Roughly one in five children (aged 5–18) has a diagnosable and treatable mental disorder. But specialist services are overstrained. So in 2017 the government set up a school-based version of NHS Talking Therapies for children falling below the threshold for specialist services. It is called Mental Health Support Teams in schools.

In this chapter, we evaluate this service and show the treatment has the potential to pay for itself within two years. But this depends on wider treatment of behavioural disorders, by such well-known treatments as parent training (e.g. Incredible Years).

Mental illness is common: at least 20 per cent of adults suffer from it at any one time. Depression and anxiety disorders are the most common conditions and they reduce life satisfaction by 0.7 points (out of 10). In the UK the health watchdog NICE recommends that all patients are offered psychological therapy. Until 2008 almost none were, but since then, NHS Talking Therapies (NHSTT) has treated some eight million patients of whom half have recovered during therapy. Many have gone back to work and the service brings more money into the Exchequer in taxes paid (and benefits not paid) to more than cover the original cost of the therapy. This happens within two years of the end of treatment. There are also important reductions in the use of NHS physical healthcare services.

But the service does not cover people suffering from addiction, personality disorder or other severe mental illness. This chapter evaluates provision of psychological therapy on a large scale to those people. It concludes that this provision too would pay for itself within two years.

This chapter outlines the ‘history’ of the development and testing of Interpersonal Psychotherapy (IPT), one of the first time-limited, manualised, evidence-based psychological treatments for depression. This overview places the inception of IPT in greater context of social history and changes in best practices in the field of psychiatry. This chapter also highlights the career of Dr. Gerald Klerman, the primary developer of IPT, and the legacy of research in IPT that was largely continued by Dr. Myrna Weissman, his collaborator and spouse. In reviewing the history of IPT, this chapter provides a broad overview of the components of the intervention, it’s adaptations for different clinical populations and settings and the research studies that have established IPT as an evidence-based psychological treatment for the past 50 years. Hence, this chapter is an excellent overview of the very detailed chapters that will follow in the book. The chapter ends with a discussion of future directions and challenges for disseminating IPT to wider clinical providers and populations in the upcoming decade.

This chapter provides a brief overview of empirical research supporting the efficacy and effectiveness of Interpersonal Psychotherapy (IPT). The chapter frames the discussion of IPT’s research base into three areas that may be most relevant to mental health providers and therapists: (1) Is IPT an effective psychological treatment for depression? (2) For which clients is IPT most effective?, and (3) What are the treatment mechanisms by which IPT produces symptom reduction and improves clients’ functioning? In this manner, the first question is addressed through the review of recent meta-analyses that focus on IPT alone or in relation to other evidence-based psychological interventions. The next question focuses on personalised approaches to matching clients with IPT based upon presenting problems or individual strengths. The last question addresses a deeper understanding of active treatment components in IPT that produce changes in clients’ symptoms and functioning and can be used to increase treatment effectiveness. The chapter concludes that IPT is an effective treatment for depression and more research is needed to advance our understanding of personalising treatment interventions for clients and how IPT produces changes in symptoms and interpersonal functioning.

Interpersonal Psychotherapy Adolescent Skills Training (IPT-AST) is an evidenced-based intervention for the prevention of depression in adolescents. IST-AST is a group adaptation of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) that has been provided in school-based settings and has extensive evidence for reducing elevated depressive symptoms in adolescents and decrease their risk for developing a clinically significant episode of major depression. This chapter provides the rationale for IST-AST and the adaptations that expand this intervention for treatment delivery in group settings. It clearly describes aspects of implementing IPT-AST at both the individual and group level for participating adolescents, while outlining the goals and strategies used in each session. The aspects of administering IST-AST are highlighted in a case vignette that illustrates both the individual adolescent and the group experience. Lastly, the chapter includes an updated overview of the empirical evidence that supports the use of IPT-AST as an effective and evidence-based psychological intervention for the prevention of depression in adolescents.

Family-based interpersonal psychotherapy (FB-IPT) is a developmental adaptation of Interpersonal Psychotherapy for Depressed Adolescent (IPT-A) and an evidence-based psychological intervention for treating depression in preadolescent children between the ages of 8–12. This chapter describes the developmental issues related to early-onset depression in children 12 and younger, and the interpersonal risk and protective factors that contribute to depressive symptoms in preteens. This chapter outlines the structure and goals of the 14-session intervention, as well as the developmental adaptations in FB-IPT, including increasing the frequency of parent and parent–child meetings, expanding the limited sick role for parents and adding a set of Parent Tips, an increased focus on comorbid anxiety symptoms and adding visuals to the mood rating scale, communication analysis and decision analysis. A detailed case study utilising FB-IPT with a depressed preadolescent and parent demonstrates the real-life application of this psychological treatment and highlights common challenges in implementing FB-IPT. The chapter wraps up with a discussion of the clinical studies that have supported the development and preliminary efficacy of FB-IPT and suggestions for future directions and areas of dissemination.

In this chapter, we examine how the basic principles and structure of IPT have evolved, and how fundamental treatment components and strategies have become refined or expanded with dissemination are outlined. We look through the lens of a practicing IPT therapist and illustrate the orientation, framework and implementation of IPT for contemporary application. Interpersonal Psychotherapy (IPT) is a time-limited (16–20 session), evidence-based psychological therapy which focuses on mood and interpersonal relationships. IPT recognises the significance of life events, particularly those involving interpersonal relationships, which often coincide with the onset of an episode of depression. The therapy is structured around three key principles: (1) a clear focus on interpersonal issues exploring and addressing interpersonal difficulties as they relate to a person’s emotional distress, concentrating on present relationships, (2) the identification of one of four main focus/problem areas, grief, role transitions, interpersonal role disputes or interpersonal sensitivities and (3) treatment structured into three phases – Beginning (1–4); Middle (5–12) and Ending (13–16). IPT sets clear goals to alleviate the presenting symptoms and improve interpersonal functioning. The IPT therapist helps clients to explore emotions, understand patterns in relationships and develop strategies to address the identified problem.

This chapter reviews the use of Interpersonal Depression (IPT) in treating perinatal depression or depression related to pregnancy or the birth of a child or other issues in the postpartum period. Written by guest author and experienced psychologist, Dr Lilian Wanless, this chapter describes the biological, psychological and social issues related to the adaptation to pregnancy, the experience and aftermath of labor and delivery and challenges of parenting a newborn. Although the original structure and clinical strategies in the original IPT model are retained, Wanless describes how particular aspects of IPT, most notably the focal/ problem area of Role Transitions, can be effectively employed to help reduce depression and increase adjustment of mothers in the perinatal period. Wanless provides a rich clinical case description, illustrating how therapist conduct IPT with women experiencing depression in the perinatal period. The chapter concludes with a review of the empirical base of research studies examining the efficacy and implementation of IPT and future directions for the dissemination of IPT for perinatal depression.

The first developmental adaptation of IPT was Dr. Laura Mufson and colleagues’ Interpersonal Psychotherapy for Depressed Adolescents (IPT-A). This seminal adaptation retained the structure and focus of the adult model of IPT, while a range of clinical strategies the developmental competencies and interpersonal issues common with adolescents. This chapter describes the original model of IPT-A as specified by Mufson and colleagues but also includes its relationship to a growing body of knowledge of adolescent development, including the intersection between neurological development and interpersonal changes that take place during adolescence. A case study illustrates the use of IPT-A techniques across phases of treatment and identifies many of the practical considerations of implementing this treatment model, based on our real-world experience of using IPT-A and working clinically with adolescents. The chapter concludes with a summary of the most current research on the efficacy and effectiveness of IPT-A that has established this evidence-based treatment as an enduring and thriving adaptation of IPT.

The theoretical orientation of Interpersonal Psychotherapy (IPT) focuses on the contribution of an individual’s interpersonal and social context to the development and maintenance of mental health difficulties. We describe a selection of contemporary theories that underpin IPT, attachment theory, mentalisation and contemporary interpersonal theory. Attachment theory examines the early interpersonal experiences between a parent and young child that build internal working models of relationships that influence many of the interpersonal issues examined in a course of IPT. Mentalisation is founded in attachment theory and has been referred to as the capacity to cognitively represent or imagine others’ needs, desires, feelings, beliefs, goals and purposes to interpret human behaviour. The capacity to mentalise is thought to develop through attachment relationships but is able to increased through self-awareness and curiosity about others’ mental states. IPT may improve depression by increasing a client’s ability to mentalise in their interpersonal interactions. inally, Interpersonal Communication theory extends our understanding of ‘here and now’ communication in dyadic interpersonal relationships. We go on to consider how specific IPT techniques may provide the structure and experience for a client to break down these cycles of communication with others.

Brief IPT (IPT-B) is an abbreviated version of IPT and is designed to deliver an effective course of IPT in eight sessions. The overall structure of IPT is preserved, but therapists deliver a full course of psychotherapy in fewer sessions. The initial phase of IPT is reduced from three to two sessions, and only a single session is allotted for the ending phase. Thus, 8-session IPT-B has a defined beginning, middle and end but proceeds more rapidly than a standard course of IPT. In the United States, IPT-B was developed to meet the needs of non-treatment seeking populations unable to participate in a full course of IPT, including depressed mothers of psychiatrically ill children and depressed pregnant women on low incomes. In Scotland, IPT-B was developed for deployment in clinical settings such as primary care. Emerging clinical applications of IPT-B include its use in general psychiatric samples and delivery via telehealth. We also describe the structure and components of IPT-B including changes made to the standard IPT model to shorten its duration. We summarise empirical evidence supporting the efficacy of IPT-B and provide a case vignette to illustrate the application of IPT-B in the real world.

With its focus on role transitions, grief, interpersonal disputes and loneliness, IPT is a relevant psychological treatment modality for older adults who present with depression and common situations that arise with the ageing process. In its application with older adults, the IPT treatment model is retained without any significant changes to the original protocol but significant and important contextual issues must be understood and examined by the practicing therapist. This chapter outlines general issues pertaining to ageing that factor into the assessment task for the Initial Phase of IPT, inform the choice of a focal/problem area in the Middle Phase and guide the implementation of IPT skills and strategies with older adults. Importantly, research has shown that IPT can be easily and successfully applied to depressed older people to alleviate their depressive symptoms and contribute to improved interpersonal functioning and quality of life.

The prevailing paradigm used by most researchers and physicians to understand depression appears myopic and deficient, and the treatments derived from it are ineffective. A broader perspective is required for understanding why people in contemporary societies are vulnerable to chronic depression. Evolutionary psychoneuroimmunology synthesizes insights from evolutionary biology, evolutionary psychiatry, neuroscience, immunology, and psychology to provide a broad scientific framework for understanding the relatively high prevalence of depression in people with contemporary western lifestyles. A range of findings indicates that the mismatch between the environments in which Homo sapiens evolved and the environments it currently habits – characterized by sedentary lifestyles, obesogenic diets, fragmented communities, loneliness – contributes in several ways to depression prevalence in contemporary societies. Understanding depression in contemporary Homo sapiens requires not just analyzing the proximate mechanisms contributing to it, such as chronic stress, poor diet, and low-grade systemic inflammation, but also the evolutionary question of why a mind that has undergone hundreds of thousands of years of evolution can be so vulnerable to such severe and debilitating mental health problems. Tinbergen’s four questions, a fundamental conceptual framework used in ethology, evolutionary biology, and evolutionary psychology, organizes these different levels of analysis in a coherent framework for this book.

Societies differ in their inhabitants’ mental well-being. Many affluent and democratic countries, such as the UK and Australia, rank significantly lower in mental well-being than many developing countries, such as Tanzania and Dominican Republic. Many societal factors can either decrease or improve the mental well-being of the people living in those societies. Much of the contemporary burden of depression arises from an evolutionary mismatch between human psychobiology and contemporary western lifestyles characterized by chronic stress, social fragmentation, physical inactivity, circadian disruption, and ultraprocessed diets. These conditions promote low-grade systemic inflammation and dysregulate evolved mood-regulation systems. However, there are measures that societies can implement to address these issues. These include providing safer and more stimulating childhood environments; promoting healthy lifestyles through various policy measures; refining societal values from status competition toward eudaimonia; using evolutionary psychology and biophilic design in urban planning; and giving more opportunities for individuals to discover their ikigai, “a reason for being.” More broadly, not all cultural and technological innovations are inherently negative for human health and well-being. It would be sensible to take advantage of the best parts of these innovations and developments while continuously acknowledging the core constituents of a well-led and fulfilling life.

Low-grade systemic inflammation and neuroinflammation are implicated in the development and maintenance of some cases of depression. This chapter explores the evolutionary psychoneuroimmunological pathways characterizing the inflammatory pathogenesis of depression. The strongest evidence for the link between inflammation and major depressive disorder comes from studies in humans and other animals that have found that the activation of the immune system by immune challenges or by the administration of proinflammatory cytokines induces symptoms of depression in individuals without any previous mental disorders. An estimated 34% of the adult US population have low-grade systemic inflammation. As many as 27% of depressed patients may be affected by neuroinflammation. Low-grade systemic inflammation and neuroinflammation appear to be evolutionarily novel and likely maladaptive pathophysiological outcomes caused by contemporary western lifestyles – most notably by such factors as contemporary western diets, obesity, visceral fat, gut dysbiosis, and chronic stress. Inflammatory states may cause symptoms of depression because the increase of proinflammatory cytokines can lead to the body reacting to it as it does with infection: to produce sickness behaviors that help save energy so that the immune system can overcome the infection, which in this case is not an infection but a more chronic lifestyle-driven inflammatory state.