Generating Psychotherapy Breakthroughs: Transtheoretical Strategies From Population Health Psychology

Over the past 40 years, few breakthroughs have dramatically increased the impacts of psychotherapy. There have been new and exciting therapies, but the research does not convincingly demonstrate that any recent or more established therapies produce greater impacts than 40 years ago. Seven strategies from the transtheoretical model that have produced breakthroughs in health psychology/population health are analyzed to illustrate how they can similarly generate breakthroughs in mental health outcomes. The first three strategies can enhance impacts by increasing the percentage of troubled populations entering and completing best-practice treatments: reach, recruit, and retain. The fourth strategy accords higher value to synergy than to specificity by generating more benefits from whole-health therapies that briefly treat the small number of behaviors that account for a large percentage of chronic disabilities and premature deaths. The fifth breakthrough strategy creates multiple synergistic changes within individuals; changing one problem behavior promotes the probabilities that individuals will change a second problem (coaction). The sixth strategy increases impacts by complementing psychologists with tailored technology that extends their influence into homes, schools, workplaces, and communities. The seventh strategy calls on researchers to test their innovations against best practices and to benchmark outcomes, like those found with depression. We conclude by advancing a framework that can generate more inclusive and effective psychotherapies by integrating individual health care with population health practices. Public Significance Statement This article presents seven transtheoretical strategies that have produced breakthroughs in population health to illustrate how they can similarly generate breakthroughs in mental health outcomes. New models of psychological service delivery can increase health impacts and reduce the burdens of mental disorders.