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

Part of: Being an Anti-Racist CBT therapist

Published online by Cambridge University Press:  26 November 2021

Madeeha Latif ,
Falahat Awan ,
Mirrat Gul ,
M. Omair Husain Open the ORCID record for M. Omair Husain [Opens in a new window] ,
M. Ishrat Husain ,
Kumail Sayyed ,
Taj Magsi ,
Saiqa Naz ,
Ozlem Aylem Open the ORCID record for Ozlem Aylem [Opens in a new window]  and
Peter Phiri Open the ORCID record for Peter Phiri [Opens in a new window]
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Madeeha Latif
Affiliation:
Sindh Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
Falahat Awan
Affiliation:
Sindh Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
Mirrat Gul
Affiliation:
Department of Preventive Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan
M. Omair Husain*
Affiliation:
Department of Psychiatry, University of Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
M. Ishrat Husain
Affiliation:
Department of Psychiatry, University of Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
Kumail Sayyed
Affiliation:
Pakistan Association of Cognitive Therapists, Karachi, Pakistan
Taj Magsi
Affiliation:
Pakistan Association of Cognitive Therapists, Karachi, Pakistan
Saiqa Naz
Affiliation:
Sheffield Specialist Psychotherapy Service, Sheffield, UK
Ozlem Aylem
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, Van der Boechorststraat 7, Amsterdam, The Netherlands
Peter Phiri
Affiliation:
Research & Development, Southern Health NHS Foundation Trust, Southampton, UK
Muhammad Irfan
Affiliation:
Department of Psychiatry, Lady Reading Hospital, Peshawar, Pakistan
Muhammad Ayub
Affiliation:
Department of Psychiatry, Queens University, Kingston, Canada
Farooq Naeem
Affiliation:
Department of Psychiatry, University of Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
*
*Corresponding author. E-mail: omair.husain@camh.ca
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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. (1) Leveraging digital and virtual platforms to deliver psychosocial interventions may contribute to addressing the significant treatment gap in low-resource settings.

  2. (2) CBT-informed guided self-help is feasible and acceptable in the treatment of common mental disorders in Pakistan.

  3. (3) The results of this study merit a larger, appropriately powered confirmatory randomized controlled trial to determine clinical and cost effectiveness.

Keywords

anxietydepressioncCBTcomputerised CBTcultural adaptationguided self-helplow middle income countriesmental healthPakistan
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e36
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Fu, Z., Burger, H., Arjadi, R., & Bockting, C. L. H. (2020). Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Psychiatry, 7, 851–864. https://doi.org/10.1016/S2215-0366(20)30256-X CrossRefGoogle ScholarPubMed

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