The added benefit of including cognitive coping in brief psychosocial interventions: A randomized controlled trial among veterans and family members in Ukraine

Psychosocial programs in low- and middle-income countries (LMIC) often omit cognitive strategies due to perceived difficulty for clients and lay providers. We evaluated the benefit of including "cognitive coping" in a brief, online intervention for conflict-affected Ukrainian veterans and family members with mild to moderate psychosocial distress. Participants were randomized to two treatment conditions based on the Common Elements Treatment Approach Psychosocial Program (CPSS). CPSS-Basic (CPSS-B) included a self-assessment, safety screening and psychoeducation. CPSS-Enhanced (CPSS-E) included these as well as cognitive coping. Distress, functional impairment, alcohol use, aggression, social disconnectedness and conflict resolution were assessed after one month. Participants also evaluated program accessibility, acceptability, appropriateness, feasibility and adoption. Of 1,177 study participants, 788 (67%) completed follow-up. Both conditions significantly improved distress, functional impairment, aggression and social disconnectedness; CPSS-E producing a greater reduction in distress than CPSS-B (ES: <i>d</i> = .22, <i>p</i> = .002). Implementation outcomes were positive across conditions, favoring CPSS-E for appropriateness (<i>d</i> = .48, 95% CI: .33, .62), feasibility (<i>d</i> = .15, 95% CI: .00, .29), adoption (<i>d</i> = .34, 95% CI: .19, .48) and acceptability (<i>d</i> = .29, 95% CI: .15, .44). Findings support the feasibility and added value of incorporating cognitive techniques into psychosocial programming in LMIC.