A common elements treatment approach for adult mental health problems in low- and middle-income countries

Laura Murray, Shannon Dorsey, Emily Haroz, Catherine Irene En-Lin Lee, Maytham M. Alsiary, Amir Haydary, William M Weiss, Paul A Bolton

Research output: Contribution to journalArticle

Abstract

This paper describes the Common Elements Treatment Approach (CETA) for adults presenting with mood or anxiety problems developed specifically for use with lay counselors in low- and middle-income countries (LMIC). Details of the intervention development, training, supervision, and decision-making process are presented. Case vignettes are used as examples throughout. Preliminary findings are presented on counselor/supervisor performance and client outcomes from practice cases completed prior to randomized controlled trials (RCT) conducted at two sites for adult survivors of torture and/or systematic violence in (a) southern Iraq and (b) Thailand-Burma border.Data suggest that local supervisors and lay counselors with little prior mental health training or experience maintained fidelity to the model. The majority of pilot clients were retained in treatment, suggesting acceptability. Using the Reliable Change Index (RCI) for each individual we examined the number of clients above a minimal threshold (z>. 1.96) for each outcome. In Iraq 100% of clients had RCIs above the threshold for depression and posttraumatic stress, and 81.8% for impaired function. In Thailand, 81.3% of clients had RCIs above minimum threshold for depression, 68.8% for posttraumatic stress, and 37.5% for impaired function.Implementation of CETA is discussed in relation to cultural issues within LMIC. These findings, combined with US-based evidence, suggest that a common elements approach warrants further development and testing as a means for addressing the treatment gap for mental health problems in LMIC.

Original languageEnglish (US)
Pages (from-to)111-123
Number of pages13
JournalCognitive and Behavioral Practice
Volume21
Issue number2
DOIs
StatePublished - 2014

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Mental Health
Iraq
Thailand
Torture
Depression
Myanmar
Therapeutics
Violence
Survivors
Decision Making
Anxiety
Randomized Controlled Trials
Counselors

Keywords

  • Cognitive behavioral therapy
  • Common elements
  • Global mental health
  • Task-shifting
  • Trauma

ASJC Scopus subject areas

  • Clinical Psychology

Cite this

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abstract = "This paper describes the Common Elements Treatment Approach (CETA) for adults presenting with mood or anxiety problems developed specifically for use with lay counselors in low- and middle-income countries (LMIC). Details of the intervention development, training, supervision, and decision-making process are presented. Case vignettes are used as examples throughout. Preliminary findings are presented on counselor/supervisor performance and client outcomes from practice cases completed prior to randomized controlled trials (RCT) conducted at two sites for adult survivors of torture and/or systematic violence in (a) southern Iraq and (b) Thailand-Burma border.Data suggest that local supervisors and lay counselors with little prior mental health training or experience maintained fidelity to the model. The majority of pilot clients were retained in treatment, suggesting acceptability. Using the Reliable Change Index (RCI) for each individual we examined the number of clients above a minimal threshold (z>. 1.96) for each outcome. In Iraq 100{\%} of clients had RCIs above the threshold for depression and posttraumatic stress, and 81.8{\%} for impaired function. In Thailand, 81.3{\%} of clients had RCIs above minimum threshold for depression, 68.8{\%} for posttraumatic stress, and 37.5{\%} for impaired function.Implementation of CETA is discussed in relation to cultural issues within LMIC. These findings, combined with US-based evidence, suggest that a common elements approach warrants further development and testing as a means for addressing the treatment gap for mental health problems in LMIC.",
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