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Brief Culturally adapted CBT (CaCBT) for depression: A randomized controlled trial from Pakistan

Naeem, Farooq; Gul, Mirrat; Irfan, Muhammad; Munshi, Tariq; Asif, Aftab; Rashid, Sadaf; Khan, Muhammad Nasar Sayeed; Ghani, Sadaf; Malik, Azmat; Aslam, Muhammad; Farooq, Saeed; Husain, Nusrat; Ayub, Muhammad


Farooq Naeem

Mirrat Gul

Muhammad Irfan

Tariq Munshi

Aftab Asif

Sadaf Rashid

Muhammad Nasar Sayeed Khan

Sadaf Ghani

Azmat Malik

Muhammad Aslam

Nusrat Husain

Muhammad Ayub


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.

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.

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.

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.


Naeem, F., Gul, M., Irfan, M., Munshi, T., Asif, A., Rashid, S., …Ayub, M. (2015). Brief Culturally adapted CBT (CaCBT) for depression: A randomized controlled trial from Pakistan. Journal of Affective Disorders, 177, 101-107.

Journal Article Type Article
Publication Date May 15, 2015
Deposit Date Nov 29, 2023
Journal Journal of Affective Disorders
Print ISSN 0165-0327
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 177
Pages 101-107
Keywords Psychiatry and Mental health; Clinical Psychology; Cognitive; Behaviour; Therapy; Depression; Adaptation; Pakistan
Public URL
Additional Information This article is maintained by: Elsevier; Article Title: Brief Culturally adapted CBT (CaCBT) for depression: A randomized controlled trial from Pakistan; Journal Title: Journal of Affective Disorders; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: Copyright © 2015 Elsevier B.V. All rights reserved.