Therapist Training on TIMBER and Policy Implications

  • Basant Pradhan
  • Narsimha R. Pinninti
  • Shanaya Rathod


The ultimate impact of any new treatment modality can be gauged by not only its efficacy in the controlled situations but also by the feasibility parameters such as the accessibility and the ease with which it can be introduced into the real-world situations of its clients. There is about a 15-year lag between academic demonstration of efficacy of a treatment and the real-world uptake of that intervention. That lag is even more for treatments that can seem labor\intensive such as psychotherapeutic interventions. Hence, new therapies should demonstrate that the skill set required is transferable and can be incorporated into the routine processes of the real-life situations cost-effectively.

This chapter provides first a brief overview of the current healthcare systems with focus on the high- and middle-income countries (HMIC) and the low- and middle-income countries (LMIC). Then this chapter describes briefly the role of the wellness component of TIMBER to address the issues of the stress and burn out in the physicians and healthcare staff in order to promote their wellness and improve quality of life. Finally, the therapist training process in TIMBER as well as its care delivery methods (existing and anticipated) in person or via videoconferencing for the clients at the individual, family, organization, national, and international levels is mentioned.


Therapist training Policy implementation Healthcare delivery Early interventions Integrated care Staff wellness 


  1. 1.
    Castillo CHM, Garrafa V, Cunha T, Hellmann F. Access to health care as a human right in international policy: critical reflections and contemporary challenges. Cien Saude Colet. 2017;22(7):2151–60. Scholar
  2. 2.
    de la Maisonneuve C, Oliveira MJ. (2013). A Projection Method for Public Health and Long Term Care Expenditures: OECD Economics Department Working Paper no 1048.
  3. 3.
    Moses H 3rd, Matheson DH, Dorsey ER, George BP, Sadoff D, Yoshimura S. The anatomy of health care in the United States. JAMA. 2013;310(18):1947–63. Scholar
  4. 4.
    Madsen W. Early 20th century conceptualization of health promotion. Health Promot Int. 2017;32(6):1041–7. Scholar
  5. 5.
    WHO. (2008). World Health Organization. The global burden of disease; accessed on 012119.
  6. 6.
    Taylor LA, Tan AX, Coyle CE, Ndumele C, Rogan E, Canavan M, et al. Leveraging the social determinants of health: what works? PLoS One. 2016;11(8):e0160217. Scholar
  7. 7.
    Clark RE, Samnaliev M. Psychosocial treatment in the 21st century. Int J Law Psychiatry. 2005;28(5):532–44.CrossRefGoogle Scholar
  8. 8.
    Richard AA, Shea K. Delineation of self-care and associated concepts. J Nurs Scholarsh. 2011;43(3):255–64. Scholar
  9. 9.
    Lake AJ, Staiger PK. Seeking the views of health professionals on translating chronic disease self-management models into practice. Patient Educ Couns. 2010;79(1):62–8.CrossRefGoogle Scholar
  10. 10.
    Musich S, Wang S, Hawkins K, Klemes A. The impact of personalized preventive care on health care quality, utilization, and expenditures. Popul Health Manag. 2016;19(6):389–97. Scholar
  11. 11.
    Lehman AF a, Steinwachs DM. Evidence-based psychosocial treatment practices in schizophrenia: lessons from the client outcomes research team (PORT) project. J Am Acad Psychoanal Dyn Psychiatry. 2003;31(1):141–54.CrossRefGoogle Scholar
  12. 12.
    Dieleman JL, Baral R, Birger M, Bui AL, Bulchis A, Chapin A, et al. US spending on personal health care and public health, 1996-2013. JAMA. 2016;316(24):2627–46. Scholar
  13. 13.
    Stadhouders N, Koolman X, Tanke M, Maarse H, Jeurissen P. Policy options to contain healthcare costs: a review and classification. Health Policy. 2016;120(5):486–94. Scholar
  14. 14.
    Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591–608. Scholar
  15. 15.
    Obama B. United States health care reform: progress to date and next steps. JAMA. 2016;316(5):525–32. Scholar
  16. 16.
    Seth P, Scholl L, Rudd RA. (2018). Overdose deaths involving opioids, Cocaine, and Psychostimulants - United States, 2015-2016.Google Scholar
  17. 17.
    Stuckler D, Reeves A, Loopstra R, Karanikolos M, McKee M. Austerity and health: the impact in the UK and Europe. Eur J Pub Health. 2017;27(suppl_4):18–21. Scholar
  18. 18.
    Riumallo-Herl C, Basu S, Stuckler D, Courtin E, Avendano M. Job loss, wealth and depression during the Great Recession in the USA and Europe. Int J Epidemiol. 2014;43(5):1508–17. Scholar
  19. 19.
    Thekiso TB, Heron EA, Masood B, Murphy M, McLoughlin DM, Kennedy N. Mauling of the "Celtic Tiger": clinical characteristics and outcome of first-episode depression secondary to the economic recession in Ireland. J Affect Disord. 2013;151(2):455–60. Scholar
  20. 20.
    Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological treatments for the world: lessons from low- and middle-income countries. Annu Rev Clin Psychol. 2017;13:149–81. Scholar
  21. 21.
    Rathod S, Pinninti N, Irfan N, Gorczynski P, Rathod P. (2017). Mental health Service provision in low and middle income countries. Health Services insight 10. Scholar
  22. 22.
    Patel V, Weobong B, Nadkarni A, Weiss HA, Anand A, Naik S, et al. The effectiveness and cost-effectiveness of lay counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India: PREMIUM study protocol for randomized controlled trials. Trials. 2014;15:101. Scholar
  23. 23.
    Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–58.CrossRefGoogle Scholar
  24. 24.
    National Institute for Care Excellence (NICE). (2019). Psychosis and schizophrenia and overview.
  25. 25.
    Polari A, Lavoie S, Yuen HP, Amminger P, Berger G, Chen E, et al. Clinical trajectories in the ultra-high risk for psychosis population. Schizophr Res. 2018;S0920-9964(18):30044–6. Scholar
  26. 26.
    Murray R. (2012). The schizophrenia commission report. Scholar
  27. 27.
    Rathod S, Kingdon D, Pinninti NR, Turkington D, Pheri P. Cultural Adaptation of CBT for Serious Mental Illness: a guide for training and practice. West Sussex: Blackwell; 2015.CrossRefGoogle Scholar
  28. 28.
    Rathod S, Phiri P, Harris S, Underwood C, Thagadur M, Padmanabi U, Kingdon D. Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophr Res. 2013;143(2-3):319–26. Scholar
  29. 29.
    National Access and Waiting Time Standard (AWTS) (April 2016). NHS England Publications Gateway Reference 04294
  30. 30.
    Ising H, Kraan T, Reitdijk J, et al. Four-year follow-up of cognitive behavioral therapy in persons at ultra-high risk for developing psychosis: the Dutch early detection intervention evaluation (EDIE-NL) trial. Schizophr Bull. 2017;43(2):365–74.PubMedGoogle Scholar
  31. 31.
    Mohammed K, Nolan MB, Rajjo T, Shah ND, Prokop LJ, Varkey P, Murad MH. Creating a patient-centered health care delivery system: a systematic review of health care quality from the patient perspective. Am J Med Qual. 2016;31(1):12–21. Scholar
  32. 32.
    O'Connor K, Muller Neff D, Pitman S. Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants. Eur Psychiatry. 2018;53:74–99. Scholar
  33. 33.
    Johnson J, Hall LH, Berzins K, Baker J, Melling K, Thompson C. Mental healthcare staff well-being and burnout: a narrative review of trends, causes, implications, and recommendations for future interventions. Int J Ment Health Nurs. 2018;27(1):20–32. Scholar
  34. 34.
    Pradhan BK, Pinninti NR et al. (2015-2018, Unpublished data): Implementation of the Standardized Meditation Program (StaMP) for stress reduction and enhancing quality of life in health care workers.Google Scholar
  35. 35.
    Campbell H, Hotchkiss R, Bradshaw N, Porteous M. Integrated care pathways. BMJ. 1998;316(7125):133–7.CrossRefGoogle Scholar
  36. 36.
    Rathod S, Garner C, Griffiths A, et al. Protocol for a multicentre study to assess feasibility, acceptability, effectiveness and direct costs of TRIumPH (Treatment and Recovery In PsycHosis): integrated care pathway for psychosis. BMJ Open. 2016;6:e012751.CrossRefGoogle Scholar
  37. 37.
    Chapman SA, Blash LK, Mayer K, Spetz J. Emerging roles for peer providers in mental health and substance use disorders. Am J Prev Med. 2018;54(6s3):S267–s274. Scholar
  38. 38.
    Daniels AS, Bergeson S, Myrick KJ. Defining peer roles and status among community health workers and peer support specialists in integrated systems of care. Psychiatr Serv. 2017;68(12):1296–8. Scholar
  39. 39.
    Protecting Access to Medicare Act (PAMA) 2014.
  40. 40.
    National Council for Behavioral Health, 2019. Certified community behavioral health centers.
  41. 41.
    Kunaparaju, S., Pradhan, B.K., and Parikh S (2017): Using video-conferencing to deliver TIMBER psychotherapy for PTSD: A Case Report on an Indian Client. Poster presented in the Annual Meeting of the American Psychiatric Association, San Diego.Google Scholar
  42. 42.
    Pradhan BK, Elman I. (2017-2019, unpublished data). Combining brain stimulation (rTMS) and mindfulness therapy (TIMBER) for chronic PTSD: pilot data on 3 patients.Google Scholar
  43. 43.
    Pradhan BK and Malik S (2019). Comparative efficacy of rTMS alone and in combination with EEG-biofeedback guided mindfulness therapy (TIMBER) for resistant depression: a pilot study. Annual conference of the Philadelphia Psychiatric Society.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Basant Pradhan
    • 1
  • Narsimha R. Pinninti
    • 2
  • Shanaya Rathod
    • 3
  1. 1.Department of PsychiatryCooper University HospitalCamdenUSA
  2. 2.Department of PsychiatryRowan University SOM Department of PsychiatryCherry HillUSA
  3. 3.Antelope HouseSouthern Health NHS Foundation TrustSouthamptonUK

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