Paul Bolton|Catherine Lee|Emily E. Haroz|Laura Murray|Shannon Dorsey|Courtland Robinson|Ana M. Ugueto|Judith K. Bass
A Transdiagnostic Community-Based Mental Health Treatment for Comorbid Disorders: Development and Outcomes of a Randomized Controlled Trial among Burmese Refugees in Thailand
Johns Hopkins University|Johns Hopkins University|Johns Hopkins University|Johns Hopkins University|University of Washington|Johns Hopkins University|Johns Hopkins University|Johns Hopkins University
existing studies mental health interventions lowresource settings employed highly structured interventions delivered nonprofessionals typically vary client given high comorbidity among mental health problems implementation challenges scaling multiple structured evidencebased treatments ebts transdiagnostic treatment could provide additional option approaching communitybased treatment mental health problems objective test approach specifically designed flexible treatments varying comorbid disorders among trauma survivors lowresource settingwe conducted singleblinded waitlist randomized controlled trial newly developed transdiagnostic psychotherapy common elements treatment approach ceta lowresource settings compared waitlist control wlc ceta delivered lay workers burmese survivors imprisonment torture related traumas flexibility based client presentation eligible participants reported trauma exposure met severity criteria depression andor posttraumatic stress pts participants randomly assigned ceta n 182 wlc n 165 outcomes assessed interviewers blinded participant allocation using locally adapted standard measures depression pts primary outcomes functional impairment anxiety symptoms aggression alcohol use secondary outcomes primary analysis intenttotreat n 347 including 73 participants lost followup ceta participants experienced significantly greater reductions baseline symptoms across outcomes exception alcohol use alcohol use analysis confined problem drinkers difference mean change preintervention postintervention intervention control groups 049 95 ci 059 040 depression 043 95 ci 051 035 pts 042 95 ci 058 027 functional impairment 048 95 ci 061 034 anxiety 024 95 ci 034 015 aggression 003 95 ci 044 050 alcohol use corresponds 77 reduction mean baseline depression score among ceta participants compared 40 reduction among controls respective values outcomes 76 41 anxiety 75 37 pts 67 22 functional impairment 71 32 aggression effect sizes cohens large depression 116 pts 119 moderate impaired function 063 anxiety 079 aggression 058 none alcohol use adverse events limitations study include lack longterm followup nonblinding service providers participants placebo active comparison interventionceta provided lay counselors highly effective across disorders among trauma survivors compared wlcs results support development testing transdiagnostic approaches possible treatment options alongside existing ebtsclinicaltrialsgov nct01459068 please see later article editors summary