Treatment-specific elements of psychosocial interventions delivered by non-specialist providers for the treatment of common mental disorders: a three-tiered taxonomy of active elements

Treatment-specific elements of psychosocial interventions delivered by non-specialist providers for the treatment of common mental disorders: a three-tiered taxonomy of active elements | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Treatment-specific elements of psychosocial interventions delivered by non-specialist providers for the treatment of common mental disorders: a three-tiered taxonomy of active elements Davide Papola, Federica Patania, Gloria A. Pedersen, Anushka Patel, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8881927/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Over the past decades research into psychotherapy has disproportionately focused on treatment outcomes while largely neglecting the underlying processes. Consequently, the understanding of how, for whom, and under what conditions psychotherapies are effective remains limited. To achieve this, it is essential to identify the efficacy of the individual, treatment-specific elements embedded in psychological and social interventions. This requires these elements to be identified, defined, and classified. We developed a taxonomy of treatment-specific elements of psychosocial interventions delivered by non-specialist providers for common mental disorders (depression, anxiety, related somatic complaints). We systematically reviewed 11 evidence-based intervention manuals and coded their treatment-specific elements. The resulting three-tiered taxonomy comprises 39 techniques, organized into nine components, and further grouped into five overarching families. Each element was assigned an intensity score to distinguish between core and peripheral elements. All manuals (100%) included “psychoeducation” and some form of “cognitive reframing”, particularly strategies that assist clients in linking thoughts, emotions, and behaviors. “Problem management” and “relaxation” were also widely represented, as were techniques to “strengthen social support” (73%). “Interpersonal focus” (64%) and “behavioral activation” (45%) were moderately present, while “acceptance and mindfulness” and “emotion regulation” appeared less frequently (27%). Taxonomies, particularly those based on transdiagnostic frameworks, help move beyond one-size-fits-all approaches in psychotherapy research and practice. Taxonomies are foundational to predicting how individuals with specific characteristics will respond to the active elements embedded within therapy protocols. The proposed taxonomy provides a basis for linking qualitative and quantitative research, which is instrumental to personalized care in poor-resource settings. Psychiatry Psychology psychotherapy task-sharing active elements taxonomy depression anxiety Figures Figure 1 Figure 2 Introduction Depression and anxiety account for the most significant part of the global burden of mental health disease and are associated with personal suffering, decreased quality of life, and high economic burden for society at large (Patel et al., 2018 ). Depression and anxiety share a high degree of comorbidity, and they are usually grouped under the umbrella term of “common mental disorders” (CMD) (Goldberg, 1994 ; Kessler et al., 2015 ). Despite the availability of effective treatments, only a minority of people with CMD receive adequate treatment, especially in poor-resource settings (Kohn et al., 2004 ). Reasons accounting for such a treatment gap include the high costs associated with treatment (Qin & Hsieh, 2020 ), perceived social stigma that reduces help-seeking (Evans et al., 2024 ), and the great shortage and inequitable distribution of specialized mental health care personnel, both in high- and low-resource settings (Patel et al., 2023 ). Although modifications to delivery formats, such as task-sharing and digital delivery, have increased accessibility while maintaining efficacy (Papola, Ostuzzi, et al., 2023 ; Singla et al., 2025 ), and streamlined protocols have reduced treatment duration, making psychosocial interventions more acceptable (Kvale et al., 2018 ), the mechanism of action of the intervention and the predictors of response to the intervention, which are key to personalized medicine, are still not fully understood. This is in part due to the literature on randomized controlled trials (RCTs) informing on the efficacy of psychosocial interventions is disjointed and inconsistent, resulting in an “archipelago” of dozens, if not hundreds, of different psychosocial interventions tested in trials comparing a single intervention to a no-intervention comparison for a single disorder. Furthermore, these interventions are complex, multi-element packages of common factors and treatment-specific elements (i.e., procedural techniques unique to a specific treatment) (Mulder et al., 2017 ), resulting in a “one-size-fits-all” approach for individuals with diagnosed disorders. To elucidate the efficacy of treatment specific elements, one approach is dismantling studies to discern the comparative effectiveness of specific treatment elements within complex psychosocial interventions. Although digital technologies now facilitate the realization of such studies (Furukawa et al., 2025 ), organizational and funding challenges remain major barriers to the implementation of dismantling studies on a large scale (Glasziou et al., 2006 ). An alternative strategy to parse the differences between potential mechanisms involves leveraging data sharing and employing advanced research synthesis methodologies to extract new insights from existing data Within meta-analytic techniques, component analyses offer the possibility to disentangle the distinct intervention ingredients within multicomponent interventions and model their associations between/across treatment outcomes. Component analyses thereby allow the identification of beneficial or, conversely, detrimental elements that would otherwise remain confounded within a single therapeutic protocol (Petropoulou et al., 2021 ). Recent component analysis findings are paradigmatic in this respect, highlighting behavioral activation and interoceptive exposure as the most efficacious psychotherapy components for depression and panic disorder, respectively (Furukawa et al., 2021 ; Pompoli et al., 2018 ). Furukawa and colleagues have pioneered a methodology studying digital CBT interventions for depression, implementing a statistical model that allows for the computation of risks tailored to the type of active ingredients received during the therapy and individual participants' characteristics (Furukawa et al., 2021 ). However, this scientific research did not dismantle intervention protocols using a reproducible methodology. A key assumption for approximating causal inference is that interventions are dismantled systematically. In other words, all components of the intervention should be described in terms of their intended targets, with the corresponding activities stated. Developing reliable and trustworthy taxonomies is an essential preliminary step to making information on treatment-specific elements available for analysis according to the most recent advancements in evidence synthesis, such as component analyses using individual participant data. This manuscript describes the process of building an updated taxonomy for psychosocial interventions to treat anxiety and depression delivered by non-specialist providers (NSP), specifically conceived and developed for quantitative measurement. Methods Identification and selection of manuals The present paper presents the qualitative phase of a broader project employing a mixed-methods approach to investigate which treatment-specific elements, delivered through task-shared psychosocial interventions, are most effective for individuals suffering from common mental disorders (including depression, anxiety, and related somatic complaints). Additionally, the project aims to assess the influence of participant-level prognostic factors and effect modifiers on intervention outcomes. Following the methodology outlined in the project protocol (Papola, Karyotaki, et al., 2023 ), we first identified RCTs that met a predefined PICO (Population, Intervention, Comparator, Outcome) framework. Subsequently, we retrieved and conducted a qualitative analysis of the manualized protocols for task-shared interventions evaluated within these trials. Study selection and data extraction Four bibliographical databases, MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL), along with the International Clinical Trials Registry Platform, were systematically searched from their inception through March 15, 2023, by two independent researchers to identify RCTs eligible for inclusion. Additionally, the reference lists of systematic reviews concerning psychosocial interventions delivered by NSPs were also screened (Papola et al., 2024 ; Papola et al., 2020 ; Purgato et al., 2018 ; van Ginneken et al., 2021 ). The search strategy combined index terms and free-text keywords related to depression, anxiety, psychological distress, and task-shared mental health interventions, applying filters specific to RCTs (see online supplemental file, appendix A). Two researchers (DP and DC) independently screened the titles, abstracts, and full texts of potentially relevant articles, following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins et al., 2024 ). Studies were eligible for inclusion if they met the following criteria: (a) RCTs comparing a psychosocial intervention with either an inactive control condition or another psychosocial intervention for the treatment of adults diagnosed with common mental disorders (CMDs), defined as depressive disorders (ICD-11 codes: 6A70–6A7Z) and/or anxiety- and fear-related disorders (ICD-11 codes: 6B00–6B06). Diagnosis could be established through a structured clinical interview (e.g., Mini-International Neuropsychiatric Interview) or inferred based on proxy measures such as elevated baseline scores on validated self-report measures assessing psychological distress (e.g., General Health Questionnaire-12), depressive symptoms (e.g., Patient Health Questionnaire-9), or anxiety symptoms (e.g., Beck Anxiety Inventory); (b) the psychosocial intervention must have been delivered by a NSP; (c) interventions could be delivered in various formats, including individual or group-based, face-to-face, or guided self-help modalities. No restrictions were placed on the study setting, allowing for the inclusion of studies conducted in both low- and middle-income countries (LMICs) and high-income countries (HICs). We excluded studies enrolling participants with severe mental disorders (e.g., schizophrenia, bipolar disorder), somatoform disorders, substance use disorders, disorders specifically related to violence or stress (e.g., post-traumatic stress disorder [PTSD]), disorders associated with pregnancy, childbirth, or the puerperium, as well as studies involving participants with suicidal intent or cognitive impairments (e.g., intellectual disability, dementia). Additionally, we excluded trials that tested trauma-focused interventions or employed stepped or collaborative care models. In the second phase, we retrieved the intervention manuals or standard operating procedures associated with the identified trials. Manuals were obtained either through publicly available online sources or by directly contacting the study authors. Development of the Taxonomy of Treatment specific elements We aimed to develop a taxonomy of treatment-specific elements, defined as intervention processes grounded in distinct psychological mechanisms through which a particular intervention is theorized to produce therapeutic benefit (Duncan et al., 2010 ; Fonagy & Clark, 2015 ; Mulder et al., 2017 ; Pedersen et al., 2020 ). These elements were identified as those commonly shared across various task-sharing intervention protocols. We further categorized treatment-specific elements into two hierarchical levels: components and techniques. Components refer to the processes of steps and skills specifically designed to prompt changes in behavior, cognition, or emotion in ways that the client perceives to be desirable. Techniques, on the other hand, are the specific procedures that patients are taught to implement such skills during sessions. For each technique and component identified within a treatment manual, we assigned a score of either one or two, reflecting the degree of emphasis placed on the element, such that higher scores indicated greater emphasis. Elements judged as central to the intervention’s therapeutic intent were assigned two points, while those considered peripheral or supportive were assigned one point. To analyze the intervention manuals and systematically extract active treatment-specific elements, we followed established methodologies for developing taxonomies of practice elements (Chorpita & Daleiden, 2009 ; Chorpita et al., 2005 ; Michie et al., 2013 ; Pedersen et al., 2020 ; Singla et al., 2017 ). We conducted multiple rounds of coding, both collaboratively and independently. Working in pairs, we first generated an initial list of eligible codes by reading the manuals multiple times. This list was then reviewed to identify and eliminate any duplicates or redundancies. Each code was then operationalized by the research team and classified as either a component or a technique. We intentionally restricted the final set of elements to those that appeared consistently across the target literature. This approach was adopted to avoid excessive fragmentation, akin to a “homeopathic dilution”, that would undermine the clinical coherence and interpretability of the identified components and techniques. All codes and intervention manuals were imported into Dedoose , a qualitative data analysis software (Huynh, 2021 ; Salmona M et al., 2019 ). Several rounds of pilot testing were conducted, during which four researchers (DP, FP, GAP, AP) independently coded two or more eligible intervention protocols to evaluate and refine the taxonomy. Intercode Reliability (ICR) was assessed using intraclass correlation coefficients (ICC), as computed within Dedoose . Following each coding round, discrepancies and convergences in coding were discussed among team members, and the taxonomy was revised accordingly. By the final round of ICR, coding reliability reached a high level of agreement (ICC = 0.85–0.96). Subsequently, we sought input on the accuracy of our coding from the original treatment developers (i.e., authors of the intervention protocols and/or the principal investigators of the trials in which the interventions had been evaluated). These individuals, possessing direct expertise in the theoretical foundations and practical implementation of the interventions, were contacted via email and invited to complete a structured survey (a copy of the author survey is available in the supplementary file, appendix B). The purpose of this survey was to assess the coherence and fidelity of our disaggregation of interventions into treatment-specific elements. As a final validation step, a panel of experts in task-sharing psychosocial interventions was invited to review the proposed taxonomy (see Acknowledgements). They provided feedback on the structure of the taxonomy, including whether the distinction between components and techniques was appropriate, and whether there were any redundancies or omissions. Results The systematic search yielded a total of 13,320 records. After removing duplicates and a preliminary screening of titles and abstracts, 240 records were selected for full-text review. Ultimately, 30 RCTs met the inclusion criteria and were incorporated into the systematic review. The PRISMA flow diagram outlining the selection process is provided in the online supplemental file (Appendix C). Detailed information regarding the technical and demographic characteristics of the included trials will be presented in a subsequent publication, as per the overarching study protocol (Papola, Karyotaki, et al., 2023 ). These 30 RCTs collectively evaluated 11 unique psychosocial interventions: Problem Management Plus (PM+) (World Health Organization, 2016b ) (12 RCTs); Self-Help Plus (SH+) (World Health Organization, 2021 ) (3 RCTs); Healthy Activity Program (HAP) (PREMIUM, 2013 ) (3 RCTs); Friendship Bench (FB) (Friendship Bench Zimbabwe, 2015 ) (2 RCTs); Step-by-Step (SbS) (Carswell et al., 2018 ) (3 RCTs); Interpersonal counselling (IPC) (World Health Organization, 2016a ) (2 RCT); Addressing Anxiety and Depression (AAD) (Khan et al., 2003 ) (1 RCT); Antidepressant Skill Workbook (ASW) (Bilsker & Paterson, 2009 ) (1 RCT); Group Support Psychotherapy (GSP) (Nakimuli-Mpungu et al., 2015 ) (1 RCT); Guided Act and Feel (GAF) (Bockting & van Valen, 2015 ) (1 RCT); Psychosocial Counselling (PS) (Jordans et al., 2003 ) (1 RCT). All intervention manuals were available in English (see Table 1 ). Table 1 Description of the intervention manuals Intervention Author Access Description N of RCTs RCTs that tested the intervention Session format, length, and related strategies Problem Management Plus (PM+) World Health Organization Free download at: https://www.who.int/publications/i/item/WHO-MSD-MER-18.5 PM + is a scalable psychosocial intervention designed for people in distress due to adversity, particularly in low-resource settings. It consists of five weekly sessions focusing on practical strategies: stress management, problem-solving, behavioral activation, and strengthening social support. Delivered by trained, non-specialist helpers, PM+ aims to improve coping and emotional well-being, addressing mild-to-moderate mental health concerns in communities affected by stress and hardship. 13 (Acarturk et al., 2024 ; Acarturk, Uygun, Ilkkursun, Yurtbakan, et al., 2022 ; Akhtar et al., 2021 ; Bryant et al., 2022 ; De Graaff et al., 2020 ; de Graaff et al., 2023 ; Jordans et al., 2021 ; Khan et al., 2019 ; Rahman et al., 2016 ; Rahman et al., 2019 ; Sangraula et al., 2020 ; Spaaij et al., 2022 ) Individual and group formats five intervention sessions, 90 minutes each, delivered on a weekly basis (timing adaptable based on client’s needs). Self-Help Plus (SH+) World Health Organization Free download at: https://www.who.int/publications/i/item/9789240035119 SH + is a brief, scalable psychosocial intervention for managing stress in crisis-affected populations. Delivered as a five-session audio program with accompanying materials, it teaches evidence-based techniques like mindfulness and acceptance. Designed for groups and requiring minimal facilitation, SH+ enhances emotional resilience and well-being, making it accessible for individuals in low-resource or high-stress settings, including refugees and communities experiencing adversity. 3 (Acarturk, Uygun, Ilkkursun, Carswell, et al., 2022 ; Purgato et al., 2021 ; Tol et al., 2020 ) Group sessions - no more than 30 people (separated by gender or other characteristics depending on context) five intervention sessions, 90 minutes each. Healthy Activity Program (HAP) Sangath Available by e-mail from the authors HAP is a brief, scalable psychosocial intervention designed for counselling adults with moderate to severe depression. It mainly leverages problem management behavioral activation and strengthening social support to encourage engagement in meaningful and enjoyable activities, helping to improve mood and daily functioning. Delivered by non-specialist health workers, HAP is designed to enhance mental health at the community level in low-resource settings. 3 (Chowdhary et al., 2016 ; Jordans et al., 2019 ; Patel et al., 2017 ) Individual sessions six – eight sessions, 35 minutes each, delivered weekly. Adaptable as needed. Friendship Bench (FB) Friendship Bench Zimbabwe Free download at: https://www.friendshipbenchzimbabwe.org/ The FB programme is a Zimbabwean community-based mental health intervention where trained community health workers (known as “grandmothers”) sit on wooden park “Friendship Benches” set up at primary health care clinics or safe community spaces and provide structured problem-solving to community members who come looking for mental health support or are referred by nurses or other community members. 2 (Chibanda et al., 2016 ; Haas et al., 2023 ) Six weekly sessions of 30 to 45 minutes, including home visits when deemed necessary. Step by Step (SbS) World Health Organization Free access to the web app starting from 2025 SbS is a digital, guided self-help intervention developed by the World Health Organization to support individuals experiencing depression and anxiety. It provides psychoeducation and training in behavioural activation through an illustrated narrative, with additional therapeutic techniques such as stress management, a gratitude exercise, positive self-talk, strengthening social support, and relapse prevention. 6 (Burchert et al., 2024 ; Cuijpers, Heim, Abi Ramia, et al., 2022 ; Cuijpers, Heim, Ramia, et al., 2022 ) Five-session digital intervention through an internet-connected device, with weekly support (e.g., a 15-minute call or message) from trained non-specialist helpers. Interpersonal counselling (IPC) World Health Organization, Myrna Weissman, Helen Verdeli Free download at: https://www.who.int/publications/i/item/WHO-MSD-MER-16.4 Group IPC adapts traditional individual IPT therapy into a simplified version designed for group treatment of depression in a variety of settings. The therapy covers four main problem areas that are common to individual IPT, including grief, disputes/conflict, life changes, and loneliness/isolation. This model teaches that one or more of these problem areas trigger depression. 1 (Bolton et al., 2003 ; Matsuzaka et al., 2017 ) Individual sessions six to eight sessions, 35 minutes each, delivered weekly. Adaptable as needed. Addressing Anxiety and Depression (AAD) Kausar S. Khan, Badar S. Ali, Riffat Moazam Zaman, Sanober Mubeen, Aliya Iqbal Available by e-mail from the authors This manual is based on the training provided to the community women for becoming community-based counsellors. It offers some basic knowledge about mental health, and outlines how some basic skills can be developed to help women deal with their depression. 1 (Ali et al., 2003 ) Individual sessions, eight sessions, delivered weekly. Antidepressant Skill Workbook (ASW) Dan Bilsker, Randy Paterson Free download at: https://www.sfu.ca/carmha/publications/antidepressant-skills-workbook.html ASW is a self-care manual about psychological strategies in managing depression. It provides an overview of depression, explains how it can be effectively managed, and gives a step-by-step guide to changing patterns that trigger depression. This self-care guide shows how to use cognitive and behavioural methods to make changes in thinking and actions that help one to emerge from depression and make it less likely to recur. 1 (Murphy et al., 2020 ) Structured workbook based on CBT principles, with coaching support by a non-specialist provider. Three main modules. Group support psychotherapy (GSP) Etheldreda Nakimuli-Mpungu, Kizito Wamala, James Okello, Raymond Odokonyero, Steve Alderman, Seggane Musisi Available by e-mail from the authors The GSP intervention is a CBT-based protocol in which the group facilitator provides information by conducting psycho-education, encouraging active participation of group members in all therapy activities, and normalizing the group members’ experiences. By sharing their thoughts (self-disclosure), the group members provide positive ideas that strengthen positive feelings and adaptive thoughts. This generates a supportive emotional bond within the group. 1 (Nakimuli-Mpungu et al., 2020 ) Group sessions (10–12 participants per group), eight sessions, two hours each, delivered weekly. Guided Act and Feel (GAF) University of Groningen Available by e-mail from the authors GAF focuses on monitoring daily mood and activities, followed by encouraging users to do pleasurable, mood-independent, pre-planned activities. The program includes psychoeducation about depression and the basic background of behavioural activation, monitoring mood and behaviour or activities, expansion of potential mood-independent pleasurable activities and overcoming difficulties during the process, and getting insight into the effect of avoidance behaviour.. 1 (Arjadi et al., 2018 ) Eight weekly structured digital modules that can be completed in 30 to 45 minutes per module. Lay counsellors give feedback on assignments for each module (approximately 30–60 min per week for each participant) Psychosocial counselling (PC) Mark J.D. Jordans, Wietse A. Tol, Bhogendra Sharma, Mark van Ommeren Available by e-mail from the authors This manual is the adaptation for adults for a psychosocial counseling manual for children living in difficult circumstances. The manual is based on rapport building, assessment of an understanding of the problem, goal setting, problem management, making a plan of action, and termination of counselling. 1 (Markkula et al., 2019 ) Two individual meetings during the first week and weekly individual meetings in weeks two, three, and four. The table format is taken from Pedersen et al., 2020 (Pedersen et al., 2020 ) The final codebook comprised 53 distinct codes, organized into a three-tiered taxonomy of treatment-specific elements. Specifically, the taxonomy included 39 techniques, grouped into 9 components, which were further categorized into five overarching families: psychoeducation, cognitive processes, stress and emotional management, behavioral techniques, and interpersonal relationships and support (Fig. 1). A definition for each element is provided in Table 2 , along with examples taken from the manuals. \ Figure 2 presents a summary of the distribution of the nine components and the 39 techniques across the 11 intervention manuals, listed in descending order of frequency. Orange bars indicate the presence of components and techniques that received at least one point, while superimposed blue bars highlight elements assigned two points, i.e., those deemed central to the intervention's therapeutic model. Psychoeducation Instructions on the delivery of psychoeducation were included in all 11 manuals reviewed (100%), with the majority (10 manuals, 82%) positioning psychoeducation as a central component of the intervention. Typically, psychoeducation is present at the outset of the manuals, but also as new activities are introduced to clarify how the upcoming technique is intended to address the overarching clinical issue. The content generally aims to help patients understand the etiology, symptomatology, and clinical course of CMDs as well as how psychological and pharmacological treatments work. Explanations regarding causative factors are frequently provided, and symptom descriptions are included. In addition, fundamental psychopathological concepts are introduced to facilitate a shared vocabulary between the client and the NSP delivering the intervention. Cognitive processes Elements underpinning cognitive processes, encompassing both second and third-wave cognitive strategies, were ubiquitous across the manuals. Particularly prevalent within the cognitive reframing component was enhancing psychological insight by systematically exploring the “links among emotions, thoughts, and behaviors”, a technique present in all reviewed manuals. Insight-building strategies help clients focus on internal experiences that might otherwise remain fragmented or underacknowledged, thereby facilitating a clearer understanding of the reciprocal influence between cognition and emotional-behavioral responses. A natural extension of this technique, “self-monitoring”, is the second most frequently applied insight-building element. This technique encourages clients to track the interplay between emotional experiences, thoughts, and behaviors over time. NSPs facilitate it through session-based symptom monitoring tools and structured homework review. In this way, learning is reinforced by prompting reflection on how newly adopted behaviors influence mood. “Socratic questioning” encourages reflection and critical thinking to lead to the emergence of new insights. Less frequently employed techniques were explicitly aimed at reinterpreting the meaning of events by evaluating reported thoughts and generating alternative, more adaptive interpretations. These included “imagery techniques”, “decatastrophizing”, and “reappraisal/re-attribution”, which are designed to reduce cognitive distortions and foster more balanced appraisals of stressful situations. The second component of the family includes acceptance and mindfulness (three manuals, 27%), including “self-compassion”, “letting go”, “creating space for thoughts and feelings”, “cognitive defusion”, and mindfulness-based techniques such as “grounding” and “emotional awareness”. Acceptance and mindfulness are described as a unique component, as they are almost always integrated to promote psychological flexibility, emphasizing awareness of internal experiences and strategies to deal with stressors adaptively rather than reactively. Such a component is at the heart of the SH+ manual (World Health Organization, 2021 ). Stress and Emotional Management The Stress and Emotional Management category groups techniques aimed at regulating emotional responses to improve relational engagement. This category is composed of two distinct components, relaxation (eight manuals, 73%) and emotion regulation (three manuals, 27%), each addressing different aspects of stress management. The relaxation component targets the reduction of physiological arousal and the somatic burden commonly associated with chronic stress and anxiety. It comprises three principal techniques: “breathing exercises”, which regulate the autonomic nervous system by primarily activating the parasympathetic response; progressive “muscle relaxation”, which involves the systematic tensing and releasing of muscle groups to alleviate physical tension; and “meditation”, aimed at fostering a state of mental clarity and calm. Among all the manuals reviewed, only PM + and SbS include dedicated modules focused specifically on relaxation and its associated techniques. In other manuals, relaxation is often referenced as a supplementary strategy to enhance the intervention, but its role remains peripheral rather than integral to the core therapeutic processes. Second-wave CBT principles primarily informed the emotion regulation component. One observed technique is “attentional deployment”, which redirects attention away from distressing stimuli. Another, less commonly applied strategy is “response modulation”, which entails modifying the outward expression of emotions to influence emotional experience, for example, through expressive suppression. Behavioral techniques The Behavioral Activation category encompasses actions aimed at increasing fruitful engagement in activities and practical challenges. This category consists of two primary components: behavioral activation and problem management. Problem management, utilized in eight manuals (73%), aims at enhancing individuals’ capacity to address and resolve target problems in everyday life that contribute to the perpetuation of psychological distress. This component employs a structured, step-by-step approach, which includes “listing problems”, “choosing and defining specific problems” to focus on, generation of potential solutions through “brainstorming”, “selecting strategies”, and finally the development of “actionable strategies”. The behavioral activation component, featured in five manuals (45%), operates on the principle that reduced engagement in positive activities contributes to the onset and maintenance of common mental disorders. Techniques include “goal setting”, “scheduling activities”, “graded task assignment”, and “addressing avoidance behaviors”. Interpersonal Relationships and Support The Interpersonal Relationships and Support category groups components and techniques that are used to strengthen social support, enhance communication using interpersonal techniques, and/or develop assertiveness skills to improve relational dynamics. This category comprises two core components: strengthening social support and interpersonal focus. Strengthening social support is the most frequently implemented component within the family and among the most implemented in general (eight manuals, 73%). It emphasizes developing and maintaining supportive social networks through a two-pronged approach. On the one hand, techniques such as “involving a significant other” and, in case of group format, “receiving group feedback” foster a collaborative environment within the therapeutic setting. Conversely, outside the therapeutic setting, “establishing and maintaining effective communication” and “income-generating skills” techniques promote the (re)activation of long-term social connections and promote integration through financial stability, respectively. The interpersonal focus component is implemented in seven of the manuals (64%), and focuses on clients' interpersonal dynamics and communication patterns. Techniques such as “clarification” and “communication analysis” help individuals identify and modify maladaptive interaction styles that contribute to relational difficulties. “Role-playing” may be employed to practice communication in a safe, controlled environment, while the “interpersonal inventory” is a tool that the therapist uses to review the quality of the patient relationships. Finally, “assigning the sick role” may help individuals communicate their needs and limitations more effectively within and outside the therapeutic setting. “Assertive communication” teaches clients how to advocate for themselves by taking an assertive stance. “Acting on personal values” helps individuals to align their actions and decisions with their core beliefs, fostering a sense of autonomy and self-respect. Discussion We conducted a systematic review of RCTs that tested psychosocial interventions delivered by NSP to treat depression, anxiety, and related somatic complaints. We obtained the intervention manuals by searching online or by contacting the trial authors or manual developers directly. We then used qualitative methods to break down these interventions into their treatment-specific elements, which we categorized as techniques and components. Components were subsequently grouped into families. The result of this process is the three-tiered taxonomy presented in the results section. All manuals covered at least psychoeducation and some form of cognitive reframing. These two elements represent the most universally implemented components in the psychosocial intervention manuals delivered by NSP under review. Psychoeducation was consistently present and intensively delivered, underpinning its central role in helping clients understand and manage their conditions. Cognitive reframing was similarly emphasized, particularly through assisting clients in connecting thoughts, emotions, and behaviors. Problem management and relaxation techniques were also well represented. When included, problem management was consistently a central focus of the manual, while relaxation subcomponents, such as breathing exercises and muscle relaxation, were commonly cited but tended to be peripheral to the core of the interventions. Strengthening social support and behavioral activation were moderately present, but when employed, were central components of the manual. In contrast, components related to third-wave CBT strategies, such as acceptance techniques, emotion regulation, and mindfulness practices were less frequently included. Finally, interpersonal techniques were often brought about by manuals but seldom represented the core of the therapy. Our work builds on previous taxonomies. In their investigation, Singla et al. identified 18 elements and 12 in-session techniques, which were not specifically attributed to a corresponding element (Singla et al., 2017 ). Following Michie et al., who clustered their 93 behavior change techniques into 16 groups (Michie et al., 2013 ), we decided to nest layers from the more specific (techniques) to the more generic (families). We also considered the “distillation and matching model” proposed by Chorpita, which involves factoring or “distilling” key components from multiple interventions so that they can be “matched” to individual clients based on demographic and contextual factors, with the aim of achieving a successful therapy outcome (Chorpita et al., 2005 ). While these experiments offer viable methods to achieve precise and replicable results, how the “successful outcome” of therapy should be intended and measured remains a question yet to be fully answered. What if more than one match occurs between the client’s demographic characteristics and his specific mental health problem? What if there were not only beneficial matches but also detrimental ones? These more specific questions related to the beneficial (or detrimental) effect of components tailored to the particular characteristics of trial participants have now started to be answered thanks to new advances in research methodology and data computing (Furukawa et al., 2021 ; Furukawa et al., 2025 ). Our taxonomy aligns with this progress, as it was specifically designed to support quantitative analyses. To this end, our taxonomy is structured into three hierarchical levels of increasing depth and specificity: the “family” level, the “component” level, and the “technique” level. This structure enables the level of component analysis to be adapted to the granularity of the available data. For example, when large datasets are available, more detailed analyses can be conducted at the technique level; conversely, when data is limited, broader yet still informative analyses can be carried out at the family level. By disentangling the efficacy of individual components and matching them with individual participant characteristics, only effective elements are implemented. In contrast, ineffective ones can be stripped off, making a critical step toward treatment personalization in routine practice. We based our taxonomy on treatment-specific elements of task-sharing interventions tested in trials for common mental disorders for clinical, methodological, and feasibility-related reasons. First, task-sharing is a good model for studying treatment-specific factors because treatments are generally short in duration and highly protocolized. Furthermore, therapy is delivered by NSPs who undergo brief training. Second, the demand for mental health treatment is rising due to the vast treatment gap, particularly in resource-poor settings. Developing a taxonomy of specific factors in task-sharing interventions is in line with the World Health Organization's efforts to democratize access to mental healthcare by promoting low-intensity treatment protocols and standardizing the delivery of task-sharing interventions via digital platforms. Such platforms are now also used to train NSPs and guide the assessment of their competencies (Kohrt et al., 2025 ; Patel et al., 2022 ; World Health Organization, 2022 ). Moreover, task-sharing is becoming increasingly relevant in industrialized nations, given the emergence of pockets of poverty where access to professional healthcare is limited (Husain et al., 2024 ; Singla et al., 2025 ); for this reason, we did not limit our search to low- and middle-income countries only, and our results also inform about task-sharing interventions delivered to vulnerable populations living in industrialized nations. Finally, task-shared interventions are often transdiagnostic, meaning they transcend specific diagnostic categories and incorporate a broad range of elements, including emotional regulation, cognitive and behavioral strategies, social components, and emotional awareness training. Working with transdiagnostic interventions is consistent with current trends to interpret mental health issues through the prism of dimensions of psychopathology rather than through discrete diagnostic categories (Patel et al., 2023 ). In formulating the present taxonomy, we adopted a rigorous and reproducible methodology, which included soliciting feedback from the authors of the original trials (some of whom were also the developers of the intervention protocols) regarding their agreement with the classification of intervention elements through an online survey. As a final step, an expert panel of psychological treatment researchers was invited to review the taxonomy before finalization. Consistent with recent calls to move beyond traditional income-based frameworks for contextualizing mental health interventions, we incorporated trials conducted across diverse settings and resource environments (Papola & Patel, 2025 ). Furthermore, we categorised the intensity of each component since a given component may play a central role in one intervention yet be implemented only marginally in another. The development of statistical approaches capable of evaluating component efficacy based not only on their presence but also on their intensity, thus advancing beyond the prevailing “additive model” (Petropoulou et al., 2021 ) employed in component analyses, remains an open area for future research. We hope that this methodological innovation in qualitative research will provide a blueprint for future advances in research synthesis, marking an additional step toward the goal of treatment personalization. Our work has some limitations. First, in accordance with our study protocol (Papola, Karyotaki, et al., 2023 ), the intervention manuals selected for qualitative analysis were identified indirectly. This is because our search strategy was primarily aimed at identifying RCTs evaluating psychosocial interventions rather than the manuals themselves. Some psychosocial intervention manuals may have been excluded if they had not been tested in an RCT. Second, we focused on studies investigating interventions for individuals with common mental health conditions, such as depression or anxiety. We excluded RCTs involving participants with substance use disorders, stress-related disorders, disorders associated with interpersonal violence, or mental or behavioural disorders associated with pregnancy. Consequently, we did not consider known interventions such as the Common Elements Treatment Approach (Murray, Haroz, et al., 2020 ) and the Thinking Healthy Programme (World Health Organization, 2015 ) as these were delivered to survivors of imprisonment, torture, and related traumas (Bolton et al., 2014 ; Weiss et al., 2015 ), victims of intimate partner violence and hazardous alcohol use (Murray, Kane, et al., 2020 ), and women suffering from perinatal depression (Fuhr et al., 2019 ; Rahman et al., 2008 ; Sikander et al., 2019 ). As the overarching project described in the protocol employs a mixed-methods design, both qualitative and quantitative requirements need to be balanced (Papola, Karyotaki, et al., 2023 ). This necessitated the adoption of strict inclusion criteria, resulting in the selection of a homogeneous population, which inevitably may limit the generalizability of the resulting taxonomy. Third, the present investigation did not focus on common factors, i.e., those elements assumed to be universal for the delivery of any effective treatment, regardless of their specific treatment approach (Wampold, 2015 ). A taxonomy for these factors already exists (Pedersen et al., 2020 ), and has been instrumental in the implementation of foundational competency-based training and assessment (Pedersen et al., 2023 ). Fourth, the aforementioned taxonomy by Pedersen et al. classified psychoeducation as a common factor (Pedersen et al., 2020 ). However, Singla et al. classified psychoeducation as an 'in-session technique', which, in the context of the latter publication, can be interpreted as being more specific than common (Singla et al., 2017 ). Lastly, developing taxonomies carries an inherent risk of abstraction, which can result in the nuances between components and their modes of delivery being oversimplified. For example, psychoeducation and problem management (like any other element of the taxonomy) may be conceptualised and implemented in different ways across interventions. Similarly, the construct of social support might encompass a wider range of approaches than those identified in our classification. Even individual techniques may reasonably vary in their delivery depending on the contingencies clients and therapists face in each encounter. Nevertheless, we argue that our taxonomy provides a clear and practical framework that enables NSPs, patients, and other stakeholders to understand and manage the complexity and redundancy of task-shared psychosocial interventions. Conclusion Researcher-controlled testing at first, followed by routine implementation at scale, are the two critical steps to optimize the delivery of evidence-based interventions in routine practice (McGinty et al., 2024 ). However, how this should be put in place in low-resource settings according to a rigorous scientific rationale remains a matter of debate. In this sense, understanding what treatment-specific elements are delivered to patients is crucial. The fact that many different evidence-based psychosocial protocols can be reduced to a smaller set of elements presented in taxonomies can benefit clinical practice in at least two ways: first, because numerous manuals are exploded into a more manageable, independent, and actionable set of elements, maximizing time and resources; second, because taxonomies lay the foundation for quantitative measurement of the efficacy of such elements. Taxonomies are particularly important for psychosocial interventions delivered in settings with limited resources, where the gap in mental health treatment is almost absolute. 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PLoS ONE [Electronic Resource] 16(2):e0246631. https://doi.org/10.1371/journal.pone.0246631 Pompoli A, Furukawa TA, Efthimiou O, Imai H, Tajika A, Salanti G (2018) Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychol Med 48(12):1945–1953. https://doi.org/10.1017/s0033291717003919 PREMIUM (2013) Healthy Activity Program (HAP) . Sangath. Retrieved 4 April from https://www.mhinnovation.net/innovations/healthy-activity-program-hap Purgato M, Carswell K, Tedeschi F, Acarturk C, Anttila M, Au T, Bajbouj M, Baumgartner J, Biondi M, Churchill R, Cuijpers P, Koesters M, Gastaldon C, Ilkkursun Z, Lantta T, Nosè M, Ostuzzi G, Papola D, Popa M, Barbui C (2021) Effectiveness of Self-Help Plus in Preventing Mental Disorders in Refugees and Asylum Seekers in Western Europe: A Multinational Randomized Controlled Trial. Psychother Psychosom 90(6):403–414. https://doi.org/10.1159/000517504 Purgato M, Gastaldon C, Papola D, van Ommeren M, Barbui C, Tol WA (2018) Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Reviews 7(7):Cd011849. https://doi.org/10.1002/14651858.CD011849.pub2 Qin X, Hsieh CR (2020) Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence From China. Inquiry 57:46958020950566. https://doi.org/10.1177/0046958020950566 Rahman A, Hamdani SU, Awan NR, Bryant RA, Dawson KS, Khan MF, Azeemi MM, Akhtar P, Nazir H, Chiumento A, Sijbrandij M, Wang D, Farooq S, van Ommeren M (2016) Effect of a Multicomponent Behavioral Intervention in Adults Impaired by Psychological Distress in a Conflict-Affected Area of Pakistan: A Randomized Clinical Trial. JAMA 316(24):2609–2617. https://doi.org/10.1001/jama.2016.17165 Rahman A, Khan MN, Hamdani SU, Chiumento A, Akhtar P, Nazir H, Nisar A, Masood A, Din IU, Khan NA, Bryant RA, Dawson KS, Sijbrandij M, Wang D, van Ommeren M (2019) Effectiveness of a brief group psychological intervention for women in a post-conflict setting in Pakistan: a single-blind, cluster, randomised controlled trial. Lancet 393(10182):1733–1744. https://doi.org/10.1016/s0140-6736(18)32343-2 Rahman A, Malik A, Sikander S, Roberts C, Creed F (2008) Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372(9642):902–909. https://doi.org/10.1016/S0140-6736(08)61400-2 Salmona M, Lieber E, D K (2019) Qualitative and mixed methods data analysis using Dedoose: A practical approach for research across the social sciences. Sage Sangraula M, Turner EL, Luitel NP, Van THE, Shrestha P, Ghimire R, Bryant R, Marahatta K, Van Ommeren M, Kohrt BA, Jordans MJD (2020) Feasibility of Group Problem Management plus (PM+) to improve mental health and functioning of adults in earthquake-affected communities in Nepal. Epidemiology and Psychiatric Sciences , (no pagination) , Article e130. https://doi.org/https://dx.doi.org/10.1017/S2045796020000414 Sikander S, Ahmad I, Atif N, Zaidi A, Vanobberghen F, Weiss HA, Nisar A, Tabana H, Ain QU, Bibi A, Bilal S, Bibi T, Liaqat R, Sharif M, Zulfiqar S, Fuhr DC, Price LN, Patel V, Rahman A (2019) Delivering the Thinking Healthy Programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan. Lancet Psychiatry 6(2):128–139. https://doi.org/10.1016/s2215-0366(18)30467-x Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V (2017) Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries. Annu Rev Clin Psychol 13:149–181. https://doi.org/10.1146/annurev-clinpsy-032816-045217 Singla DR, Silver RK, Vigod SN, Schoueri-Mychasiw N, Kim JJ, Porte L, Ravitz LM, Schiller P, Lawson CE, Kiss AS, Hollon A, Dennis SD, Berenbaum C-L, Krohn TS, Gibori HA, Charlebois JE, Clark J, Dalfen DM, Davis AK, Meltzer-Brody W, S (2025) Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression: a pragmatic, noninferiority randomized trial. Nat Med 31(4):1214–1224. https://doi.org/10.1038/s41591-024-03482-w Spaaij J, Kiselev N, Berger C, Bryant RA, Cuijpers P, de Graaff AM, Fuhr DC, Hemmo M, McDaid D, Moergeli H et al (2022) Feasibility and acceptability of Problem Management Plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed-method pilot randomized controlled trial [Journal article]. Eur J Psychotraumatology 13(1):2002027. https://doi.org/10.1080/20008198.2021.2002027 Tol WA, Leku MR, Lakin DP, Carswell K, Augustinavicius J, Adaku A, Au TM, Brown FL, Bryant RA, Garcia-Moreno C, Musci RJ, Ventevogel P, White RG, van Ommeren M (2020) Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial. Lancet Global Health 8(2):e254–e263. https://doi.org/10.1016/S2214-109X(19)30504-2 van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Pachya T, Rashidian A, Borghesani L, Henschke A, Chong N, L. Y., Lewin S (2021) Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Reviews 8(8):Cd009149. https://doi.org/10.1002/14651858.CD009149.pub3 Wampold BE (2015) How important are the common factors in psychotherapy? An update. World Psychiatry 14(3):270–277. https://doi.org/10.1002/wps.20238 Weiss WM, Murray LK, Zangana GA, Mahmooth Z, Kaysen D, Dorsey S, Lindgren K, Gross A, Murray SM, Bass JK, Bolton P (2015) Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial. BMC Psychiatry 15:249. https://doi.org/10.1186/s12888-015-0622-7 World Health Organization (2015) Thinking Healthy. A manual for psychological management of perinatal depression . World Health Organization. Retrieved June 5 from https://www.who.int/publications/i/item/WHO-MSD-MER-15.1 World Health Organization (2016a) Group Interpersonal Therapy (IPT) for Depression . Retrieved April 4 from https://www.who.int/publications/i/item/WHO-MSD-MER-16.4 World Health Organization (2016b) Problem management plus (PM+): individual psychological help for adults impaired by distress in communities exposed to adversity . World Health Organization. Retrieved April 4 from https://www.who.int/publications/i/item/problem-management-plus-(-pm-)-individual-psychological-help-for-adults-impaired-by-distress-in-communities-exposed-to-adversity World Health Organization (2021) Self-Help Plus (SH+): a group-based stress management course for adults . World Health Organization. Retrieved April 4 from https://www.who.int/publications/i/item/9789240035119 World Health Organization (2022) EQUIP - Ensuring Quality in Psychological Support . Retrieved October 25 2024 from https://www.who.int/teams/mental-health-and-substance-use/treatment-care/equip-ensuring-quality-in-psychological-support Table 2 Table 2 is available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. Supplementary Files Treatmentspecificelementssupplementarymaterial.docx Table2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8881927","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591914457,"identity":"b34cc03e-aea5-450e-925f-48ac8ba540be","order_by":0,"name":"Davide Papola","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYDCCA0DEA2EyHmCoYGBgAzETiNQCZJ+BacGnB6iFAa6FsQ0mjEcL3/EzhgfeVDDk8c9uPnDg57zDeXwSuQ8YHv7ArUXyTI7BwTlnGIol7hxLONi77XAxm0S6AV6HGRxISzjM28aQ2HAjx+AA77bDiW08x/D7xeD8M6CWfwyJ84FaDv6dQ4yWG8kHDvM2MCRuAGoBMoBa2Nvwa5G88fjAwTnHJIoNgX45LHMsHazlQEIabi185xObP7ypscmTu9188OGbGuvE+c1sjA9/2ODWAgUSCQwSSNwDBDUwgKJOgrCiUTAKRsEoGKEAANK4XXK4QKB8AAAAAElFTkSuQmCC","orcid":"","institution":"WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy","correspondingAuthor":true,"prefix":"","firstName":"Davide","middleName":"","lastName":"Papola","suffix":""},{"id":591914458,"identity":"e589c1b7-71df-4cb7-8e94-f527359f1a91","order_by":1,"name":"Federica Patania","email":"","orcid":"","institution":"WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy","correspondingAuthor":false,"prefix":"","firstName":"Federica","middleName":"","lastName":"Patania","suffix":""},{"id":591914459,"identity":"9f1f6ea1-56e6-406e-8207-751be955c120","order_by":2,"name":"Gloria A. Pedersen","email":"","orcid":"","institution":"Mental Health Program, Partners in Health, Boston, MA, USA","correspondingAuthor":false,"prefix":"","firstName":"Gloria","middleName":"A.","lastName":"Pedersen","suffix":""},{"id":591914460,"identity":"b75dedf0-f408-4fc7-a533-8040db4c5afe","order_by":3,"name":"Anushka Patel","email":"","orcid":"","institution":"Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA","correspondingAuthor":false,"prefix":"","firstName":"Anushka","middleName":"","lastName":"Patel","suffix":""},{"id":591914461,"identity":"719eb54c-db94-4577-82a8-5cf208c4d90b","order_by":4,"name":"Doriana Cristofalo","email":"","orcid":"","institution":"WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy","correspondingAuthor":false,"prefix":"","firstName":"Doriana","middleName":"","lastName":"Cristofalo","suffix":""},{"id":591914462,"identity":"55747429-efda-4047-948e-6378c4db8cf3","order_by":5,"name":"Marianna Purgato","email":"","orcid":"","institution":"WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy","correspondingAuthor":false,"prefix":"","firstName":"Marianna","middleName":"","lastName":"Purgato","suffix":""},{"id":591914463,"identity":"57e69fbb-d6cc-45e0-8047-6899d7130e8f","order_by":6,"name":"Vikram Patel","email":"","orcid":"","institution":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA","correspondingAuthor":false,"prefix":"","firstName":"Vikram","middleName":"","lastName":"Patel","suffix":""},{"id":591914464,"identity":"a846608b-2c3e-4fb6-bf4f-cc719ccd517f","order_by":7,"name":"Corrado Barbui","email":"","orcid":"","institution":"WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy","correspondingAuthor":false,"prefix":"","firstName":"Corrado","middleName":"","lastName":"Barbui","suffix":""}],"badges":[],"createdAt":"2026-02-14 18:15:14","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8881927/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8881927/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102903693,"identity":"3aba4bee-9dda-48ea-b141-bebca2abf427","added_by":"auto","created_at":"2026-02-18 08:42:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1705842,"visible":true,"origin":"","legend":"\u003cp\u003eThe three-tiered taxonomy of treatment-specific elements. From left to right are \"families\", \"components\" and \"techniques\".\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8881927/v1/ed8b5de26834717346b52605.png"},{"id":102903689,"identity":"624df5b3-0ccb-408d-bb0a-7d15d95abafd","added_by":"auto","created_at":"2026-02-18 08:42:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1003296,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the nine components (left) and the 39 techniques grouped by their corresponding component (right), across the eleven intervention manuals, listed in descending order of frequency. Orange bars indicate components and techniques that received at least one point, and superimposed blue bars highlight elements that received two points.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8881927/v1/6a54dd792e2750162dbf0a4d.png"},{"id":103049428,"identity":"ea2df536-c170-44a3-828e-fb541100a291","added_by":"auto","created_at":"2026-02-20 07:41:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3378068,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8881927/v1/92f8e6d2-8b66-4d97-a156-6ebe9489f933.pdf"},{"id":102903690,"identity":"405dd11e-d54d-47bc-b4cd-b1f2aaccd9de","added_by":"auto","created_at":"2026-02-18 08:42:41","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":557264,"visible":true,"origin":"","legend":"","description":"","filename":"Treatmentspecificelementssupplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-8881927/v1/0c52be9ab27ca54db4107fab.docx"},{"id":102964645,"identity":"793149ae-0da7-481e-b0ac-cda6e9f4d2c8","added_by":"auto","created_at":"2026-02-19 04:23:07","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":690550,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8881927/v1/e43eee0d06a2290faab5d942.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eTreatment-specific elements of psychosocial interventions delivered by non-specialist providers for the treatment of common mental disorders: a three-tiered taxonomy of active elements\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDepression and anxiety account for the most significant part of the global burden of mental health disease and are associated with personal suffering, decreased quality of life, and high economic burden for society at large (Patel et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Depression and anxiety share a high degree of comorbidity, and they are usually grouped under the umbrella term of \u0026ldquo;common mental disorders\u0026rdquo; (CMD) (Goldberg, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1994\u003c/span\u003e; Kessler et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the availability of effective treatments, only a minority of people with CMD receive adequate treatment, especially in poor-resource settings (Kohn et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Reasons accounting for such a treatment gap include the high costs associated with treatment (Qin \u0026amp; Hsieh, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), perceived social stigma that reduces help-seeking (Evans et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and the great shortage and inequitable distribution of specialized mental health care personnel, both in high- and low-resource settings (Patel et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Although modifications to delivery formats, such as task-sharing and digital delivery, have increased accessibility while maintaining efficacy (Papola, Ostuzzi, et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Singla et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), and streamlined protocols have reduced treatment duration, making psychosocial interventions more acceptable (Kvale et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), the mechanism of action of the intervention and the predictors of response to the intervention, which are key to personalized medicine, are still not fully understood. This is in part due to the literature on randomized controlled trials (RCTs) informing on the efficacy of psychosocial interventions is disjointed and inconsistent, resulting in an \u0026ldquo;archipelago\u0026rdquo; of dozens, if not hundreds, of different psychosocial interventions tested in trials comparing a single intervention to a no-intervention comparison for a single disorder. Furthermore, these interventions are complex, multi-element packages of common factors and treatment-specific elements (i.e., procedural techniques unique to a specific treatment) (Mulder et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), resulting in a \u0026ldquo;one-size-fits-all\u0026rdquo; approach for individuals with diagnosed disorders.\u003c/p\u003e \u003cp\u003eTo elucidate the efficacy of treatment specific elements, one approach is dismantling studies to discern the comparative effectiveness of specific treatment elements within complex psychosocial interventions. Although digital technologies now facilitate the realization of such studies (Furukawa et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), organizational and funding challenges remain major barriers to the implementation of dismantling studies on a large scale (Glasziou et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). An alternative strategy to parse the differences between potential mechanisms involves leveraging data sharing and employing advanced research synthesis methodologies to extract new insights from existing data Within meta-analytic techniques, component analyses offer the possibility to disentangle the distinct intervention ingredients within multicomponent interventions and model their associations between/across treatment outcomes. Component analyses thereby allow the identification of beneficial or, conversely, detrimental elements that would otherwise remain confounded within a single therapeutic protocol (Petropoulou et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Recent component analysis findings are paradigmatic in this respect, highlighting behavioral activation and interoceptive exposure as the most efficacious psychotherapy components for depression and panic disorder, respectively (Furukawa et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Pompoli et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Furukawa and colleagues have pioneered a methodology studying digital CBT interventions for depression, implementing a statistical model that allows for the computation of risks tailored to the type of active ingredients received during the therapy and individual participants' characteristics (Furukawa et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, this scientific research did not dismantle intervention protocols using a reproducible methodology. A key assumption for approximating causal inference is that interventions are dismantled systematically. In other words, all components of the intervention should be described in terms of their intended targets, with the corresponding activities stated.\u003c/p\u003e \u003cp\u003eDeveloping reliable and trustworthy taxonomies is an essential preliminary step to making information on treatment-specific elements available for analysis according to the most recent advancements in evidence synthesis, such as component analyses using individual participant data. This manuscript describes the process of building an updated taxonomy for psychosocial interventions to treat anxiety and depression delivered by non-specialist providers (NSP), specifically conceived and developed for quantitative measurement.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eIdentification and selection of manuals\u003c/h2\u003e \u003cp\u003eThe present paper presents the qualitative phase of a broader project employing a mixed-methods approach to investigate which treatment-specific elements, delivered through task-shared psychosocial interventions, are most effective for individuals suffering from common mental disorders (including depression, anxiety, and related somatic complaints). Additionally, the project aims to assess the influence of participant-level prognostic factors and effect modifiers on intervention outcomes. Following the methodology outlined in the project protocol (Papola, Karyotaki, et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), we first identified RCTs that met a predefined PICO (Population, Intervention, Comparator, Outcome) framework. Subsequently, we retrieved and conducted a qualitative analysis of the manualized protocols for task-shared interventions evaluated within these trials.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy selection and data extraction\u003c/h3\u003e\n\u003cp\u003eFour bibliographical databases, MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL), along with the International Clinical Trials Registry Platform, were systematically searched from their inception through March 15, 2023, by two independent researchers to identify RCTs eligible for inclusion. Additionally, the reference lists of systematic reviews concerning psychosocial interventions delivered by NSPs were also screened (Papola et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Papola et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Purgato et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; van Ginneken et al., \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The search strategy combined index terms and free-text keywords related to depression, anxiety, psychological distress, and task-shared mental health interventions, applying filters specific to RCTs (see online supplemental file, appendix A). Two researchers (DP and DC) independently screened the titles, abstracts, and full texts of potentially relevant articles, following the recommendations of the \u003cem\u003eCochrane Handbook for Systematic Reviews of Interventions\u003c/em\u003e (Higgins et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies were eligible for inclusion if they met the following criteria: (a) RCTs comparing a psychosocial intervention with either an inactive control condition or another psychosocial intervention for the treatment of adults diagnosed with common mental disorders (CMDs), defined as depressive disorders (ICD-11 codes: 6A70\u0026ndash;6A7Z) and/or anxiety- and fear-related disorders (ICD-11 codes: 6B00\u0026ndash;6B06). Diagnosis could be established through a structured clinical interview (e.g., Mini-International Neuropsychiatric Interview) or inferred based on proxy measures such as elevated baseline scores on validated self-report measures assessing psychological distress (e.g., General Health Questionnaire-12), depressive symptoms (e.g., Patient Health Questionnaire-9), or anxiety symptoms (e.g., Beck Anxiety Inventory); (b) the psychosocial intervention must have been delivered by a NSP; (c) interventions could be delivered in various formats, including individual or group-based, face-to-face, or guided self-help modalities. No restrictions were placed on the study setting, allowing for the inclusion of studies conducted in both low- and middle-income countries (LMICs) and high-income countries (HICs). We excluded studies enrolling participants with severe mental disorders (e.g., schizophrenia, bipolar disorder), somatoform disorders, substance use disorders, disorders specifically related to violence or stress (e.g., post-traumatic stress disorder [PTSD]), disorders associated with pregnancy, childbirth, or the puerperium, as well as studies involving participants with suicidal intent or cognitive impairments (e.g., intellectual disability, dementia). Additionally, we excluded trials that tested trauma-focused interventions or employed stepped or collaborative care models.\u003c/p\u003e \u003cp\u003eIn the second phase, we retrieved the intervention manuals or standard operating procedures associated with the identified trials. Manuals were obtained either through publicly available online sources or by directly contacting the study authors.\u003c/p\u003e\n\u003ch3\u003eDevelopment of the Taxonomy of Treatment specific elements\u003c/h3\u003e\n\u003cp\u003eWe aimed to develop a taxonomy of treatment-specific elements, defined as intervention processes grounded in distinct psychological mechanisms through which a particular intervention is theorized to produce therapeutic benefit (Duncan et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Fonagy \u0026amp; Clark, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Mulder et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Pedersen et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These elements were identified as those commonly shared across various task-sharing intervention protocols. We further categorized treatment-specific elements into two hierarchical levels: components and techniques. Components refer to the processes of steps and skills specifically designed to prompt changes in behavior, cognition, or emotion in ways that the client perceives to be desirable. Techniques, on the other hand, are the specific procedures that patients are taught to implement such skills during sessions. For each technique and component identified within a treatment manual, we assigned a score of either one or two, reflecting the degree of emphasis placed on the element, such that higher scores indicated greater emphasis. Elements judged as central to the intervention\u0026rsquo;s therapeutic intent were assigned two points, while those considered peripheral or supportive were assigned one point.\u003c/p\u003e \u003cp\u003eTo analyze the intervention manuals and systematically extract active treatment-specific elements, we followed established methodologies for developing taxonomies of practice elements (Chorpita \u0026amp; Daleiden, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Chorpita et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Michie et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Pedersen et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Singla et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). We conducted multiple rounds of coding, both collaboratively and independently. Working in pairs, we first generated an initial list of eligible codes by reading the manuals multiple times. This list was then reviewed to identify and eliminate any duplicates or redundancies. Each code was then operationalized by the research team and classified as either a component or a technique. We intentionally restricted the final set of elements to those that appeared consistently across the target literature. This approach was adopted to avoid excessive fragmentation, akin to a \u0026ldquo;homeopathic dilution\u0026rdquo;, that would undermine the clinical coherence and interpretability of the identified components and techniques. All codes and intervention manuals were imported into \u003cem\u003eDedoose\u003c/em\u003e, a qualitative data analysis software (Huynh, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Salmona M et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Several rounds of pilot testing were conducted, during which four researchers (DP, FP, GAP, AP) independently coded two or more eligible intervention protocols to evaluate and refine the taxonomy. Intercode Reliability (ICR) was assessed using intraclass correlation coefficients (ICC), as computed within \u003cem\u003eDedoose\u003c/em\u003e. Following each coding round, discrepancies and convergences in coding were discussed among team members, and the taxonomy was revised accordingly. By the final round of ICR, coding reliability reached a high level of agreement (ICC\u0026thinsp;=\u0026thinsp;0.85\u0026ndash;0.96).\u003c/p\u003e \u003cp\u003eSubsequently, we sought input on the accuracy of our coding from the original treatment developers (i.e., authors of the intervention protocols and/or the principal investigators of the trials in which the interventions had been evaluated). These individuals, possessing direct expertise in the theoretical foundations and practical implementation of the interventions, were contacted via email and invited to complete a structured survey (a copy of the author survey is available in the supplementary file, appendix B). The purpose of this survey was to assess the coherence and fidelity of our disaggregation of interventions into treatment-specific elements. As a final validation step, a panel of experts in task-sharing psychosocial interventions was invited to review the proposed taxonomy (see Acknowledgements). They provided feedback on the structure of the taxonomy, including whether the distinction between components and techniques was appropriate, and whether there were any redundancies or omissions.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe systematic search yielded a total of 13,320 records. After removing duplicates and a preliminary screening of titles and abstracts, 240 records were selected for full-text review. Ultimately, 30 RCTs met the inclusion criteria and were incorporated into the systematic review. The PRISMA flow diagram outlining the selection process is provided in the online supplemental file (Appendix C). Detailed information regarding the technical and demographic characteristics of the included trials will be presented in a subsequent publication, as per the overarching study protocol (Papola, Karyotaki, et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese 30 RCTs collectively evaluated 11 unique psychosocial interventions: Problem Management Plus (PM+) (World Health Organization, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e2016b\u003c/span\u003e) (12 RCTs); Self-Help Plus (SH+) (World Health Organization, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) (3 RCTs); Healthy Activity Program (HAP) (PREMIUM, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) (3 RCTs); Friendship Bench (FB) (Friendship Bench Zimbabwe, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) (2 RCTs); Step-by-Step (SbS) (Carswell et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) (3 RCTs); Interpersonal counselling (IPC) (World Health Organization, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2016a\u003c/span\u003e) (2 RCT); Addressing Anxiety and Depression (AAD) (Khan et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) (1 RCT); Antidepressant Skill Workbook (ASW) (Bilsker \u0026amp; Paterson, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) (1 RCT); Group Support Psychotherapy (GSP) (Nakimuli-Mpungu et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) (1 RCT); Guided Act and Feel (GAF) (Bockting \u0026amp; van Valen, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) (1 RCT); Psychosocial Counselling (PS) (Jordans et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) (1 RCT). All intervention manuals were available in English (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of the intervention manuals\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN of RCTs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRCTs that tested the intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSession format, length, and related strategies\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProblem Management Plus (PM+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFree download at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/WHO-MSD-MER-18.5\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/WHO-MSD-MER-18.5\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePM\u0026thinsp;+\u0026thinsp;is a scalable psychosocial intervention designed for people in distress due to adversity, particularly in low-resource settings. It consists of five weekly sessions focusing on practical strategies: stress management, problem-solving, behavioral activation, and strengthening social support. Delivered by trained, non-specialist helpers, PM+ aims to improve coping and emotional well-being, addressing mild-to-moderate mental health concerns in communities affected by stress and hardship.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Acarturk et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Acarturk, Uygun, Ilkkursun, Yurtbakan, et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Akhtar et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Bryant et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; De Graaff et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; de Graaff et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Jordans et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Khan et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Rahman et al., \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Rahman et al., \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Sangraula et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Spaaij et al., \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual and group formats five intervention sessions, 90 minutes each, delivered on a weekly basis (timing adaptable based on client\u0026rsquo;s needs).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-Help Plus (SH+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFree download at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240035119\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240035119\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSH\u0026thinsp;+\u0026thinsp;is a brief, scalable psychosocial intervention for managing stress in crisis-affected populations. Delivered as a five-session audio program with accompanying materials, it teaches evidence-based techniques like mindfulness and acceptance. Designed for groups and requiring minimal facilitation, SH+ enhances emotional resilience and well-being, making it accessible for individuals in low-resource or high-stress settings, including refugees and communities experiencing adversity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Acarturk, Uygun, Ilkkursun, Carswell, et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Purgato et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tol et al., \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGroup sessions - no more than 30 people (separated by gender or other characteristics depending on context) five intervention sessions, 90 minutes each.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy Activity Program (HAP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSangath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailable by e-mail from the authors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHAP is a brief, scalable psychosocial intervention designed for counselling adults with moderate to severe depression. It mainly leverages problem management behavioral activation and strengthening social support to encourage engagement in meaningful and enjoyable activities, helping to improve mood and daily functioning. Delivered by non-specialist health workers, HAP is designed to enhance mental health at the community level in low-resource settings.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Chowdhary et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Jordans et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Patel et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual sessions six \u0026ndash; eight sessions, 35 minutes each, delivered weekly. Adaptable as needed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriendship Bench (FB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFriendship Bench Zimbabwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFree download at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.friendshipbenchzimbabwe.org/\u003c/span\u003e\u003cspan address=\"https://www.friendshipbenchzimbabwe.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe FB programme is a Zimbabwean community-based mental health intervention where trained community health workers (known as \u0026ldquo;grandmothers\u0026rdquo;) sit on wooden park \u0026ldquo;Friendship Benches\u0026rdquo; set up at primary health care clinics or safe community spaces and provide structured problem-solving to community members who come looking for mental health support or are referred by nurses or other community members.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Chibanda et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Haas et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSix weekly sessions of 30 to 45 minutes, including home visits when deemed necessary.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStep by Step (SbS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFree access to the web app starting from 2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSbS is a digital, guided self-help intervention developed by the World Health Organization to support individuals experiencing depression and anxiety. It provides psychoeducation and training in behavioural activation through an illustrated narrative, with additional therapeutic techniques such as stress management, a gratitude exercise, positive self-talk, strengthening social support, and relapse prevention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Burchert et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Cuijpers, Heim, Abi Ramia, et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Cuijpers, Heim, Ramia, et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFive-session digital intervention through an internet-connected device, with weekly support (e.g., a 15-minute call or message) from trained non-specialist helpers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterpersonal counselling (IPC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorld Health Organization,\u003c/p\u003e \u003cp\u003eMyrna Weissman, Helen Verdeli\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFree download at:\u003c/p\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/WHO-MSD-MER-16.4\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/WHO-MSD-MER-16.4\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup IPC adapts traditional individual IPT therapy into a simplified version designed for group treatment of depression in a variety of settings. The therapy covers four main problem areas that are common to individual IPT, including grief, disputes/conflict, life changes, and loneliness/isolation. This model teaches that one or more of these problem areas trigger depression.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Bolton et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Matsuzaka et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual sessions six to eight sessions, 35 minutes each, delivered weekly. Adaptable as needed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAddressing Anxiety and Depression (AAD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKausar S. Khan,\u003c/p\u003e \u003cp\u003eBadar S. Ali,\u003c/p\u003e \u003cp\u003eRiffat Moazam Zaman,\u003c/p\u003e \u003cp\u003eSanober Mubeen,\u003c/p\u003e \u003cp\u003eAliya Iqbal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailable by e-mail from the authors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThis manual is based on the training provided to the community women for becoming community-based counsellors. It offers some basic knowledge about mental health, and outlines how some basic skills can be developed to help women deal with their depression.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Ali et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2003\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIndividual sessions, eight sessions, delivered weekly.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntidepressant Skill Workbook (ASW)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDan Bilsker,\u003c/p\u003e \u003cp\u003eRandy Paterson\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFree download at:\u003c/p\u003e \u003cp\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sfu.ca/carmha/publications/antidepressant-skills-workbook.html\u003c/span\u003e\u003cspan address=\"https://www.sfu.ca/carmha/publications/antidepressant-skills-workbook.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eASW is a self-care manual about psychological strategies in managing depression. It provides an overview of depression, explains how it can be effectively managed, and gives a step-by-step guide to changing patterns that trigger depression. This self-care guide shows how to use cognitive and behavioural methods to make changes in thinking and actions that help one to emerge from depression and make it less likely to recur.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Murphy et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStructured workbook based on CBT principles, with coaching support by a non-specialist provider. Three main modules.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup support psychotherapy (GSP)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEtheldreda Nakimuli-Mpungu,\u003c/p\u003e \u003cp\u003eKizito Wamala,\u003c/p\u003e \u003cp\u003eJames Okello,\u003c/p\u003e \u003cp\u003eRaymond Odokonyero,\u003c/p\u003e \u003cp\u003eSteve Alderman,\u003c/p\u003e \u003cp\u003eSeggane Musisi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailable by e-mail from the authors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe GSP intervention is a CBT-based protocol in which the group facilitator provides information by conducting psycho-education, encouraging active participation of group members in all therapy activities, and normalizing the group members\u0026rsquo; experiences. By sharing their thoughts (self-disclosure), the group members provide positive ideas that strengthen positive feelings and adaptive thoughts. This generates a supportive emotional bond within the group.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Nakimuli-Mpungu et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGroup sessions (10\u0026ndash;12 participants per group), eight sessions, two hours each, delivered weekly.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuided Act and Feel (GAF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity of Groningen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailable by e-mail from the authors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGAF focuses on monitoring daily mood and activities, followed by encouraging users to do pleasurable, mood-independent, pre-planned activities. The program includes psychoeducation about\u003c/p\u003e \u003cp\u003edepression and the basic background of behavioural activation, monitoring mood and behaviour or activities, expansion of potential mood-independent pleasurable activities and overcoming difficulties during the process, and getting insight into the effect of avoidance behaviour..\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Arjadi et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEight weekly structured digital modules that can be completed in 30 to 45 minutes per module. Lay counsellors give feedback on assignments for each module (approximately 30\u0026ndash;60 min per week for each participant)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychosocial counselling (PC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMark J.D. Jordans, Wietse A. Tol, Bhogendra Sharma, Mark\u003c/p\u003e \u003cp\u003evan Ommeren\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailable by e-mail from the authors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThis manual is the adaptation for adults for a psychosocial counseling manual for children living in difficult circumstances. The manual is based on rapport building, assessment of an understanding of the problem, goal setting, problem management, making a plan of action, and termination of counselling.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(Markkula et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTwo individual meetings during the first week and weekly individual meetings in weeks two, three, and four.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eThe table format is taken from Pedersen et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2020\u003c/span\u003e (Pedersen et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe final codebook comprised 53 distinct codes, organized into a three-tiered taxonomy of treatment-specific elements. Specifically, the taxonomy included 39 techniques, grouped into 9 components, which were further categorized into five overarching families: psychoeducation, cognitive processes, stress and emotional management, behavioral techniques, and interpersonal relationships and support (Fig.\u0026nbsp;1). A definition for each element is provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, along with examples taken from the manuals.\u003c/p\u003e \\ \u003cp\u003eFigure 2 presents a summary of the distribution of the nine components and the 39 techniques across the 11 intervention manuals, listed in descending order of frequency. Orange bars indicate the presence of components and techniques that received at least one point, while superimposed blue bars highlight elements assigned two points, i.e., those deemed central to the intervention's therapeutic model.\u003c/p\u003e\n\u003ch3\u003ePsychoeducation\u003c/h3\u003e\n\u003cp\u003eInstructions on the delivery of psychoeducation were included in all 11 manuals reviewed (100%), with the majority (10 manuals, 82%) positioning psychoeducation as a central component of the intervention. Typically, psychoeducation is present at the outset of the manuals, but also as new activities are introduced to clarify how the upcoming technique is intended to address the overarching clinical issue. The content generally aims to help patients understand the etiology, symptomatology, and clinical course of CMDs as well as how psychological and pharmacological treatments work. Explanations regarding causative factors are frequently provided, and symptom descriptions are included. In addition, fundamental psychopathological concepts are introduced to facilitate a shared vocabulary between the client and the NSP delivering the intervention.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCognitive processes\u003c/h2\u003e \u003cp\u003eElements underpinning cognitive processes, encompassing both second and third-wave cognitive strategies, were ubiquitous across the manuals. Particularly prevalent within the cognitive reframing component was enhancing psychological insight by systematically exploring the \u0026ldquo;links among emotions, thoughts, and behaviors\u0026rdquo;, a technique present in all reviewed manuals. Insight-building strategies help clients focus on internal experiences that might otherwise remain fragmented or underacknowledged, thereby facilitating a clearer understanding of the reciprocal influence between cognition and emotional-behavioral responses. A natural extension of this technique, \u0026ldquo;self-monitoring\u0026rdquo;, is the second most frequently applied insight-building element. This technique encourages clients to track the interplay between emotional experiences, thoughts, and behaviors over time. NSPs facilitate it through session-based symptom monitoring tools and structured homework review. In this way, learning is reinforced by prompting reflection on how newly adopted behaviors influence mood. \u0026ldquo;Socratic questioning\u0026rdquo; encourages reflection and critical thinking to lead to the emergence of new insights. Less frequently employed techniques were explicitly aimed at reinterpreting the meaning of events by evaluating reported thoughts and generating alternative, more adaptive interpretations. These included \u0026ldquo;imagery techniques\u0026rdquo;, \u0026ldquo;decatastrophizing\u0026rdquo;, and \u0026ldquo;reappraisal/re-attribution\u0026rdquo;, which are designed to reduce cognitive distortions and foster more balanced appraisals of stressful situations.\u003c/p\u003e \u003cp\u003eThe second component of the family includes acceptance and mindfulness (three manuals, 27%), including \u0026ldquo;self-compassion\u0026rdquo;, \u0026ldquo;letting go\u0026rdquo;, \u0026ldquo;creating space for thoughts and feelings\u0026rdquo;, \u0026ldquo;cognitive defusion\u0026rdquo;, and mindfulness-based techniques such as \u0026ldquo;grounding\u0026rdquo; and \u0026ldquo;emotional awareness\u0026rdquo;. Acceptance and mindfulness are described as a unique component, as they are almost always integrated to promote psychological flexibility, emphasizing awareness of internal experiences and strategies to deal with stressors adaptively rather than reactively. Such a component is at the heart of the SH+ manual (World Health Organization, \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStress and Emotional Management\u003c/h3\u003e\n\u003cp\u003eThe Stress and Emotional Management category groups techniques aimed at regulating emotional responses to improve relational engagement. This category is composed of two distinct components, relaxation (eight manuals, 73%) and emotion regulation (three manuals, 27%), each addressing different aspects of stress management.\u003c/p\u003e \u003cp\u003eThe relaxation component targets the reduction of physiological arousal and the somatic burden commonly associated with chronic stress and anxiety. It comprises three principal techniques: \u0026ldquo;breathing exercises\u0026rdquo;, which regulate the autonomic nervous system by primarily activating the parasympathetic response; progressive \u0026ldquo;muscle relaxation\u0026rdquo;, which involves the systematic tensing and releasing of muscle groups to alleviate physical tension; and \u0026ldquo;meditation\u0026rdquo;, aimed at fostering a state of mental clarity and calm. Among all the manuals reviewed, only PM\u0026thinsp;+\u0026thinsp;and SbS include dedicated modules focused specifically on relaxation and its associated techniques. In other manuals, relaxation is often referenced as a supplementary strategy to enhance the intervention, but its role remains peripheral rather than integral to the core therapeutic processes.\u003c/p\u003e \u003cp\u003eSecond-wave CBT principles primarily informed the emotion regulation component. One observed technique is \u0026ldquo;attentional deployment\u0026rdquo;, which redirects attention away from distressing stimuli. Another, less commonly applied strategy is \u0026ldquo;response modulation\u0026rdquo;, which entails modifying the outward expression of emotions to influence emotional experience, for example, through expressive suppression.\u003c/p\u003e\n\u003ch3\u003eBehavioral techniques\u003c/h3\u003e\n\u003cp\u003eThe Behavioral Activation category encompasses actions aimed at increasing fruitful engagement in activities and practical challenges. This category consists of two primary components: behavioral activation and problem management.\u003c/p\u003e \u003cp\u003eProblem management, utilized in eight manuals (73%), aims at enhancing individuals\u0026rsquo; capacity to address and resolve target problems in everyday life that contribute to the perpetuation of psychological distress. This component employs a structured, step-by-step approach, which includes \u0026ldquo;listing problems\u0026rdquo;, \u0026ldquo;choosing and defining specific problems\u0026rdquo; to focus on, generation of potential solutions through \u0026ldquo;brainstorming\u0026rdquo;, \u0026ldquo;selecting strategies\u0026rdquo;, and finally the development of \u0026ldquo;actionable strategies\u0026rdquo;.\u003c/p\u003e \u003cp\u003eThe behavioral activation component, featured in five manuals (45%), operates on the principle that reduced engagement in positive activities contributes to the onset and maintenance of common mental disorders. Techniques include \u0026ldquo;goal setting\u0026rdquo;, \u0026ldquo;scheduling activities\u0026rdquo;, \u0026ldquo;graded task assignment\u0026rdquo;, and \u0026ldquo;addressing avoidance behaviors\u0026rdquo;.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eInterpersonal Relationships and Support\u003c/h2\u003e \u003cp\u003eThe Interpersonal Relationships and Support category groups components and techniques that are used to strengthen social support, enhance communication using interpersonal techniques, and/or develop assertiveness skills to improve relational dynamics. This category comprises two core components: strengthening social support and interpersonal focus.\u003c/p\u003e \u003cp\u003eStrengthening social support is the most frequently implemented component within the family and among the most implemented in general (eight manuals, 73%). It emphasizes developing and maintaining supportive social networks through a two-pronged approach. On the one hand, techniques such as \u0026ldquo;involving a significant other\u0026rdquo; and, in case of group format, \u0026ldquo;receiving group feedback\u0026rdquo; foster a collaborative environment within the therapeutic setting. Conversely, outside the therapeutic setting, \u0026ldquo;establishing and maintaining effective communication\u0026rdquo; and \u0026ldquo;income-generating skills\u0026rdquo; techniques promote the (re)activation of long-term social connections and promote integration through financial stability, respectively.\u003c/p\u003e \u003cp\u003eThe interpersonal focus component is implemented in seven of the manuals (64%), and focuses on clients' interpersonal dynamics and communication patterns. Techniques such as \u0026ldquo;clarification\u0026rdquo; and \u0026ldquo;communication analysis\u0026rdquo; help individuals identify and modify maladaptive interaction styles that contribute to relational difficulties. \u0026ldquo;Role-playing\u0026rdquo; may be employed to practice communication in a safe, controlled environment, while the \u0026ldquo;interpersonal inventory\u0026rdquo; is a tool that the therapist uses to review the quality of the patient relationships. Finally, \u0026ldquo;assigning the sick role\u0026rdquo; may help individuals communicate their needs and limitations more effectively within and outside the therapeutic setting. \u0026ldquo;Assertive communication\u0026rdquo; teaches clients how to advocate for themselves by taking an assertive stance. \u0026ldquo;Acting on personal values\u0026rdquo; helps individuals to align their actions and decisions with their core beliefs, fostering a sense of autonomy and self-respect.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe conducted a systematic review of RCTs that tested psychosocial interventions delivered by NSP to treat depression, anxiety, and related somatic complaints. We obtained the intervention manuals by searching online or by contacting the trial authors or manual developers directly. We then used qualitative methods to break down these interventions into their treatment-specific elements, which we categorized as techniques and components. Components were subsequently grouped into families. The result of this process is the three-tiered taxonomy presented in the results section.\u003c/p\u003e \u003cp\u003eAll manuals covered at least psychoeducation and some form of cognitive reframing. These two elements represent the most universally implemented components in the psychosocial intervention manuals delivered by NSP under review. Psychoeducation was consistently present and intensively delivered, underpinning its central role in helping clients understand and manage their conditions. Cognitive reframing was similarly emphasized, particularly through assisting clients in connecting thoughts, emotions, and behaviors. Problem management and relaxation techniques were also well represented. When included, problem management was consistently a central focus of the manual, while relaxation subcomponents, such as breathing exercises and muscle relaxation, were commonly cited but tended to be peripheral to the core of the interventions. Strengthening social support and behavioral activation were moderately present, but when employed, were central components of the manual. In contrast, components related to third-wave CBT strategies, such as acceptance techniques, emotion regulation, and mindfulness practices were less frequently included. Finally, interpersonal techniques were often brought about by manuals but seldom represented the core of the therapy.\u003c/p\u003e \u003cp\u003eOur work builds on previous taxonomies. In their investigation, Singla et al. identified 18 elements and 12 in-session techniques, which were not specifically attributed to a corresponding element (Singla et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Following Michie et al., who clustered their 93 behavior change techniques into 16 groups (Michie et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), we decided to nest layers from the more specific (techniques) to the more generic (families). We also considered the \u0026ldquo;distillation and matching model\u0026rdquo; proposed by Chorpita, which involves factoring or \u0026ldquo;distilling\u0026rdquo; key components from multiple interventions so that they can be \u0026ldquo;matched\u0026rdquo; to individual clients based on demographic and contextual factors, with the aim of achieving a successful therapy outcome (Chorpita et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). While these experiments offer viable methods to achieve precise and replicable results, how the \u0026ldquo;successful outcome\u0026rdquo; of therapy should be intended and measured remains a question yet to be fully answered. What if more than one match occurs between the client\u0026rsquo;s demographic characteristics and his specific mental health problem? What if there were not only beneficial matches but also detrimental ones? These more specific questions related to the beneficial (or detrimental) effect of components tailored to the particular characteristics of trial participants have now started to be answered thanks to new advances in research methodology and data computing (Furukawa et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Furukawa et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Our taxonomy aligns with this progress, as it was specifically designed to support quantitative analyses. To this end, our taxonomy is structured into three hierarchical levels of increasing depth and specificity: the \u0026ldquo;family\u0026rdquo; level, the \u0026ldquo;component\u0026rdquo; level, and the \u0026ldquo;technique\u0026rdquo; level. This structure enables the level of component analysis to be adapted to the granularity of the available data. For example, when large datasets are available, more detailed analyses can be conducted at the technique level; conversely, when data is limited, broader yet still informative analyses can be carried out at the family level. By disentangling the efficacy of individual components and matching them with individual participant characteristics, only effective elements are implemented. In contrast, ineffective ones can be stripped off, making a critical step toward treatment personalization in routine practice.\u003c/p\u003e \u003cp\u003eWe based our taxonomy on treatment-specific elements of task-sharing interventions tested in trials for common mental disorders for clinical, methodological, and feasibility-related reasons. First, task-sharing is a good model for studying treatment-specific factors because treatments are generally short in duration and highly protocolized. Furthermore, therapy is delivered by NSPs who undergo brief training. Second, the demand for mental health treatment is rising due to the vast treatment gap, particularly in resource-poor settings. Developing a taxonomy of specific factors in task-sharing interventions is in line with the World Health Organization's efforts to democratize access to mental healthcare by promoting low-intensity treatment protocols and standardizing the delivery of task-sharing interventions via digital platforms. Such platforms are now also used to train NSPs and guide the assessment of their competencies (Kohrt et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Patel et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; World Health Organization, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Moreover, task-sharing is becoming increasingly relevant in industrialized nations, given the emergence of pockets of poverty where access to professional healthcare is limited (Husain et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Singla et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2025\u003c/span\u003e); for this reason, we did not limit our search to low- and middle-income countries only, and our results also inform about task-sharing interventions delivered to vulnerable populations living in industrialized nations. Finally, task-shared interventions are often transdiagnostic, meaning they transcend specific diagnostic categories and incorporate a broad range of elements, including emotional regulation, cognitive and behavioral strategies, social components, and emotional awareness training. Working with transdiagnostic interventions is consistent with current trends to interpret mental health issues through the prism of dimensions of psychopathology rather than through discrete diagnostic categories (Patel et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn formulating the present taxonomy, we adopted a rigorous and reproducible methodology, which included soliciting feedback from the authors of the original trials (some of whom were also the developers of the intervention protocols) regarding their agreement with the classification of intervention elements through an online survey. As a final step, an expert panel of psychological treatment researchers was invited to review the taxonomy before finalization. Consistent with recent calls to move beyond traditional income-based frameworks for contextualizing mental health interventions, we incorporated trials conducted across diverse settings and resource environments (Papola \u0026amp; Patel, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Furthermore, we categorised the intensity of each component since a given component may play a central role in one intervention yet be implemented only marginally in another. The development of statistical approaches capable of evaluating component efficacy based not only on their presence but also on their intensity, thus advancing beyond the prevailing \u0026ldquo;additive model\u0026rdquo; (Petropoulou et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) employed in component analyses, remains an open area for future research. We hope that this methodological innovation in qualitative research will provide a blueprint for future advances in research synthesis, marking an additional step toward the goal of treatment personalization.\u003c/p\u003e \u003cp\u003eOur work has some limitations. First, in accordance with our study protocol (Papola, Karyotaki, et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), the intervention manuals selected for qualitative analysis were identified indirectly. This is because our search strategy was primarily aimed at identifying RCTs evaluating psychosocial interventions rather than the manuals themselves. Some psychosocial intervention manuals may have been excluded if they had not been tested in an RCT. Second, we focused on studies investigating interventions for individuals with common mental health conditions, such as depression or anxiety. We excluded RCTs involving participants with substance use disorders, stress-related disorders, disorders associated with interpersonal violence, or mental or behavioural disorders associated with pregnancy. Consequently, we did not consider known interventions such as the Common Elements Treatment Approach (Murray, Haroz, et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and the Thinking Healthy Programme (World Health Organization, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) as these were delivered to survivors of imprisonment, torture, and related traumas (Bolton et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Weiss et al., \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), victims of intimate partner violence and hazardous alcohol use (Murray, Kane, et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), and women suffering from perinatal depression (Fuhr et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Rahman et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Sikander et al., \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). As the overarching project described in the protocol employs a mixed-methods design, both qualitative and quantitative requirements need to be balanced (Papola, Karyotaki, et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This necessitated the adoption of strict inclusion criteria, resulting in the selection of a homogeneous population, which inevitably may limit the generalizability of the resulting taxonomy. Third, the present investigation did not focus on common factors, i.e., those elements assumed to be universal for the delivery of any effective treatment, regardless of their specific treatment approach (Wampold, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). A taxonomy for these factors already exists (Pedersen et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), and has been instrumental in the implementation of foundational competency-based training and assessment (Pedersen et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Fourth, the aforementioned taxonomy by Pedersen et al. classified psychoeducation as a common factor (Pedersen et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, Singla et al. classified psychoeducation as an 'in-session technique', which, in the context of the latter publication, can be interpreted as being more specific than common (Singla et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Lastly, developing taxonomies carries an inherent risk of abstraction, which can result in the nuances between components and their modes of delivery being oversimplified. For example, psychoeducation and problem management (like any other element of the taxonomy) may be conceptualised and implemented in different ways across interventions. Similarly, the construct of social support might encompass a wider range of approaches than those identified in our classification. Even individual techniques may reasonably vary in their delivery depending on the contingencies clients and therapists face in each encounter. Nevertheless, we argue that our taxonomy provides a clear and practical framework that enables NSPs, patients, and other stakeholders to understand and manage the complexity and redundancy of task-shared psychosocial interventions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eResearcher-controlled testing at first, followed by routine implementation at scale, are the two critical steps to optimize the delivery of evidence-based interventions in routine practice (McGinty et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, how this should be put in place in low-resource settings according to a rigorous scientific rationale remains a matter of debate. In this sense, understanding what treatment-specific elements are delivered to patients is crucial. The fact that many different evidence-based psychosocial protocols can be reduced to a smaller set of elements presented in taxonomies can benefit clinical practice in at least two ways: first, because numerous manuals are exploded into a more manageable, independent, and actionable set of elements, maximizing time and resources; second, because taxonomies lay the foundation for quantitative measurement of the efficacy of such elements. Taxonomies are particularly important for psychosocial interventions delivered in settings with limited resources, where the gap in mental health treatment is almost absolute.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAcarturk C, Kurt G, İlkkurşun Z, de Graaff AM, Bryant R, Cuijpers P, Fuhr D, McDaid D, Park AL, Sijbrandij M, Ventevogel P, Uygun E (2024) Effectiveness of group problem management plus in distressed Syrian refugees in T\u0026uuml;rkiye: a randomized controlled trial. 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Retrieved April 4 from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/problem-management-plus-(-pm-)-individual-psychological-help-for-adults-impaired-by-distress-in-communities-exposed-to-adversity\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/problem-management-plus-(-pm-)-individual-psychological-help-for-adults-impaired-by-distress-in-communities-exposed-to-adversity\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2021) \u003cem\u003eSelf-Help Plus (SH+): a group-based stress management course for adults\u003c/em\u003e. World Health Organization. Retrieved April 4 from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240035119\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240035119\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2022) \u003cem\u003eEQUIP - Ensuring Quality in Psychological Support\u003c/em\u003e. Retrieved October 25 2024 from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/mental-health-and-substance-use/treatment-care/equip-ensuring-quality-in-psychological-support\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/mental-health-and-substance-use/treatment-care/equip-ensuring-quality-in-psychological-support\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 2","content":"\u003cp\u003eTable 2 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"e657a70e-a7d6-4dfe-8ae1-670e5becaf14","identifier":"10.13039/501100000780","name":"European Commission","awardNumber":"101061648","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"European Commission","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"psychotherapy, task-sharing, active elements, taxonomy, depression, anxiety","lastPublishedDoi":"10.21203/rs.3.rs-8881927/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8881927/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOver the past decades research into psychotherapy has disproportionately focused on treatment outcomes while largely neglecting the underlying processes. Consequently, the understanding of how, for whom, and under what conditions psychotherapies are effective remains limited. To achieve this, it is essential to identify the efficacy of the individual, treatment-specific elements embedded in psychological and social interventions. This requires these elements to be identified, defined, and classified.\u003c/p\u003e \u003cp\u003eWe developed a taxonomy of treatment-specific elements of psychosocial interventions delivered by non-specialist providers for common mental disorders (depression, anxiety, related somatic complaints). We systematically reviewed 11 evidence-based intervention manuals and coded their treatment-specific elements. The resulting three-tiered taxonomy comprises 39 techniques, organized into nine components, and further grouped into five overarching families. Each element was assigned an intensity score to distinguish between core and peripheral elements.\u003c/p\u003e \u003cp\u003eAll manuals (100%) included \u0026ldquo;psychoeducation\u0026rdquo; and some form of \u0026ldquo;cognitive reframing\u0026rdquo;, particularly strategies that assist clients in linking thoughts, emotions, and behaviors. \u0026ldquo;Problem management\u0026rdquo; and \u0026ldquo;relaxation\u0026rdquo; were also widely represented, as were techniques to \u0026ldquo;strengthen social support\u0026rdquo; (73%). \u0026ldquo;Interpersonal focus\u0026rdquo; (64%) and \u0026ldquo;behavioral activation\u0026rdquo; (45%) were moderately present, while \u0026ldquo;acceptance and mindfulness\u0026rdquo; and \u0026ldquo;emotion regulation\u0026rdquo; appeared less frequently (27%).\u003c/p\u003e \u003cp\u003eTaxonomies, particularly those based on transdiagnostic frameworks, help move beyond one-size-fits-all approaches in psychotherapy research and practice. Taxonomies are foundational to predicting how individuals with specific characteristics will respond to the active elements embedded within therapy protocols. The proposed taxonomy provides a basis for linking qualitative and quantitative research, which is instrumental to personalized care in poor-resource settings.\u003c/p\u003e","manuscriptTitle":"Treatment-specific elements of psychosocial interventions delivered by non-specialist providers for the treatment of common mental disorders: a three-tiered taxonomy of active elements","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 08:42:36","doi":"10.21203/rs.3.rs-8881927/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9992d3d7-a5b4-44b6-b743-c9db2ef3bf5e","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":62940321,"name":"Psychiatry"},{"id":62940322,"name":"Psychology"}],"tags":[],"updatedAt":"2026-02-18T08:42:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 08:42:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8881927","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8881927","identity":"rs-8881927","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}