February 15, 2017

What Can Multicomponent Interventions Offer in the Treatment of Psychiatric Disorders?

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Anup Sharma, MD, PhD, and Michael E. Thase, MD

University of Pennsylvania, Philadelphia


Multicomponent interventions (MCIs) are treatment strategies that have multiple behavioral components designed to work together to improve outcomes. A component can be defined as any part of an intervention that can be interchanged for the purpose of evaluation. Examples include a smartphone application designed to increase medication adherence, a content topic in a health education group, or any other distinct, consistently delivered part of a behavioral intervention. There has been growing interest in evaluating MCIs in psychiatric disorders. What can MCIs offer in the treatment of our patients?

As an example, a recently published randomized controlled trial (RCT) evaluated a brief behavioral MCI for adults with psychological distress in a conflict-affected region. Delivered by lay health workers, the intervention included empirical strategies for problem solving, behavioral activation, social support, and stress management. The study compared the intervention to enhanced usual care on measures of anxiety and depression. After 3 months of treatment, the intervention group showed significantly lower mean scores for anxiety, depression, post-traumatic stress, and functional impairment. Improvements across multiple symptoms demonstrate the effectiveness of the intervention on transdiagnostic dimensions of psychopathology.

Another example is our recent waitlist-controlled RCT evaluating the addition of a yoga intervention in patients with major depressive disorder following inadequate response to antidepressants. The yoga intervention consisted of a manual-based, group program featuring a breathing-based meditation technique called Sudarshan Kriya yoga (SKY), which includes a series of sequential breathing exercises that bring practitioners into a restful meditative state. During the first study phase, participants completed a program that featured SKY, yoga postures, sitting meditation, and stress education. During the second phase, participants attended weekly SKY follow-up sessions and were asked to complete a home practice version of SKY. After 2 months, participants receiving the SKY intervention demonstrated significant improvements in depression and anxiety compared to the waitlist control group.

These studies highlight the potential value of MCIs in the treatment of psychiatric disorders. Among the advantages of these interventions is the ability to complement existing psychopharmacologic treatments, target multiple symptom domains, and provide low-cost interventions in a group environment. Challenges in evaluating these interventions include designing adequate control interventions and isolating the impact of different components on treatment response. Different strategies are available to systematically evaluate individual components of a MCI for the purpose of maximizing effectiveness of the intervention.

In conclusion, MCIs offer unique advantages for patients with psychiatric disorders. However, additional research is needed to properly evaluate these interventions, especially in the context of standard care. This topic provides an open and exciting area for investigation.

Financial disclosure:Dr Sharma has no relevant personal financial relationships to report. Dr Thase has received grants from Agency for Healthcare Research and Quality, Alkermes, Forest, National Institute of Mental Health, Otsuka, PharmaNeuroboost, and Roche and has acted as an advisor or consultant for Alkermes, AstraZeneca, Bristol-Myers Squibb, Cerecor, Eli Lilly, Forest, Gerson Lehman Group, GlaxoSmithKline, Guidepoint Global, Lundbeck, MedAvante, Merck, Neuronetics, Novartis, Ortho-McNeil, Otsuka, Pamlab, Pfizer, Shire, Sunovion, and Takeda.​

Category: Anxiety , Depression
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