Preliminary evaluation of a culturally adapted CBT-based online programme for depression and anxiety from a lower middle-income country

2021 ◽  
Vol 14 ◽  
Author(s):  
Madeeha Latif ◽  
Falahat Awan ◽  
Mirrat Gul ◽  
M. Omair Husain ◽  
M. Ishrat Husain ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Controlled Trial ◽  
Intervention Group ◽  
Anxiety And Depression ◽  
Middle Income ◽  
Randomized Controlled ◽  
Self Help ◽  
Culturally Adapted

Abstract Online cognitive behaviour therapy (CBT), self-help and guided self-help (GSH) interventions have been found to be efficacious and cost-effective for treatment of anxiety and depression, but there are limited data from low- and middle-income countries on culturally adapted digital interventions for these common mental disorders. The aim of this study was to investigate the feasibility and acceptability of an online culturally adapted CBT-based guided self-help (CaCBT-GSH) for patients with anxiety and depression in Pakistan. This randomized controlled trial recruited 39 participants from primary care in Karachi, Pakistan and randomized them to two groups. The intervention group received seven modules of CaCBT-GSH plus treatment as usual (TAU) over 12 weeks. The control group was a waitlist control plus TAU. The primary outcomes were feasibility and acceptability. Clinical outcomes included results from the Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHODAS 2). Assessments were carried out at baseline and at 12 weeks. All 39 individuals who met eligibility criteria for the study agreed to participate. Adherence to the intervention was excellent, with 85% (17/20) completing more than five modules. Statistically significant improvements were found in all clinical outcomes in the intervention group. This was the first trial of an online CaCBT-GSH intervention, which was found to be feasible and acceptable to Pakistani patients with anxiety and depression. CaCBT-GSH may help improve symptoms, depression, anxiety and overall functioning in this population. The results provide rationale for a larger, confirmatory randomized controlled trial of digital CaCBT-GSH. Key learning aims (1) Leveraging digital and virtual platforms to deliver psychosocial interventions may contribute to addressing the significant treatment gap in low-resource settings. (2) CBT-informed guided self-help is feasible and acceptable in the treatment of common mental disorders in Pakistan. (3) The results of this study merit a larger, appropriately powered confirmatory randomized controlled trial to determine clinical and cost effectiveness.

scholarly journals Culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan: feasibility randomized controlled trial

2020 ◽  
pp. 1-12
Author(s):  
Madeeha Latif ◽  
M. Ishrat Husain ◽  
Mirrat Gul ◽  
Saiqa Naz ◽  
Muhammad Irfan ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Female Victims ◽  
Randomized Controlled ◽  
Self Help ◽  
Culturally Adapted ◽  
Cognitive Behaviour ◽  
Secondary Outcomes

Abstract Background: Cognitive behaviour therapy (CBT), self-help and guided self-help interventions have been found to be efficacious and cost effective for victims of trauma, but there are limited data from low- and middle-income countries on culturally adapted interventions for trauma. Aims: To investigate the feasibility and acceptability of culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan. Method: This randomized controlled trial (RCT) recruited 50 participants from shelter homes in Karachi and randomized them to two equal groups. The intervention group received GSH in nine sessions over 12 weeks. The control group was a waitlist control. The primary outcomes were feasibility and acceptability. Secondary outcomes included Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHO DAS 2). Assessments were carried out at baseline and at 12 weeks. Results: Out of 60 clients who met DSM-5 criteria for post-traumatic stress disorder (PTSD), 56 (93.3%) agreed to participate in the study. Retention to the intervention group was excellent, with 92% (23/25) attending more than six sessions. Statistically significant differences were noted post-intervention in secondary outcomes in favour of the intervention. Conclusions: A trial of CatCBT GSH was feasible and the intervention was acceptable to Pakistani women who had experienced domestic violence. Furthermore, it may be helpful in improving symptoms of PTSD, depression, anxiety and overall functioning in this population. The results provide a rationale for a larger, confirmatory RCT of CatCBT GSH.

scholarly journals Efficacy of Six-weeks Therapist Guided Online-Therapy Versus Self-Help Internet-based Therapy on COVID-19 Invoked Anxiety and Depression Among Individuals in Oman During COVID-19 pandemic. An Open Label, Pragmatic Randomized Controlled Trial. (Preprint)

2020 ◽  
Author(s):  
Mohammed Al Alawi ◽  
Roopa K McCall ◽  
Alya Sultan ◽  
Naser Al Balushi ◽  
Tamadhir Al-Mahrouqi ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Psychological Distress ◽  
Controlled Trial ◽  
Intervention Group ◽  
Anxiety And Depression ◽  
Online Therapy ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Self Help ◽  
E Mail

BACKGROUND The coronavirus (COVID-19) pandemic has led to a notable increase in psychological distress, globally. Oman is no exception to this, with several studies indicating high levels of anxiety and depression among the Omani public. There is a need for adaptive and effective interventions aiming at improving the increased levels of psychological distress arising from the COVID-19 pandemic. OBJECTIVE This study aimed at assessing the efficacy of therapist guided Online-Therapy versus self-help, e-mail delivered, therapy focusing on COVID-19-induced symptoms of anxiety and depression among individuals living in Oman during the COVID-19 pandemic. METHODS This was a 6-week pragmatic randomized controlled trial involving 60 participants who were recruited from a study sample surveyed for symptoms of anxiety/depression among the public in Oman amid the COVID-19 pandemic. The participants in the intervention group were allocated to receive 1 online session per week for 6 weeks from certified psychotherapists in Oman in Arabic or English. The Psychotherapists utilized Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) interventions. The participants in the control group received an automatic weekly newsletter via e-mail containing self-help information and tips to cope with distress associated with COVID-19. The information mainly consisted of behavioral tips revolving around the principles of CBT and ACT. The primary outcome was measured by comparing the change in the mean Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scores from baseline to the end of the study (after six sessions) between the two arms. The secondary outcome was comparing the proportions of participants with depression and anxiety in the two groups. RESULTS Data from 46 participants were analyzed (22 in intervention arm and 24 in control arm). There was no statistical difference in baseline characteristics between both arms. Analysis of covariance indicated a significant reduction in the GAD scores (F(1,43) = 7.307; P = 0.010) between the two arms after adjusting for baseline scores. The intervention arm GAD scores reduced more than those of the control arm (B = -3.27; P = 0.010). The intervention arm had a greater reduction in PHQ-9 mean scores (F(1,43) = 8.298; P = 0.006) when compared to the control arm (B = -4.311; P = 0.006). While the levels of anxiety and depression reduced in both study arms, the reduction was higher in the intervention group (P values of <0.049 and <0.022, respectively). CONCLUSIONS This study provides preliminary evidence to support the efficacy of Online-Therapy for improving the symptoms of anxiety and depression during the COVID-19 crisis in Oman. Therapist guided Online-Therapy was noted to be superior to self-help Internet-based therapy, however, both therapies could be considered as viable options. CLINICALTRIAL ClinicalTrials.gov NCT04378257

scholarly journals Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial

2020 ◽  
Author(s):  
Syed Usman Hamdani ◽  
Zill-e- Huma ◽  
Aqsa Masood ◽  
Kiana Zhou ◽  
Zainab Ahmed ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Randomized Controlled Trial ◽  
Common Mental Disorders ◽  
Psychological Intervention ◽  
Controlled Trial ◽  
Routine Care ◽  
Anxiety And Depression ◽  
Randomized Controlled ◽  
Care Facilities

Abstract Background In many low resource settings, the provision of government mental health care services is limited to specialized psychiatry units in urban hospital care facilities, where the most common treatment for common mental disorders (CMDs) is pharmacotherapy, occasionally with adjunct nonspecific psychological support. We aimed to evaluate the effectiveness of adding a low intensity, psychological intervention, Problem Management Plus (PM+) for CMDs into routine care in a specialized mental health care facility in Pakistan. Methods A two arm, single-blind individual randomized controlled trial (RCT) was carried out with adults (N=192), referred for psychological support by psychiatrists. The study participants were randomized (1:1) to PM+ plus Treatment as Usual (TAU) (n = 96) or TAU only (n = 96). The primary outcomes were symptoms of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and functional impairment as measured by WHO Disability Assessment Schedule (WHODAS-12) at 20-weeks after baseline. Results The analysis was done on intention-to-treat principle. The linear mixed model analysis showed that at 20-weeks after baseline, there was a significant reduction in symptoms of anxiety and depression (mean [SD], 16.23 [8.81] vs 19.79 [7.77]; AMD, -3.10; 95% CI, −0.26 to −5.76); p =0.03 and improvement in functioning (mean [SD], 22.94 [9.37] vs 27.37 [8.36]; AMD, -4.35; 95% CI, -1.45 to -7.24); p =0.004 in PM+ plus TAU versus TAU group. The follow-up rate was 67% at primary end-point. Conclusions Specialized care facilities in LMICs may consider adding brief, evidence-based psychological treatments for CMDs to their routine care.

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