Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-23T23:41:40.878Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  30 September 2020

Madeeha Latif ,
M. Ishrat Husain ,
Mirrat Gul ,
Saiqa Naz ,
Muhammad Irfan ,
Muhammad Aslam ,
Falahat Awan ,
Ayesha Sharif ,
Shanaya Rathod  and
Saeed Farooq
...Show all authors
Madeeha Latif
Affiliation:
Dow University of Health Sciences, Karachi, Pakistan
M. Ishrat Husain*
Affiliation:
Department of Psychiatry, University of Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
Mirrat Gul
Affiliation:
Department of Prevention Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan
Saiqa Naz
Affiliation:
Sheffield Specialist Psychotherapy Service, Sheffield, UK
Muhammad Irfan
Affiliation:
Department of Psychiatry, Lady Reading Hospital, Peshawar, Pakistan
Muhammad Aslam
Affiliation:
Recovery Psychotherapy Centre, Lahore, Pakistan
Falahat Awan
Affiliation:
Dow University of Health Sciences, Karachi, Pakistan
Ayesha Sharif
Affiliation:
Pakistan Association of Cognitive Behaviour Therapists, Lahore, Pakistan
Shanaya Rathod
Affiliation:
Southern Health NHS Foundation Trust, Southampton, UK
Saeed Farooq
Affiliation:
Keele University, Staffordshire, UK
Muhammad Ayub
Affiliation:
Queens University, Kingston, Ontario, Canada
Farooq Naeem
Affiliation:
Department of Psychiatry, University of Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
*
*Corresponding author. Email: ishrat.husain@camh.ca
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

cultural adaptationguided self-helpPakistantrauma
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 1 , January 2021 , pp. 50 - 61
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alaoui, S. E., Hedman-Lagerlöf, E., Ljótsson, B., & Lindefors, N. (2017). Does internet-based cognitive behaviour therapy reduce healthcare costs and resource use in treatment of social anxiety disorder? A cost-minimisation analysis conducted alongside a randomised controlled trial. BMJ Open, 7, e017053. https://doi.org/10.1136/bmjopen-2017-017053 CrossRefGoogle ScholarPubMed
APA (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. Washington, DC, USA: American Psychological Association. https://www.apa.org/ptsd-guideline Google Scholar
Aslam, M., Irfan, M., & Naeem, F. (2015). Brief culturally adapted cognitive behaviour therapy for obsessive compulsive disorder: a pilot study. Pakistan Journal of Medical Sciences, 31, 874–879. https://doi.org/10.12669/pjms.314.7385 Google ScholarPubMed
Ayub, M., Irfan, M., Nasr, T., Lutufullah, M., Kingdon, D., & Naeem, F. (2009). Psychiatric morbidity and domestic violence: a survey of married women in Lahore. Social Psychiatry and Psychiatric Epidemiology, 44, 953–960. https://doi.org/10.1007/s00127-009-0016-6 CrossRefGoogle ScholarPubMed
Beck, A., Nadkarni, A., Calam, R., Naeem, F., & Husain, N. (2016). Increasing access to cognitive behaviour therapy in low and middle income countries: a strategic framework. Asian Journal of Psychiatry, 22, 190–195. https://doi.org/10.1016/j.ajp.2015.10.008 CrossRefGoogle ScholarPubMed
Bhikha, A. G., Farooq, S., Chaudhry, N., & Husain, N. (2012). A systematic review of explanatory models of illness for psychosis in developing countries. International Review of Psychiatry, 24, 450–462. https://doi.org/10.3109/09540261.2012.711746 CrossRefGoogle ScholarPubMed
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. The Cochrane Database of Systematic Reviews, 12, CD003388. https://doi.org/10.1002/14651858.CD003388.pub4 Google Scholar
Bower, P., Richards, D., & Lovell, K. (2001). The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review. British Journal of General Practice, 51, 838–845.Google ScholarPubMed
Chatterjee, S., Naik, S., John, S., Dabholkar, H., Balaji, M., Koschorke, M., Varghese, M., Thara, R., Weiss, H. A., Williams, P., McCrone, P., Patel, V., & Thornicroft, G. (2014). Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial. Lancet, 383, 1385–1394. https://doi.org/10.1016/S0140-6736(13)62629-X CrossRefGoogle ScholarPubMed
Chowdhary, N., Jotheeswaran, A. T., Nadkarni, A., Hollon, S. D., King, M., Jordans, M. J. D., Rahman, A., Verdeli, H., Araya, R., & Patel, V. (2014). The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review. Psychological Medicine, 44, 1131–1146. https://doi.org/10.1017/S0033291713001785 CrossRefGoogle ScholarPubMed
Cuijpers, P. (1997). Bibliotherapy in unipolar depression: a meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 28, 139–147. https://doi.org/10.1016/S0005-7916(97)00005-0 CrossRefGoogle ScholarPubMed
Cuijpers, Pim, & Schuurmans, J. (2007). Self-help interventions for anxiety disorders: an overview. Current Psychiatry Reports, 9, 284–290.CrossRefGoogle ScholarPubMed
Derogatis, L. R., & Lazarus, L. (1994). SCL-90-R, Brief Symptom Inventory, and matching clinical rating scales. In Maruish, M. E. (ed), The Use of Psychological Testing for Treatment Planning and Outcome Assessment (pp. 217–248). Lawrence Erlbaum Associates, Inc.Google Scholar
Durlak, J. A. (2009). How to select, calculate, and interpret effect sizes. Journal of Pediatric Psychology, 34, 917–928. https://doi.org/10.1093/jpepsy/jsp004 CrossRefGoogle ScholarPubMed
Ehring, T., Razik, S., & Emmelkamp, P. M. G. (2011). Prevalence and predictors of posttraumatic stress disorder, anxiety, depression, and burnout in Pakistani earthquake recovery workers. Psychiatry Research, 185, 161–166. https://doi.org/10.1016/j.psychres.2009.10.018 CrossRefGoogle ScholarPubMed
Falbe-Hansen, L., Le Huray, C., Phull, B., Shakespeare, C., & Wheatley, J. (2009). Using guided self-help to treat common mental health problems: the Westminster Primary Care Psychology Service. London Journal of Primary Care, 2, 61–64.10.1080/17571472.2009.11493246CrossRefGoogle ScholarPubMed
Federici, S., Bracalenti, M., Meloni, F., & Luciano, J. V. (2017). World Health Organization disability assessment schedule 2.0: an international systematic review. Disability and Rehabilitation, 39, 2347–2380. https://doi.org/10.1080/09638288.2016.1223177 CrossRefGoogle Scholar
Golding, J. M. (1999). Intimate partner violence as a risk factor for mental disorders: a meta-analysis. Journal of Family Violence, 14, 99–132. https://doi.org/10.1023/A:1022079418229 CrossRefGoogle Scholar
Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: a meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43, 531–548. https://doi.org/10.1037/0033-3204.43.4.531 CrossRefGoogle ScholarPubMed
Hedman, E., Ljótsson, B., & Lindefors, N. (2012). Cognitive behavior therapy via the internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Review of Pharmacoeconomics & Outcomes Research, 12, 745–764. https://doi.org/10.1586/erp.12.67 CrossRefGoogle ScholarPubMed
Husain, N., Afsar, S., Ara, J., Fayyaz, H., Rahman, R. U., Tomenson, B., Hamirani, M., Chaudhry, N., Fatima, B., Husain, M., Naeem, F., & Chaudhry, I. B. (2014). Brief psychological intervention after self-harm: randomised controlled trial from Pakistan. British Journal of Psychiatry: Journal of Mental Science, 204, 462–470. https://doi.org/10.1192/bjp.bp.113.138370 CrossRefGoogle ScholarPubMed
Jonas, D. E., Cusack, K., Forneris, C. A., Wilkins, T. M., Sonis, J., Middleton, J. C., Feltner, C., Meredith, D., Cavanaugh, J., Brownley, K. A., Olmsted, K. R., Greenblatt, A., Weil, A., & Gaynes, B. N. (2013). Psychological and Pharmacological Treatments for Adults with Posttraumatic Stress Disorder (PTSD). Agency for Healthcare Research and Quality (USA). http://www.ncbi.nlm.nih.gov/books/NBK137702/ Google Scholar
Jordans, M. J. D., Luitel, N. P., Garman, E., Kohrt, B. A., Rathod, S. D., Shrestha, P., Komproe, I. H., Lund, C., & Patel, V. (2019). Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal. British Journal of Psychiatry: Journal of Mental Science, 215, 485–493. https://doi.org/10.1192/bjp.2018.300 CrossRefGoogle ScholarPubMed
Julious, S. A. (2005). Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics, 4, 287–291. https://doi.org/10.1002/pst.185 CrossRefGoogle Scholar
LaBore, K., Ahmed, T., Rizwan-Ur-Rashid, , & Ahmed, R. (2019). Prevalence and predictors of violence against women in Pakistan. Journal of Interpersonal Violence, 886260518824652. https://doi.org/10.1177/0886260518824652 Google ScholarPubMed
Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863. https://doi.org/10.3389/fpsyg.2013.00863 CrossRefGoogle ScholarPubMed
Lewis, C., Roberts, N. P., Simon, N., Bethell, A., & Bisson, J. I. (2019). Internet-based cognitive behavioural therapy (i-CBT) for post-traumatic stress disorder (PTSD): systematic review and meta-analysis. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13079 CrossRefGoogle ScholarPubMed
Lewis, G., Anderson, L., Araya, R., Elgie, E., Harrison, G., Proudfoot, J., Schmidt, U., Sharp, D., Weightman, A., & Williams, C. (2003). Self-Help Interventions for Mental Health Problems [Report to the Department of Health]. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4125794.pdf Google Scholar
Murphy, D., Ross, J., Ashwick, R., Armour, C., & Busuttil, W. (2017). Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans. European Journal of Psychotraumatology, 8, 1398001. https://doi.org/10.1080/20008198.2017.1398001 CrossRefGoogle ScholarPubMed
Naeem, F., Ayub, M., Gobbi, M., & Kingdon, D. (2009, December 1). Development of Southampton Adaptation Framework for CBT (SAF-CBT): a framework for adaptation of CBT in non-western culture. Journal of Pakistan Psychiatric Society. http://www.pakmedinet.com/15940 Google Scholar
Naeem, F., Irfan, M., Zaidi, Q. A., Kingdon, D., & Ayub, M. (2008). Angry wives, abusive husbands: relationship between domestic violence and psychosocial variables. Women’s Health Issues, 18, 453–462.CrossRefGoogle ScholarPubMed
Naeem, F., Waheed, W., Gobbi, M., Ayub, M., & Kingdon, D. (2011). Preliminary evaluation of culturally sensitive CBT for depression in Pakistan: findings from Developing Culturally-Sensitive CBT Project (DCCP). Behavioural and Cognitive Psychotherapy, 39, 165–173. https://doi.org/10.1017/S1352465810000822 CrossRefGoogle Scholar
Naeem, F., Sarhandi, I., Gul, M., Khalid, M., Aslam, M., Anbrin, A., Saeed, S., Noor, M., Fatima, G., Minhas, F., Husain, N., & Ayub, M. (2014). A multicentre randomised controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan. Journal of Affective Disorders, 156, 224–227. https://doi.org/10.1016/j.jad.2013.10.051 CrossRefGoogle ScholarPubMed
Naeem, F., Gul, M., Irfan, M., Munshi, T., Asif, A., Rashid, S., Khan, M. N. S., Ghani, S., Malik, A., Aslam, M., Farooq, S., Husain, N., & Ayub, M. (2015a). Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. Journal of Affective Disorders, 177, 101–107. https://doi.org/10.1016/j.jad.2015.02.012 CrossRefGoogle ScholarPubMed
Naeem, F., Saeed, S., Irfan, M., Kiran, T., Mehmood, N., Gul, M., Munshi, T., Ahmad, S., Kazmi, A., Husain, N., Farooq, S., Ayub, M., & Kingdon, D. (2015b). Brief culturally adapted CBT for psychosis (CaCBTp): a randomized controlled trial from a low income country. Schizophrenia Research. https://doi.org/10.1016/j.schres.2015.02.015 CrossRefGoogle ScholarPubMed
Naeem, F., Phiri, P., Nasar, A., Munshi, T., Ayub, M., & Rathod, S. (2016). An evidence-based framework for cultural adaptation of cognitive behaviour therapy: process, methodology and foci of adaptation. World Cultural Psychiatry Research Review, 11, 67–70.Google Scholar
Naslund, J. A., Aschbrenner, K. A., Araya, R., Marsch, L. A., Unützer, J., Patel, V., & Bartels, S. J. (2017). Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. The Lancet. Psychiatry, 4, 486–500. https://doi.org/10.1016/S2215-0366(17)30096-2 CrossRefGoogle ScholarPubMed
Patel, V., Weobong, B., Weiss, H. A., Anand, A., Bhat, B., Katti, B., Dimidjian, S., Araya, R., Hollon, S. D., King, M., Vijayakumar, L., Park, A.-L., McDaid, D., Wilson, T., Velleman, R., Kirkwood, B. R., & Fairburn, C. G. (2017). The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. The Lancet, 389, 176–185. https://doi.org/10.1016/S0140-6736(16)31589-6 CrossRefGoogle ScholarPubMed
Rahman, A., Hamdani, S. U., Awan, N. R., Bryant, R. A., Dawson, K. S., Khan, M. F., Azeemi, M. M.-H., Akhtar, P., Nazir, H., Chiumento, A., Sijbrandij, M., Wang, D., Farooq, S., & Ommeren, M. van. (2016). Effect of a multicomponent behavioral intervention in adults impaired by psychological distress in a conflict-affected area of Pakistan: a randomized clinical trial. JAMA, 316, 2609–2617. https://doi.org/10.1001/jama.2016.17165 CrossRefGoogle Scholar
Rathod, S., Kingdon, D., Phiri, P., & Gobbi, M. (2010). Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users’ and health professionals’ views and opinions. Behavioural and Cognitive Psychotherapy, 38, 511–533. https://doi.org/10.1017/S1352465810000378 CrossRefGoogle ScholarPubMed
Rathod, S., Phiri, P., Harris, S., Underwood, C., Thagadur, M., Padmanabi, U., & Kingdon, D. (2013). Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophrenia Research, 143, 319–326. https://doi.org/10.1016/j.schres.2012.11.007 CrossRefGoogle ScholarPubMed
Rathod, S., Gega, L., Degnan, A., Pikard, J., Khan, T., Husain, N., Munshi, T., & Naeem, F. (2018). The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses. Neuropsychiatric Disease and Treatment, 14, 165–178. https://doi.org/10.2147/NDT.S138430 CrossRefGoogle ScholarPubMed
Rathod, S., Phiri, P., & Naeem, F. (2019). An evidence-based framework to culturally adapt cognitive behaviour therapy. The Cognitive Behaviour Therapist, 12. https://doi.org/10.1017/S1754470X18000247 CrossRefGoogle Scholar
Razik, S., Ehring, T., & Emmelkamp, P. M. G. (2013). Psychological consequences of terrorist attacks: prevalence and predictors of mental health problems in Pakistani emergency responders. Psychiatry Research, 207, 80–85. https://doi.org/10.1016/j.psychres.2012.09.031 CrossRefGoogle ScholarPubMed
Tareen, M. S., McDowell, C., Naqvi, K., Bashir, A., Keenan, P., ur Rehman, A., & Farrell, D. P. (2012). Evaluation of an Urdu version of the Impact of Event Scale-Revised. International Psychiatry, 9, 20–22. https://doi.org/10.1192/S1749367600002952 Google Scholar
Üstün, T. B., Chatterji, S., Kostanjsek, N., Rehm, J., Kennedy, C., Epping-Jordan, J., Saxena, S., von Korff, M., & Pull, C. (2010). Developing the World Health Organization Disability Assessment Schedule 2.0. Bulletin of the World Health Organization, 88, 815–823. https://doi.org/10.2471/BLT.09.067231 CrossRefGoogle ScholarPubMed
Waqas, A., Aedma, K. K., Tariq, M., Meraj, H., & Naveed, S. (2019). Validity and reliability of the Urdu version of the Hospital Anxiety and Depression Scale for assessing antenatal anxiety and depression in Pakistan. Asian Journal of Psychiatry, 45, 20–25. https://doi.org/10.1016/j.ajp.2019.08.008 CrossRefGoogle ScholarPubMed
Weiss, D., & Marmar, C. (1996). Impact of Event Scale-Revised (IES-R) for DSM-IV – PTSD: National Center for PTSD. In Assessing Psychological Trauma and PTSD (pp. 399–411). Guilford. https://www.ptsd.va.gov/professional/assessment/adult-sr/ies-r.asp Google Scholar
WHO. (2008). Integrating Mental Health into Primary Care: A Global Perspective. World Health Orgniazation. http://www.who.int/mental_health/policy/Mental%20health%20+%20primary%20care-%20final%20low-res%20140908.pdf Google Scholar
Wickersham, A., Petrides, P. M., Williamson, V., & Leightley, D. (2019). Efficacy of mobile application interventions for the treatment of post-traumatic stress disorder: a systematic review. Digital Health, 5, 2055207619842986. https://doi.org/10.1177/2055207619842986 CrossRefGoogle ScholarPubMed
Wu, K. K., Li, F. W., & Cho, V. W. (2014). A randomized controlled trial of the effectiveness of brief-CBT for patients with symptoms of posttraumatic stress following a motor vehicle crash. Behavioural and Cognitive Psychotherapy, 42, 31–47. https://doi.org/10.1017/S1352465812000859 CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.