A Common Elements Treatment Approach for Adult Mental Health Problems in
Low- and Middle-Income Countries
Laura K. Murray, Johns Hopkins Bloomberg School of Public Health
Shannon Dorsey, University of Washington
Emily Haroz and Catherine Lee, Johns Hopkins Bloomberg School of Public Health
Maytham M. Alsiary, University of Babylon
Amir Haydary, University of Karbala
William M. Weiss and Paul Bolton, Johns Hopkins Bloomberg School of Public Health
This paper describes the Common Elements Treatment Approach (CETA) for adults presenting with mood or anxiety problems developed
specifically for use with lay counselors in low- and middle-income countries (LMIC). Details of the intervention development, training,
supervision, and decision-making process are presented. Case vignettes are used as examples throughout. Preliminary findings are presented
on counselor/supervisor performance and client outcomes from practice cases completed prior to randomized controlled trials (RCT)
conducted at two sites for adult survivors of torture and/or systematic violence in (a) southern Iraq and (b) Thailand-Burma border.
Data suggest that local supervisors and lay counselors with little prior mental health training or experience maintained fidelity to the
model. The majority of pilot clients were retained in treatment, suggesting acceptability. Using the Reliable Change Index (RCI) for each
individual we examined the number of clients above a minimal threshold (z N 1.96) for each outcome. In Iraq 100% of clients had
RCIs above the threshold for depression and posttraumatic stress, and 81.8% for impaired function. In Thailand, 81.3% of clients
had RCIs above minimum threshold for depression, 68.8% for posttraumatic stress, and 37.5% for impaired function.
Implementation of CETA is discussed in relation to cultural issues within LMIC. These findings, combined with US-based evidence,
suggest that a common elements approach warrants further development and testing as a means for addressing the treatment gap for
mental health problems in LMIC.