The role of specific and non-specific factors in a brief group psychological intervention for psychological distress: a randomised clinical trial

AimsAlthough brief psychological interventions in low-and-middle-income-countries have been shown to be effective, they have typically been tested against usual or enhanced usual care (EUC). This design has precluded delineation of the role of specific and non-specific factors in influencing symptom reduction outcomes. This study evaluates the impact of a group psychological intervention (adapted version of WHOs Problem Management Plus; PM+; titled Coping with COVID) against non-directive group Supportive Counselling (SC) on psychological distress during the COVID-19 pandemic in India. MethodsBetween October 2020 and December 2022, this two-arm single-blind, controlled trial randomised 183 young adults in Bangalore, India who screened positive for psychological distress to either Coping with COVID (n = 91) or SC (n=92), on a 1:1 basis. Coping with COVID comprised six weekly small group sessions delivered by videoconferencing that taught stress coping strategies. SC also involved six weekly group sessions that were led by a facilitator and offered non-directive support. The primary outcomes were anxiety and depression as measured by the Hospital Anxiety and Depression Scales (HADS) assessed at baseline, post-intervention, 2-months, and 6-months after treatment. The primary outcome timepoint was the 2-month assessment. Secondary outcomes included generalised worry, positive wellbeing, pandemic-related stress, and suicidal ideation. ResultsOne hundred and sixty-one participants (88%) were retained at the 2-month follow-up. Intent-to-treat analyses indicated that the Coping with COVID condition did not lead to significant reductions in in anxiety (mean difference 0.24 [95% CI, -1.01,1.48], p>0.05), or depression (mean difference .03 [95% CI, -1.19, 1.26], p>0.05) relative to SC. Similarly, there were no significant differences between conditions for all secondary outcomes. ConclusionsThe findings suggest that the benefits of strategies that comprise transdiagnostic scalable psychological interventions may not surpass non-specific factors in driving symptom reduction. There is a need to further evaluate the non-specific factors in scalable psychological programs because focusing on these may have implications for ease of training and implementation.