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

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.

Cognitive-behavioral therapy for psychological harm in domestically abused women: systematic review and meta-analysis

“…A systematic review was conducted in which eight articles were selected to assess the current empirical evidence of CBT for the treatment of psychological harm in domestically abused women. To begin with, based on the articles selected according to the inclusion and exclusion criteria, the majority of publications have been conducted at the international level (87.5%) (Andersson et al, 2021;Graham-Bermann et al, 2019;Greene et al, 2019;Johnson et al, 2020;Latif et al, 2021;Orang et al, 2018;Osma et al, 2022), compared to the regional (12.5%) (Habigzang et al, 2018); however, at the national level, no studies addressing the proposed topic were found in the databases consulted up to the date of review. Possibly the absence of research in Ecuador on CBT in DV may be attributable to multiple factors such as the lack of funding (governmental or private) for intervention projects, the inexistence of a governing body that regulates the practice of psychotherapists (Guano & Costales, 2021) complete, or pay for a treatment, which will make it difficult to establish processes for research purposes.…”

Trauma‐focused guided self‐help interventions for posttraumatic stress disorder: A meta‐analysis of randomized controlled trials

“…A considerable degree of heterogeneity was observed, especially among PTSD effect sizes, potentially suggesting that caution should be applied when interpreting the summary effects, (Deeks et al, 2011) One outlier (demonstrating a much stronger effect of TF-GSH) was identified in each meta-analysis (Latif et al, 2021;Sloan et al, 2012).…”

“…Several outliers (Latif et al, 2021;Sloan et al, 2012) were identified (see Figure 2). See Figure S2 F I G U R E 1 Preferred reporting items for reviews and meta-analysis flow chart of study selection process Removing the Latif et al (Latif et al, 2021) depressive symptoms effect size reduced the strength of the effect of TF-GSH on depressive symptoms by g = 0.17 and almost eliminated heterogeneity among depressive symptom effect sizes (reducing τ 2 by 0.44). A moderate effect favouring TF-GSH was observed for depressive symptoms (k = 12, g = −0.56, 95% CI: −0.78, −0.33), with a small degree of heterogeneity among effect sizes (Q (11) = 27.14, p < .01, τ 2 = 0.09, I 2 = 58%).…”

“…Knaevelsrud & Maercker, 2009;Knaevelsrud et al, 2015Lange et al, 2003;Latif et al, 2021;Lewis et al, 2017;Nieminen et al, 2016;Sloan et al, 2012;Spence et al, 2011;Wagner et al, 2006) phone monitoring (k = 1),(Lehavot et al, 2021) nontrauma writing (k = 1),(Vinke et al, 2019) general support (k = 1),(Ivarsson et al, 2014) and supportive counseling (k = 1)(Litz et al, 2007). Trials evaluating the efficacy of TF-GSH were conducted in a range of countries and in relation to a broad range of traumas.…”

“…Several different TF-GSH protocols were tested. Therapist input entailed less than 1 h (k = 1),(Vinke et al, 2019) 3.7-4.5 h (k = 4),(Gawlytta et al, 2017;Lange et al, 2003;Latif et al, 2021;Sloan et al, 2012) 7-5-8.3 h (k = 5),(Knaevelsrud & Maercker, 2009;Knaevelsrud et al, 2015 Lehavot SIDDAWAY ET AL.…”