title: Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan.
abstract: OBJECTIVE
  To determine the efficacy of brief Culturally adapted CBT (CaCBT) for depression when added to Treatment As usual (TAU)-delivered by trained therapists using a manual compared with alone TAU.
  
  
  METHODS
  This was an assessor-blinded, randomised controlled clinical trial. Particpants with a diagnosis of depression, attending psychiatry departments of three teaching hospitals in Lahore, Pakistan, were included in the study. We screened a total of 280 patients and randomly allocated 137 of them to CaCBT plus Treatment As Usual (TAU) [Treatment group] or to TAU alone [Control group]. Assessments were completed at baseline, at 3 months and at 9 months after baseline. Reduction in depression score (Hospital Anxiety and Depression-Depression Subscale) at 3 months was primary outcome measure. The secondary outcome measures included anxiety scores (Hospital Anxiety and Depression-Anxiety Subscale), somatic symptoms (Bradford Somatic Inventory), disability (Brief Disability Questionnaire) and satisfaction with the treatment.
  
  
  RESULTS
  A total of 69 participants were randomised to Treatment group and 68 to Control group. Participants in Treatment group showed statistically significant improvement in depression (p=0.000), anxiety (p=0.000), somatic symptoms (p=0.005) and disability (p=0.000). This effect was sustained at 9 months after baseline (Except for disability). Participants in Treatment group also reported higher satisfaction with treatment compared with those in Control group.
  
  
  CONCLUSIONS
  Brief CaCBT can be effective in improving depressive symptoms, when compared with treatment as usual. This is the first report of a trial of Culturally adapted CBT from South Asia and further studies are needed to generalise these findings.
authors.affiliation: Department of Psychiatry, Queens University, Kingston, Ontario, Canada. Electronic address: farooqnaeem@yahoo.com.
authors.forename: Farooq
authors.initials: F
authors.lastname: Naeem
authors.affiliation: Department of Psychiatry, Sir Ganga Ram Hospital, Lahore, Pakistan.
authors.forename: Mirrat
authors.initials: M
authors.lastname: Gul
authors.affiliation: Department of Psychiatry and Behavioural Sciences, Peshawar Medical College, Peshawar, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Irfan
authors.affiliation: Department of Psychiatry, Queens University, Kingston, Ontario, Canada.
authors.forename: Tariq
authors.initials: T
authors.lastname: Munshi
authors.affiliation: Department of Psychiatry and Behavioural Sciences, Mayo Hospital, Lahore, Pakistan.
authors.forename: Aftab
authors.initials: A
authors.lastname: Asif
authors.affiliation: Department of Psychiatry, Sir Ganga Ram Hospital, Lahore, Pakistan.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Rashid
authors.affiliation: Department of Psychiatry, Services Hospital, Lahore, Pakistan.
authors.forename: Muhammad Nasar Sayeed
authors.initials: MN
authors.lastname: Khan
authors.affiliation: Pakistan Association of Cognitive Therapists, Pakistan.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Ghani
authors.affiliation: Pakistan Association of Cognitive Therapists, Pakistan.
authors.forename: Azmat
authors.initials: A
authors.lastname: Malik
authors.affiliation: Pakistan Association of Cognitive Therapists, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Aslam
authors.affiliation: Department of Psychiatry, PGMI Lady Reading Hospital Peshawar, Pakistan; Staffordshire University, UK.
authors.forename: Saeed
authors.initials: S
authors.lastname: Farooq
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Nusrat
authors.initials: N
authors.lastname: Husain
authors.affiliation: Department of Developmental Disabilities, Queens University, Kingston, Ontario, Canada.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ayub
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003469:Culture; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan; D011614:Psychotherapy, Brief / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Adaptation; Behaviour; Cognitive; Depression; Pakistan; Therapy