Telehealth-Delivered Cognitive Processing Therapy for Earthquake Survivors in Türkiye: A Pilot Randomised Controlled Trial

Abstract

Natural disasters disproportionately affect mental health in low- and middle-income countries (LMICs), where access to specialised trauma-focused treatments is limited. Although cognitive processing therapy (CPT) is wellsupported by evidence, its use in post-disaster settings remains underexplored. This pilot randomised controlled trial evaluated the feasibility, acceptability, and preliminary effectiveness of telehealth-delivered CPT among earthquake-affected adults in T & uuml;rkiye. Thirty-six participants with elevated post-traumatic stress disorder (PTSD) symptoms were randomised to either telehealth-delivered CPT or a treatment-as-usual (TAU) control group. Outcomes included PTSD (PCL-5), depression (PHQ-9), anxiety (GAD-7), psychological distress (K10), and well-being (WHO-5), assessed at baseline, post-treatment, and 1-month follow-up. CPT was feasible and acceptable, with high treatment completion rates (88.8%). At 1-month follow-up, the CPT group showed greater reductions in PTSD symptoms relative to TAU (adjusted mean difference = -21.812, 95% CI -29.07, -14.54, p < 0.001, d = 1.63). CPT also led to improvements in depression (adjusted mean difference = -3.15, 95% CI -6.19, -0.11, p = 0.045, d = 0.59), anxiety (adjusted mean difference = -2.54, 95% CI -4.98, -0.10, p = 0.046, d = 0.58), distress (adjusted mean difference = -7.62, 95% CI -11.66, -3.55, p < 0.001, d = 1.07) and well-being (adjusted mean difference = 4.57, 95% CI 1.62, 7.51, p = 0.014, d = 0.82). These findings suggest that telehealth-delivered CPT is a feasible, acceptable, and potentially effective intervention for post-disaster mental health care in LMIC settings. To our knowledge, this is the first trial to adapt and evaluate CPT for post-disaster care in an LMIC context.