Acceptance and efficacy of a metacognitive self-help intervention in an Arabic-speaking mixed patient sample with depression and/or obsessive–compulsive disorder: A randomized controlled trial

Abstract

Objective: In Arabic-speaking countries, most individuals with depression or obsessive–compulsive disorder (OCD) do not seek or receive evidence-based treatment due to a dearth of facilities, shame/self-stigma, or religious concerns. The feasibility and effectiveness of “Western” psychotherapeutic concepts have rarely been evaluated for Arabic-speaking populations. The present study examined the efficacy of My Metacognitive Training (myMCT), a trans-therapeutic self-help manual, in a mixed sample of participants with depression and/or OCD. We considered both participants with depression and/or OCD because a number of cognitive biases and dysfunctional beliefs are shared by the two disorders. Method: The myMCT manual was translated into Arabic. A total of 160 individuals with either self-reported OCD and/or self-reported depression were recruited. Individuals were assessed at baseline and then randomized either to myMCT ( n = 84) or to a wait-list control condition ( n = 76). Six weeks later, individuals were invited to the post assessment. The Beck Depression Inventory (BDI-II) served here as the primary outcome. Secondary outcomes were the Obsessive–Compulsive Inventory–Revised (OCI-R) and the self-rating version of the Yale-Brown Obsessive Compulsive Scale (OCD patients only). Individuals were reimbursed with a 17€ voucher. Results: Completion rates were similarly low in the two groups (myMCT: 37%, controls: 35%). Presumably because of the high rate of noncompletion and nonadherence (29%), the intention-to-treat analyses failed to yield a significant effect. Those who had at least started the myMCT intervention improved significantly on the BDI-II at a large effect size. A significantly larger improvement among those who had started or completed the myMCT intervention was also seen on the OCI-R at a large effect size. Conclusions: Individuals who studied the myMCT manual showed large improvement on the BDI-II, irrespective of their primary symptomatology. However, the results are seriously compromised by the low completion rates in both conditions. Importantly, evaluations using the same manual in other language populations (and with other background cultures) produced good to excellent retention rates. The study demonstrates that self-help manuals may not represent a suitable medium for large-scale dissemination of evidence-based self-help material in an Arab population and corroborates prior findings suggesting low adherence in this population. Whether smartphone apps and Internet interventions represent more viable alternatives than self-help manuals needs to be tested, as well as specific barriers preventing dissemination and completion in this population.