key: cord-0053795-4rfsz1iy authors: Sijbrandij, Marit; Kleiboer, Annet; Farooq, Saeed title: Editorial: Low-Intensity Interventions for Psychiatric Disorders date: 2020-11-25 journal: Front Psychiatry DOI: 10.3389/fpsyt.2020.619871 sha: 74ec7c899b6722cbd4f794963b46cfc0978afd88 doc_id: 53795 cord_uid: 4rfsz1iy nan Essentially, low-intensity interventions are treatments with a low usage of "specialist therapist" time (1) . These include a broad variety of interventions such as group interventions, brief versions of individual therapies (i.e., not more than approximately six sessions), interventions supported by self-help materials or internet-based platforms (1, 2) , or task-shifting interventions that are delivered by non-specialists such as paraprofessionals or lay health workers. The advantages of low intensity interventions are obvious: shorter and less time-intensive treatments are cheaper and easier to integrate into primary and community health care settings, or within stepped care models. This may increase the access to mental health interventions for larger numbers of people in need of mental health care. However, low-intensity treatments also have challenges and disadvantages. For example, relapse rates with low-intensity treatment for anxiety and depression are relatively high (3), it is yet unknown for which patients low-intensity treatments are most suited, and -integrated into a stepped-care system-unsuccessful low-intensity treatment may discourage patients in pursuing a high-intensity treatment. During the past decade, the evidence for low-intensity interventions for psychiatric disorders has been accruing. Global mental health researchers have put the worldwide mental health treatment gap on the scientific agenda, referring to the enormous difference between people in need and the people actually receiving mental health care (4). This gap is highest in low-income settings where resources for providing mental health care are scarce. Alongside to educating higher numbers of mental health professionals, and increasing budget for mental health expenditures, task-shifting is another strategy to increase access to mental health care. Recent randomized controlled trials (RCTs) in low-resource settings such as Pakistan (5) and Kenya (6) have shown positive effects of low-intensity task-shifting strategies in reducing symptoms of depression, anxiety, and posttraumatic stress disorder. Less is known about whether scaling up low-intensity interventions improves access to mental health care, but studies are underway [see (7) ]. Building A specific set of low intensity interventions are the digital and e-mental health interventions. Most of the evaluations of e-mental health programs has been done in high-income settings, but exciting new studies in low-income settings are now appearing along with the increased use of digital media. WHO's Step-by-Step, described by Harper Shehadeh et al., is available in Arabic and English through smartphone, tablet, or computer, and is based on CBT and PST strategies. An uncontrolled pilot evaluation in Lebanon found that over time, symptoms of depression improved in participants, and the content of the intervention itself and the digital delivery mode to be acceptable and feasible. However, there was also significant attrition, predominantly due to lack of motivation and technical problems. This is a common complicating factor when implementing e-mental health interventions. To see which participants drop-out from low-intensity e-health intervention, Kazlauskas et al. investigated predictors to adherence to a brief (1 to 3 h) internet self-help intervention for adjustment disorder in Lithuania, a high-income country but with limited access to mental health interventions. The intervention included body relaxation, mindfulness, time management, and resolving conflicts in interpersonal relationships. The authors found a number of factors to be important in predicting adherence, such as being female, being older, having high expectations and already following regular face-to-face treatment. In addition to task-shifting and digital advances, innovations in content and delivery of low-intensity interventions also found a place in this Research Topic. For example, Kong et al. provided an overview of the use of Tai Chi in regulating emotion, and its potential to be used as a low intensity intervention for depression. Accessible virtual reality (VR) technologies, such as the use of consumer VR glasses, provide interesting new opportunities to scale up VR interventions to larger groups of patients. The first generation of VR interventions were highintensity treatments for anxiety disorders, phobias and PTSD often requiring large installations located in research or treatment centers (8) . Although still in its early stages, Lindner, Hamilton et al. describe how VR could be used to deliver a low-intensity intervention for depression. In a second paper in this Research Topic, Lindner, Miloff et al. describe their uncontrolled pilot study on the effects of a single-session automated low-intensity VR intervention with gaming elements to reduce spider phobia in psychology students. The intervention was well-tolerated, and results were promising. This will, however, require replication in a larger RCT (Lindner, Miloff et al.). In sum, low-intensity interventions are to stay, both in the clinic and in the community. With the current COVID-19 pandemic challenging the mental health systems of countries worldwide, the availability of highly scalable strategies to deliver interventions remotely and/ or digitally to people in need of psychological treatments is as timely as ever. Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review Low intensity CBT interventions: a revolution in mental health care How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study The Lancet Commission on global mental health and sustainable development Effect of a multicomponent behavioral intervention in adults impaired by psychological distress in a conflict-affected area of Pakistan: a randomized clinical trial Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: a randomised clinical trial Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.