King's College London

Research portal

“If there is a tension about something, I can solve it”: A qualitative investigation of change processes in a trial of brief problem-solving interventions for common adolescent mental health problems in India

Research output: Contribution to journalArticlepeer-review

Kanika Malik, Rachana Parikh, Rooplata Sahu, Paulomi Sudhir, Christopher Fairburn, Vikram Patel, Daniel Michelson

Original languageEnglish
JournalPsychology and Psychotherapy: Theory, Research and Practice
E-pub ahead of print9 Nov 2022

Bibliographical note

Funding Information: This research was funded by a Wellcome Trust Principal Research Fellowship grant to VP (106919/Z/15/Z), . The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Publisher Copyright: © 2022 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.


King's Authors


Objectives: There is limited understanding of change processes and long-term effects of low-intensity psychosocial interventions. We investigated these aspects in two brief problem-solving intervention formats for adolescents with elevated mental health symptoms and associated distress/impairment. Methods: This qualitative study was nested within a school-based randomized controlled trial in New Delhi, India, which compared two problem-solving intervention formats: a lay counsellor-led format supported by printed materials (intervention arm) and printed problem-solving materials alone (“bibliotherapy” control arm). A total of 32 participants, ranging in age from 14 to 20 years (mean = 16.4 years, SD = 1.9) and comprising 21 males and 11 females, were interviewed across both trial arms at 12-month follow-up. Results: Five themes were derived using thematic framework analysis. The “impacts on symptoms and functioning” theme described symptomatic improvements and functional gains. “Processes underlying problem solving” reflected changes in positive beliefs, attitudes and emotions when confronted with problems, and the use of a more effective problem-solving coping style. “Experiences of problem-solving materials” covered benefits (e.g. access to relatable stories and readymade solutions) and limitations (e.g. diminishing use over time) of printed problem-solving handouts. “Role of supporting figures” accounted for the facilitating roles played by counsellors and trusted others. There were also accounts of researchers functioning as de facto counsellors in the bibliotherapy arm. “Recommended modifications for intervention delivery” included more flexible and private ways to access the interventions, greater personalization of the counselling process, more engaging and relevant supporting materials, and suggestions for widening access to the interventions in schools and community settings. Conclusions: We infer from our qualitative analysis that changes in problem-solving style and problem orientation underpinned long-term symptomatic and functional improvements. Participants in the counsellor-led intervention appeared better able to sustain the use of problem-solving skills and generalize this approach beyond the original presenting problems. We attribute the differences between arms to the influence of direct advice and supportive interactions with counsellors. Practice implications are discussed.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454