Previously submitted to: JMIR Mental Health (no longer under consideration since May 22, 2025)
Date Submitted: May 21, 2025
Open Peer Review Period: May 22, 2025 - May 22, 2025
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Efficacy of Cognitive Behavioral Therapy and Pharmacological Interventions in Treating Adult Psychological Distress in Peshawar, Khyber Pakhtunkhwa, Pakistan. A Randomized Controlled Trial
ABSTRACT
Background:
Psychological distress is a growing public health concern in Pakistan, particularly in urban centers like Peshawar. This study aimed to compare the effectiveness of Cognitive Behavioral Therapy (CBT) and pharmacological treatment in reducing depression, anxiety, and improving health status, physical activity, and sleep quality among adults.
Objective:
This study provides robust evidence supporting the efficacy of both Cognitive Behavioral Therapy (CBT) and pharmacological interventions in reducing psychological distress among adults in Peshawar, Khyber Pakhtunkhwa. Through comprehensive assessment across multiple domains including depression, anxiety, health status, physical activity, and sleep quality both interventions demonstrated statistically significant improvements.
Methods:
A randomized controlled trial was conducted with 300 participants, evenly divided into CBT (n=150) and pharmacotherapy (n=150) groups. Participants received 12 weeks of either CBT or prescribed medications. Validated tools such as the Beck Depression Inventory-II, Hamilton Anxiety Scale, SF-36, and Pittsburgh Sleep Quality Index were used to measure outcomes before and after treatment. Data were analyzed using Wilcoxon Signed-Rank and Paired Sample t-tests.
Results:
Both CBT and pharmacotherapy significantly reduced depression and anxiety levels in males and females (p < 0.005). CBT showed slightly greater improvements, especially in anxiety reduction. Health status improved more in the CBT group for both males and females. Physical activity levels increased significantly in both groups, with slightly higher gains seen in females receiving pharmacotherapy and males in the CBT group. Sleep quality also improved in all groups, with the CBT group, particularly females, experiencing the greatest improvements.
Conclusions:
Both treatments were effective in managing psychological distress, but CBT showed slightly stronger results across most outcomes. These findings support CBT as a valuable first-line treatment option in mental health care settings in Peshawar.
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