Lebanon

Beirut

PARTNER

WHO

Lebanon is a small middle-income country often facing political turmoil, internal conflict, and border tensions. It hosts more than a million Syrian refugees, the second-highest number in the world which greatly affects its political, economic, and social stability. Lebanese and Syrian refugees have significant mental health needs, but the country lacks the specialized personnel needed to deal with such needs.

By using computerized psychological self-help therapy, or E-mental health, this project addresses diseases associated with anxiety and depression. Due to its digital nature, the intervention is cost-effective and scalable, as well as in line with the Lebanese mental health strategy 2015-2020. The therapy is also evidence-based and low intensity – meaning it doesn’t need to be delivered by a specialized mental health professional – and therefore, requires fewer resources. The delivery method is also ideal for Lebanon, a country with widespread access to the internet and smartphones.

The E-mental health intervention adapts both WHO’s face-to-face cognitive behavioural therapy (CBT) program, known as PM+ (Problem Management Plus) and a storytelling approach. PM+ is a scalable intervention for adults impaired by distress in communities exposed to adversity. It can be applied to improve aspects of mental health and psychosocial well-being no matter how severe an individual’s problems are. Storytelling also provides relatable content for patients allowing them to tackle depression or anxiety. Sessions are based on therapeutic principles: cognitive-behavioural elements, stress management (addressed through a breathing exercise) and some cognitive coping.

The first phase of the project, undertaken with the support of the University of Zurich, is to develop a generic computer-based CBT (c-CBT) intervention in English that will then be adapted for Lebanon (in Arabic). The software will be tested in a few health service settings in Beirut and will assess Lebanese, Palestinian and Syrian refugees suffering from anxiety or depression. WHO is in charge of coordination and works closely with Lebanon’s Ministry of Health. The generic version will be used as the starting point for future adaptations in different contexts around the world.

In the second phase, the Lebanese c-CBT intervention will undergo randomized control trials (RCT) to scientifically confirm its effectiveness. This will provide rigorous evidence of the efficacy of an e-mental health approach in a middle-income country. Outcome evaluation is central to this project, and a mixed method (qualitative and quantitative) approach will be used.

In the third phase, WHO will build on the successful collaboration and partnership with the Lebanese Ministry of Public Health to implement Step-by-Step outside of a research context. Step-by-Step will be scaled up in Lebanon in order to provide much needed mental health support to people across the country and to develop a sustainable implementation model that can be used in other countries around the world.