Remarks y Although, as described under justifications, many psychosocial interventions had beneficial effects in maintenance therapy, the efficacy of family interventions, family psychoeducation and CBT were most robust (210). Moreover, a subsequent analysis examining only family interventions found that simple family psychoeducation is the most recommendable one. y Acceptance and commitment therapy (ACT): A manualized third-generation behavioural therapy that incorporates acceptance and mindfulnessbased strategies to help individuals in overcoming negative thoughts and feelings. y Assertive community treatment: An intensive, highly integrated approach for community mental health service delivery. The teams visit the individuals at home and provide clinical assessments and crisis interventions, along with psychosocial and functional assistance. This can be considered as a more active form of case management, because it is more holistic and integrated with coordinated services that promote increased wellness for the person. y Case management: Usually each person is assigned to a case manager who contacts them regularly (e.g. once a week) and can provide more intensive support in case of particularly acute needs. y Cognitive behavioural therapy (CBT): CBT for psychosis is usually based on an individualized case formulation and the establishment of collaborative goals with the person requiring the therapy. Therapy components include the improvement of existing coping strategies, the development and practice of new ones, the modification of delusional beliefs and beliefs about hallucinations and the challenge of dysfunctional schemas. Adaptive views of self are strengthened, including the re-evaluation of negative beliefs about the self. y Family interventions: An intervention involving the individual’s relatives, which can have several different aims. These include construction of an alliance with relatives who care for the person with a psychotic disorder, reduction of adverse family atmosphere, enhancement of the capacity of relatives to anticipate and solve problems, maintenance of reasonable expectations for the person’s performance, and attainment of desirable change in relatives’ behaviour and belief systems. y Family psychoeducation: Similar to psychoeducation for individuals, the following areas are usually covered for families: symptoms of psychosis, pharmacological and psychosocial treatments, and prevention of relapse, with a special focus on the role of the family. The intervention might be delivered to the relatives alone, involve the individual, or be delivered in a multifamily context. More active aspects such as coping skills might be involved, but the primary focus is the provision of information. y Integrated interventions: Interventions that were explicitly defined as a combination of different treatments, for example individual CBT plus family intervention plus assertive outreach. y Mindfulness-based interventions (MF): The intervention consists of guided meditation followed by reflective group discussion aimed at facilitating understanding, or metacognitive insight. During meditation, participants bring full awareness to difficult voices, feelings, thoughts and images, and also become aware of habitual coping reactions, safety behaviours and their effects. In meditation they practice letting go of these reactions and learn to observe and allow psychotic experiences to come and go without reacting. Meditation and discussion lead to insight that struggling, judging and ruminating on psychotic experience creates distress, while mindful observation and acceptance of psychotic experience is empowering and calming. y Psychoeducation: Psychoeducation can be defined as the education of a person with a psychiatric disorder in subject areas that serve the goals of treatment and rehabilitation. In individuals with a psychotic disorder, it usually covers the following topics: symptoms of psychosis, models of psychosis, effects and side-effects of medicine, maintenance medicine, psychotherapy for psychosis, early symptoms of relapse and relapse prevention. y Rehabilitation: Usually includes a prevocational day programme, recreational and social activities, apartment living and transitional employment opportunities with the aim of increasing the ability of the person to function independently in the community. y Relapse prevention programmes: Interventions that generally include education for recognizing early symptoms of relapse, a system of symptoms monitoring, and a crisis plan and intervention in case the symptoms increase over a certain threshold. y Telemedicine: Individuals and their family members are regularly contacted via SMS or telephone call with the main aim of monitoring symptoms. If the symptoms appear to be above a certain threshold, an alert is activated and a visit with the clinician is organized.

Implementation considerations y Not all forms of psychological interventions may be available in LMICs. y Attempts should be made to involve family and carers in maintenance treatment. y Family psychoeducation, a relatively simple intervention that has been proven effective, should be offered in all settings. y Differences in mental health infrastructure and resources should be considered. y Variations in cultural context should be considered. There may be acceptability issues. y Country adaptation and translation of training materials and tools for the provision of psychological interventions is essential. y Face-to-face psychological interventions delivered by service providers is human resource-intensive as they require substantial provider time, training and supervision. y Integrating the provision of psychological interventions into primary care provides many advantages, including more holistic health care, increased accessibility of mental health services for people in need of care, opportunities for reducing the stigma of mental health problems and reduced costs. y For the safe implementation of psychological interventions for people with psychosis by non-specialized professionals, supervision by a mental health specialist is an important aspect that should be considered and planned prior to commencement (209).