Journal
COGNITIVE AND BEHAVIORAL PRACTICE
Volume 21, Issue 2, Pages 111-123Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cbpra.2013.06.005
Keywords
common elements; trauma; global mental health; task-shifting; cognitive behavioral therapy
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Funding
- NIMH NIH HHS [T32 MH014592, K23 MH077532, R34 MH081764, R25 MH080916] Funding Source: Medline
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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 (R CI) 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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