smooth running of the group. An illustrated guide is also provided which summarises key concepts from the course.
The five sessions cover:
- Unhooking from difficult thoughts and feelings
- Acting on values
- Being kind
- Making room for difficult emotions
Each session comprises of:
- Review of concepts and practice of skills from previous sessions
- Introduction of new skills
- Brief group discussions and self-reflection exercises
- Encouragement of daily practice of key skills
The long-term objective is to improve the mental health and functioning of people in humanitarian settings through demonstrating the efficacy of SH+ in randomised controlled trials in at least two different populations. This project –similar to Problem Management Plus and Step by Step aims to enhance the evidence base and availability of psychosocial interventions that are scalable and accessible even when humanitarian access is limited, thus overcoming current barriers to implementation of evidence-based support.