A multicentre randomised controlled trial of a carer supervised Culturally adapted CBT (CaCBT) based self-help for depression in Pakistan

BackgroundCognitive Behaviour Therapy (CBT) based self-help has been found to be effective for treating depression and anxiety. There is some evidence to suggest that CBT needs to be culturally adapted for it to be effective in non-Western cultures. CBT is not widely used in low and middle income countries and there is a need to test its effectiveness in different settings and formats, including self-help.MethodsWe describe a RCT of a Culturally adapted CBT (CaCBT) based self-help manual in Pakistan. The trial was conducted in psychiatry departments in three cities. Assessments were carried out at baseline and at 12 weeks, using Hospital Anxiety and Depression Scale, Bradford somatic Inventory and brief disability Questionnaire.ResultsAt the end of the trial CaCBT based self-help was found to be effective against care as usual in reducing the symptoms of depression and anxiety, as well as somatic symptoms and disability.LimitationsThis study was conducted only in secondary care and required either patient or a carer to be able to read and write.ConclusionsThis is the first study outside West of a CBT based self-help intervention for depression. This study highlights the importance of using cost effective interventions in developing world in low intensity formats. Future studies should focus on trying these resources in different settings, like primary care, and with the use of audio/video or multimedia resources to improve compliance in patients with lower literacy.