Early Adolescent Skills for Emotions (EASE) intervention for the treatment of psychological distress in adolescents: study protocol for randomised controlled trials in Lebanon and Jordan

Abstract

Background: There are significant barriers to providing accessible, quality mental health care for young adolescents affected by adversity. In an attempt to overcome this, the World Health Organization (WHO) has developed the Early Adolescent Skills for Emotions (EASE) psychological intervention for young adolescents with internalising problems. EASE is group-based (seven sessions for adolescents, three sessions for their caregivers) and can be delivered by non-specialist providers. This paper outlines the study protocols for two trials of EASE in the Middle East-one in Lebanon and one in Jordan. Methods: We will conduct two, single-blind, two-arm, individually randomised group treatment trials in Lebanon and Jordan, with at least 445 young adolescents per trial. Adolescents will be screened eligible for the trial if they demonstrate levels of psychological distress indicative of internalizing problems requiring treatment. Participants will be randomly assigned to receive the EASE intervention, or enhanced usual care (one home-visit psychoeducation session). The primary outcome is reduction in overall child-reported psychological distress over time, with 3 months post-treatment as the primary end point. Secondary child-reported outcomes include post-traumatic stress symptoms, depression symptoms, daily functioning, and wellbeing. Secondary caregiver-reported outcomes include parenting style, overall child distress, and caregiver psychological distress. Coping strategy use will be explored as a mediator of treatment effects in Lebanon, and relevant moderators of treatment effects will be explored. Discussion: These trials will provide the first assessments of the effectiveness of the EASE intervention for use in the Middle East, with important implications for the use of low-intensity, non-specialist interventions for this age range.

Psychological and Psychosocial Interventions for PTSD, Depression and Anxiety Among Children and Adolescents in Low- and Middle-Income Countries: A Meta-Analysis

“…EASE was developed for young adolescents and is the adapted version of the World Health Organization (WHO) developed intervention Problem Management Plus (PM+; WHO, 2016). PM+ is a psychological intervention to reduce psychological distress in populations affected by adversities and is delivered by non-professional helpers (56).…”

The Cultural and Contextual Adaptation Process of an Intervention to Reduce Psychological Distress in Young Adolescents Living in Lebanon

“…Trainers conducted 10 structured observations in total, whereby they rated facilitators on fidelity and competency, using a standardized observation tool developed specifically for EASE (35). Facilitators were rated on whether they completed each component of the session (yes or no), on how well they delivered each section of the session (done well, done partially, needs improvement), and two general competency items which assessed the use of group facilitation skills, and basic helping skills (done well, done partially, needs improvement).…”

“…The research informs the wider field of global mental health in terms of opportunities and challenges of implementing psychological interventions in diverse settings of low resources and high adversity, and the potential to contribute to closing the global treatment gap (4). Child and adolescent mental health continues to be an area lacking sufficient attention, especially in under-resourced settings (7), and the results of this formative work, and forthcoming pilot trial and randomized controlled trial will provide further evidence on effective strategies to address this global issue (35).…”

Feasibility trial of a brief scalable psychological intervention for Syrian refugee adolescents in Jordan

“…responses to assessments), and (c) identify factors to be considered in the preparation of a definitive controlled trial (e.g. recruitment strategy, assessments) (Brown et al, 2019 ).…”