Appendix E: Glossary
This provides definitions of a number of terms, based on definitions from related NICE guidelines. The list aims to cover the most commonly used terms and is not intended to be exhaustive.
Active monitoring: an active process of assessment, monitoring symptoms and functioning, advice and support for people with mild common mental health disorders that may spontaneously remit. It involves discussing the presenting problem(s) and any concerns that the person may have about them, providing information about the nature and course of the disorder, arranging a further assessment, normally within 2 weeks, and making contact if the person does not attend follow-up appointments. Also known as 'watchful waiting'.
Applied relaxation: a psychological intervention that focuses on applying muscular relaxation in situations and occasions where the person is or might be anxious. The intervention usually consists of 12 to 15 weekly sessions (fewer if the person recovers sooner, more if clinically required), each lasting 1 hour.
Alcohol dependence: characterised by craving, tolerance, a preoccupation with alcohol and continued drinking in spite of harmful consequences.
Befriending: meeting and talking with someone with a mental health problem usually once a week; this would be provided as an adjunct to any psychological or pharmacological intervention. The befriender may accompany the befriendee on trips to broaden their range of activities and offer practical support with ongoing difficulties.
Behavioural activation: a psychological intervention for depression that aims to identify the effects of behaviour on current symptoms, mood and problem areas. It seeks to reduce symptoms and problematic behaviours through behavioural tasks related to reducing avoidance, activity scheduling, and enhancing positively reinforced behaviours. The intervention usually consists of 16 to 20 sessions over 3 to 4 months.
Behavioural couples therapy: a psychological intervention that aims to help people understand the effects of their interactions on each other as factors in the development and maintenance of symptoms and problems, and to change the nature of the interactions so that the person's mental health problems improve. The intervention should be based on behavioural principles and usually consists of 15 to 20 sessions over 5 to 6 months.
Cognitive behavioural therapy (CBT): a psychological intervention where the person works collaboratively with the therapist to identify the effects of thoughts, beliefs and interpretations on current symptoms, feelings states and problems areas. They learn the skills to identity, monitor and then counteract problematic thoughts, beliefs and interpretations related to the target symptoms or problems, and appropriate coping skills. Duration of treatment varies depending on the disorder and its severity but for people with depression it should be in the range of 16 to 20 sessions over 3 to 4 months; for people with GAD it should usually consist of 12 to 15 weekly sessions (fewer if the person recovers sooner, more if clinically required), each lasting 1 hour.
Collaborative care: in the context of this guideline, a coordinated approach to mental and physical healthcare involving the following elements: case management which is supervised and has support from a senior mental health professional; close collaboration between primary and secondary physical health services and specialist mental health services; a range of interventions consistent with those recommended in this guideline, including patient education, psychological and pharmacological interventions, and medication management; and long-term coordination of care and follow-up.
Computerised cognitive behavioural therapy: a form of cognitive behavioural therapy that is provided via a stand-alone computer-based or web-based programme. It should include an explanation of the CBT model, encourage tasks between sessions, and use thought-challenging and active monitoring of behaviour, thought patterns and outcomes. It should be supported by a trained practitioner who typically provides limited facilitation of the programme and reviews progress and outcome. The intervention typically takes place over 9 to 12 weeks, including follow-up.
Counselling: a short-term supportive approach that aims to help people explore their feelings and problems, and make dynamic changes in their lives and relationships. The intervention usually consists of six to ten sessions over 8 to 12 weeks.
Eye movement desensitisation and reprocessing (EMDR): a psychological intervention for PTSD. During EMDR, the person is asked to concentrate on an image connected to the traumatic event and the related negative emotions, sensations and thoughts, while paying attention to something else, usually the therapist's fingers moving from side to side in front of the person's eyes. After each set of eye movements (about 20 seconds), the person is encouraged to discuss the images and emotions they felt during the eye movements. The process is repeated with a focus on any difficult, persisting memories. Once the person feels less distressed about the image, they are asked to concentrate on it while having a positive thought relating to it. The treatment should normally be 8 to 12 sessions when the PTSD results from a single event. When the trauma is discussed in the treatment session, longer sessions than usual are generally necessary (for example 90 minutes). Treatment should be regular and continuous (usually at least once a week).
Exposure and response prevention (ERP): a psychological intervention used for people with OCD that aims to help people to overcome their need to engage in obsessional and compulsive behaviours. With the support of a practitioner, the person is exposed to whatever makes them anxious, distressed or fearful. Rather than avoiding the situation, or repeating a compulsion, the person is trained in other ways of coping with anxiety, distress or fear. The process is repeated until the person no longer feels this way.
Facilitated self-help: in the context of this guideline, facilitated self-help (also known as guided self-help or bibliotherapy) is defined as a self-administered intervention, which makes use of a range of books or other self-help manuals, and electronic materials based on the principles of CBT and of an appropriate reading age. A trained practitioner typically facilitates the use of this material by introducing it, and reviewing progress and outcomes. The intervention consists of up to six to eight sessions (face-to-face and via telephone) normally taking place over 9 to 12 weeks, including follow-up.
Group-based peer support (self-help) programme: in the context of this guideline, a support (self-help) programme delivered to groups of patients with depression and a shared chronic physical health problem. The focus is on sharing experiences and feelings associated with having a chronic physical health problem. The programme is supported by practitioners who facilitate attendance at the meetings, have knowledge of the patients' chronic physical health problem and its relationship to depression, and review the outcomes of the intervention with the individual patients. The intervention consists typically of one session per week over a period of 8 to 12 weeks.
Harmful drinking: a pattern of alcohol consumption causing health problems directly related to alcohol. This could include psychological problems such as depression, alcohol-related accidents or physical illness such as acute pancreatitis.
Interpersonal therapy (IPT): a psychological intervention that focuses on interpersonal issues. The person works with the therapist to identify the effects of problematic areas related to interpersonal conflicts, role transitions, grief and loss, and social skills, and their effects on current symptoms, feelings states and problems. They seek to reduce symptoms by learning to cope with or resolve such problems or conflicts. The intervention usually consists of 16 to 20 sessions over 3 to 4 months.
Low-intensity interventions: brief psychological interventions with reduced contact with a trained practitioner, where the focus is on a shared definition of the presenting problem, and the practitioner facilitates and supports the use of a range of self-help materials. The role adopted by the practitioner is one of coach or facilitator. Examples include: facilitated and non-facilitated self-help, computerised CBT, physical activity programmes, group-based peer support (self-help) programmes, and psychoeducational groups.
Mindfulness-based cognitive therapy: a group-based skills training programme using techniques drawn from meditation and cognitive therapy designed specifically to prevent depressive relapse or recurrence of depression. Its aim is to enable people to learn to become more aware of bodily sensations, and thoughts and feelings associated with depressive relapse. The intervention usually consists of eight weekly 2-hour sessions and four follow-up sessions in the 12 months after the end of treatment.
Non-facilitated self-help: in the context of this guideline, non-facilitated self-help (also known as pure self-help or bibliotherapy) is defined as a self-administered intervention, which makes use of written or electronic materials based on the principles of CBT and of an appropriate reading age. The intervention usually involves minimal contact with a practitioner (for example an occasional short telephone call of no more than 5 minutes) and includes instructions for the person to work systematically through the materials over a period of at least 6 weeks.
Paraprofessional: a staff member who is trained to deliver a range of specific healthcare interventions, but does not have NHS professional training, such as a psychological wellbeing practitioner.
Physical activity programme: in the context of this guideline, physical activity programmes are defined as structured and group-based (with support from a competent practitioner) and consist typically of three sessions per week of moderate duration (24 minutes to 1 hour) over 10 to 14 weeks (average 12 weeks).
Psychoeducation: the provision of information and advice about a disorder and its treatment. It usually involves an explanatory model of the symptoms and advice on how to cope with or overcome the difficulties a person may experience. It is usually of brief duration, instigated by a healthcare professional, and supported by the use of written materials.
Psychoeducational groups: a psychosocial group-based intervention based on the principles of CBT that has an interactive design and encourages observational learning. It may include presentations and self-help manuals. It is conducted by trained practitioners, with a ratio of one therapist to about 12 participants and usually consists of six weekly 2-hour sessions.
Somatic symptoms: physical symptoms of common mental health disorders, which form part of the cluster of symptoms that are necessary for achieving a diagnosis. They may include palpitations or muscular tension in an anxiety disorder or lethargy and sleep disturbance in depression. In some cases they may be the main symptom with which a person first presents; they do not constitute a separate diagnosis and should be distinguished from somatoform disorders and medically unexplained symptoms.
Short-term psychodynamic psychotherapy: a psychological intervention where the therapist and person explore and gain insight into conflicts and how these are represented in current situations and relationships including the therapeutic relationship. Therapy is non-directive and recipients are not taught specific skills (for example, thought monitoring, re-evaluating, and problem solving.) The intervention usually consists of 16 to 20 sessions over 4 to 6 months.
Severity: see the section on 'assessing severity of common mental health disorders' below.
Trauma-focused CBT: a type of CBT specifically developed for people with PTSD that focuses on memories of trauma and negative thoughts and behaviours associated with such memories. The structure and content of the intervention are based on CBT principles with an explicit focus on the traumatic event that led to the disorder. The intervention normally consists of 8 to 12 sessions when the PTSD results from a single event. When the trauma is discussed in the treatment session, longer sessions than usual are generally necessary (for example 90 minutes). Treatment should be regular and continuous (usually at least once a week).
Assessing severity of common mental health disorders: definitions
Assessing the severity of common mental health disorders is determined by three factors: symptom severity, duration of symptoms and associated functional impairment (for example, impairment of vocational, educational, social or other functioning).
Mild generally refers to relatively few core symptoms (although sufficient to achieve a diagnosis), a limited duration and little impact on day-to-day functioning.
Moderate refers to the presence of all core symptoms of the disorder plus several other related symptoms, duration beyond that required by minimum diagnostic criteria, and a clear impact on functioning.
Severe refers to the presence of most or all symptoms of the disorder, often of long duration and with very marked impact on functioning (for example, an inability to participate in work-related activities and withdrawal from interpersonal activities).
Persistent subthreshold refers to symptoms and associated functional impairment that do not meet full diagnostic criteria but have a substantial impact on a person's life, and which are present for a significant period of time (usually no less than 6 months and up to several years).