A multicentre randomised controlled trial of a carer supervised Culturally adapted CBT (CaCBT) based self-help for depression in Pakistan (original) (raw)
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Background: Depression is the principal cause of disability in the world. High prevalence rates of depression in general populations and college students have been found worldwide and in various cultural groups. Low-intensity cognitive behavioural internet-delivered treatment has demonstrated efficacy in high-income-countries (HICs). However little is known of their potential for adaptation and efficacy in low and middle-income countries. Methods: Study (1) involves the cultural adaptation of the Space from Depression cognitive-behaviour internet-delivered programme with an asynchronous support for depressive symptoms. This includes initial researcher/clinician adaptation and the integration of cultural assessment feedback of the programme by a panel of experts and users through the theoretically-based Cultural Relevance Questionnaire (CRQ). Study (2) describes the implementation of the culturally adapted intervention using a randomised controlled trial methodology. The efficacy trial will include an active treatment group and a waiting-list control group of participants meeting eligibility criteria (mild to moderate depression symptoms). The active condition will consist of 7 weekly modules of internet-delivered cognitive behavioural therapy (iCBT) Space from Depression, with post-session feedback support. The primary outcome will be the Patient Health Questionnaire (PHQ-9). The study also involves collection of client reported significant events and client satisfaction with the internet-delivered treatment. Data will be collected at baseline and at post-treatment (week 7), and at follow-up (week 20/ 3 months). Analysis will be conducted on the intention-to-treat basis.
BMC Women's Health
Background: British Pakistanis are one of the largest ethnic minority groups living in the UK, with high rates of maternal depression being reported in this population. Evidence suggests that culturally-adapted Cognitive Behavioural Therapy (CBT)-based interventions for depression, may improve clinical outcomes and patient satisfaction. This study was conducted to develop and test the feasibility and acceptability of a culturally-adapted, CBT-based, manual-assisted intervention in British Pakistani mothers experiencing maternal depression. Methods: A mixed-method feasibility study that included qualitative interviews followed by the development of a CBTbased intervention for mothers with mild to moderate depression. Following the qualitative interviews, a CBT-based intervention called the Positive Health Program (PHP) was developed and delivered consisting of 12-weekly sessions. A before and after design was used to explore the feasibility and acceptability of the Positive Health Programme. Results: A culturally-adapted CBT-based group intervention (PHP) was acceptable to this group and improvements were reported in depression and health-related quality of life. The women's understanding of 'depression' as a general consensus was in physical terms, but with an onset triggered by psychosocial causes. The most commonly reported factors contributing to depression were marital disharmony, lack of social support, and financial difficulties. Past help offered was primarily antidepressants, which were not welcomed by most of the women. A lack of availability of culturally sensitive interventions and the limited cultural sensitivity of NHS staff was also reported. Conclusion: This study provides preliminary evidence for the feasibility and acceptability of a CBT-based culturallyadapted group psychological intervention for British Pakistani mothers.
Thesis Manchester Uk the University of Manchester 2013, 2013
Introduction. Recent reports indicate inequalities for ethnic minority women in maternal health and a need for tailored maternity services to improve access to care. High rates of postnatal depression among British Pakistani women have been reported. These women tend to suffer from persistent depression and have both, poorer access to and outcomes from evidence based psychosocial interventions, compared to the majority of the population. Trials for Cognitive Behaviour Therapy based interventions for postnatal depression appear to improve clinical outcomes and patient satisfaction. However, no study to date has developed an intervention for this group of women that is culturally sensitive. The overall aim of this thesis was to explore a culturally adapted psychosocial intervention with British Pakistani women with persistent postnatal depression, and use the results of these investigations to develop a culturally adapted cognitive behavioural therapy (CBT) based intervention to the meet the needs of persistently depressed British Pakistani women. Methods. This thesis employed a two-phase design based on the Medical Research Council's (MRC) complex intervention framework. In the first phase, qualitative interviews were conducted to explore the experiences of British Pakistani women with persistent postnatal depression and the type of help they would find acceptable. These interviews were analysed using framework analysis. Following the findings from phase 1, a culturally adapted CBT based manualised intervention was developed in phase 2, to target the British Pakistani women's needs and measured participants' satisfaction and engagement. Results. Three emergent themes from qualitative interviews with fifteen British Pakistani women with persistent postnatal depression were identified. These were: 1) causes of persistent postnatal depression; 2) impact of the depression; 3) past help sought and current treatment required for management of persistent postnatal depression. A feasibility study of a culturally adapted CBT based manualised intervention for persistent postnatal depression resulted in high levels of service user satisfaction and engagement. These women found the intervention, both accessible and acceptable for their needs. Fifteen women with persistent postnatal depression took part in the intervention. Significant improvements were found in depression, marital relationships, quality of parenting, and health. Significant improvements in perceived social support were not found. Conclusions. This systematic mixed method approach to the development and testing of a manualised culturally appropriate intervention will provide a framework for those developing culturally adapted interventions for British Pakistani women. A culturally adapted group CBT based intervention was acceptable to British Pakistani women with persistent postnatal depression. A larger trial is currently underway to investigate efficacy of this intervention in terms of reducing depression, and improving social functioning, marital and parental relations, and health. Declaration I declare no portion of the work referred to in the thesis has been submitted in support of an application for another degree or qualification of this or any other university or other institute of learning.
2018
Background: Depressive disorders are the principal cause of disability in the world, with an upward trend in prevalence in low and middle income countries (LMICs). Depression can be effectively treated, however, several barriers in Colombia affect people's access to treatment (e.g. cost, personal stigma, limited availability of the mental health service). Internetdelivered interventions have demonstrated efficacy in high income countries and therefore may have relevance in LMICs. Aims: To assess the efficacy of the culturally adapted cognitive behavioural internet-delivered for depression Method: The study used a mixed method approach utilising in study 1, the development of a systematic and theoretically informed approach, using quantitative and qualitative methods to assist in the cultural adaptation of the Space from Depression intervention and in study 2 a randomised control design to examine the efficacy of the culturally-adapted intervention in college students in Colombia. Study (1) involved the cultural adaptation of the Space from Depression cognitive-behavioural internet-delivered programme for depressive symptoms. The adaptation involved a cultural sensitivity framework (CSF), alongside an ecological validity framework (EVF) and principles from cross-cultural assessment research. This includes initial researcher/clinician adaptation and the integration of cultural assessment feedback of the programme by a panel of experts and users using the theoretically-based Cultural Relevance Questionnaire (CRQ). Study (2) consisted of the implementation of the culturally adapted intervention using a randomised controlled design. The efficacy trial included an internetdelivered cognitive behavioural therapy (iCBT) group and a waiting list (WL) control group of participants meeting eligibility criteria (mild to moderate depressive symptoms). The active condition consisted of 7 weekly modules of CBT Space from Depression, with post-session feedback from a trained supporter. The primary outcome included the Patient Health I would like to acknowledge my mother, family and friends. In memory of my father who was and still is my intellectual inspiration. I want to acknowledge Santiago for all of the support and patience on these years from Colombia. I also want to thank you, my brother, Juan Camilo who was my personal designer on these years, who made the animations in the online programme intervention and helped me with the posters' design in my presentations. A special thank you to my supervisor Derek Richards, who supported this project at the very beginning and in the end, who always believe in me and encourage me to do my best. Also, a special thanks to my supervisor Laco Timulak for all your support and learning experience. Thank you to the whole team in SilverCloud who facilitated this research and let me learn more about online interventions. Sarah Connell thanks to helping in my data analysis. Thanks for the collaborations in Colombia who made possible this project and all of the volunteers' supporters from the two universities in Colombia. A special thank you, Leonidas Castro, for your support in this project.
International Journal of …, 2010
Background: Psychological therapies especially Cognitive Behaviour Therapy (CBT) are used widely in the West to help patients with psychiatric problems. Cognitive Behaviour Therapy has an established evidence base for the treatment of different emotional disorders. In spite of these developments in the developed world, patients in most developing countries hardly benefit from non pharmacological interventions. Although a significant number of psychologists are trained in Pakistan each year, psychological interventions play only a minor role in treatment plans in Pakistan. We conducted interviews with psychologists in Pakistan, to explore their experiences and their views on "providing CBT in Pakistan". These interviews were conducted as part of a project whose focus was to try to develop culturally-sensitive CBT in Pakistan.
Transcultural adaptation of cognitive behavioral therapy ( CBT ) in Asia
Asia-Pacific Psychiatry, 2020
Background: Cognitive behavior therapy (CBT) is an evidence based therapy and is now recommended by national organizations in many high income countries. CBT is underpinned by the European values and therefore for it to be effective in other cultures it needs to be adapted. Aims: This paper describes an evidence based approach to culturally adapt CBT in Asian context, areas of focus for such adaptation and lessons learned. Methods: An environmental scan of the literature, description of local CBT associations and perspectives from these organizations. Results: Cultural adaptation of CBT focuses on three main areas; 1 awareness of culture and related issues, 2 assessment and 3 adjustment in therapy techniques.