Trauma is a touchstone for other severe mental health disorders, including post-traumatic stress disorder (PTSD), depression, and anxiety. This is particularly problematic in places researchers refer to as low-resource settings, or a place where there are both limited health professionals and limited access to formal mental health training. So researchers from Johns Hop­kins Uni­ver­sity in Mary­land and the Uni­ver­sity of Wash­ing­ton developed Common Elements Treatment Approach (CETA), an easy-to-learn therapy that can be implemented in such settings. A new study published in PLOS Medicine reveals how effective the therapy was in treating trauma survivors in Thailand.

First, some background: Myanmar (Burma) is about five kilometers northwest of Thailand. Researchers cited two million Burmese have sought asylum in Thailand since 1984, including many survivors of systematic violence and torture, with increased symptoms of PTSD, depression, and anxiety. With virtually no mental health care system in Myanmar, researchers spent a lot of time identifying and measuring local health problems, as well as testing mental health instruments and interventions before conducting CETA as part of their study. “Imposing treatment developed in a different culture with no consideration of local appropriateness may be harmful and may increase distrust of nontraditional practices,” researchers wrote.

CETA combines a variety of approaches used in a mental health intervetion, from psychoeducation to cognitive coping. Each hour-long CETA session aims to both assess individual patients, and identify the necessary steps he or she needs to take to reduce symptoms. Counselors also practice these steps and skills in and between sessions.

The 347 Burmese refugees included in the study all met the criteria for significant PTSD and/or depression. After researchers randomly assigned refugees to the control group or the group receiving CETA, local counselors were brought on to provide treatment within the community "because of lack of professional mental health services and the frequent reluctance of clients to attend clinics for fear of apprehension by Thai authorities.” And compared to the control group, refugees who received CETA experienced a significantly greater reduction in symptoms of PTSD, depression, and anxiety. These refugees also reported improvement in functional impairment, anxiety, and aggression during follow-up sessions months later.

“We undertook this study as a first test of a new approach to flexible treatment of varying and comorbid common mental health problems at the community level,” researchers explained. “We found that local counselors were able to apply this approach correctly and effectively."

Until now, CETA has only been implemented in high-income countries. Now that researches have seen success in Thailand, they believe it warrants further development and testing of similar approaches as a way to treat mental health disorders across the globe.

Source: Bolton P, Lee C, Haroz EE, et al. A Transdiagnostic Community-Based Mental Health Treatment for Comorbid Disorders: Development and Outcomes of a Randomized Controlled Trial among Burmese Refugees in Thailand. PLoS Med. 2014.