Asian Journal of Cognitive Behavior Therapy

Attitudes of Mental Health Professionals Toward Digital Cognitive Behavioral Therapy in Pakistan

Tue, 30 Jun 2026 09:22:30 +0000

Background: Digital mental health services are growing at a swift pace around the world, and there is an urgent need to understand the attitudes of professionals towards technology-assisted psychological treatments in low and middle-income countries. This study explored the attitudes of mental health professionals in Pakistan towards digital Cognitive Behavioral Therapy (CBT), which is the use of internet platforms or mobile applications to provide CBT.

Methods: A cross-sectional survey design using a quantitative approach was used. There were 80 mental health professionals (clinical psychologists, counsellors and psychiatrists) who participated (Mage = 36.32, SD = 9.91). A 31 items instrument developed by the researchers measured seven domains of the attitudes. The instrument assessed seven domains: knowledge and training, perceived effectiveness and clinical confidence, cultural fit and contextual adaptation, online therapeutic alliance, digital literacy and technology confidence, workload/supervision/professional support, and willingness to implement/perceived barriers. Frequency distributions and valid percentages were used to analyse the data.

Results: Results showed positive attitudes overall, with the exception of a few items. The willingness to use digital CBT, if trained, was the most highly endorsed item (95.0%). There was a general consensus on the importance of cultural adaptability and the incorporation of Islamic values and Pakistani family dynamics. The systemic barriers were shown to be significant, especially the lack of supervision (50.0% access), lack of organisational support (23.8% disagreed), and infrastructural issues like unreliable internet and electricity (77.5% acknowledged).

Conclusion: Results indicated that there is a high level of attitudinal readiness amongst the mental health professionals in Pakistan, but it will take targeted training, institutional support and culturally adapted digital platforms to be implemented.

Translation and Cultural Adaptation of the Dysfunctional Attitude Scale (DAS) into Urdu

Tue, 30 Jun 2026 00:00:00 +0000

Background: Dysfunctional attitudes are negative, unhelpful beliefs that play a central role in emotional distress and are a core component of Beck’s cognitive theory of depression. The 35-item Dysfunctional Attitude Scale (DAS-35), developed by Mathers Clinic, has been used in research and applied settings to assess dysfunctional attitudes; however, evidence supporting its psychometric performance in clinical populations remains limited.

Objectives: To translate, culturally adapt, and evaluate the psychometric properties of the Urdu version of the DAS-35 in a Pakistani sample.

Method: Ethical approval was obtained from the institutional review board of the University of Malakand (Ref: UOM/PSY/191; 03-02-2026). A multi-method cross-sectional design was used across three phases. First, the DAS-35 was translated into Urdu following MAPI guidelines for linguistic validation. Second, the translated version was pre-tested with 100 bilingual university students. Third, the final Urdu version was administered to 600 participants (300 individuals with elevated depressive symptoms and 300 from the general population) aged 15–65 years. The Urdu version of the Hospital Anxiety and Depression Scale (HADS) was used to assess convergent validity and classify participants based on depressive symptom severity. Internal consistency, discriminative validity, convergent validity, gender differences, and confirmatory factor analysis (CFA) were conducted using SPSS 27 and R (lavaan package).

Results: Internal consistency ranged from α = .47 to .68, with lower values for the Approval and Achievement subscales. Participants endorsed dysfunctional attitudes across all seven domains, with Entitlement and Approval showing the highest means. Three subscales (Approval, Love, and Perfectionism) and nine items significantly differentiated between the elevated symptom and general population groups. Significant negative correlations were observed between DAS-35 subscales and HADS scores, supporting convergent validity. No gender differences emerged at the subscale level, although four items showed significant differences. CFA of the seven-factor model indicated poor fit (χ²(539)=2931.27, p<.001; CFI=.57; TLI=.53; RMSEA=.086; SRMR=.085). Four items had factor loadings below .30, particularly in Approval and Achievement domains.

Conclusion: The Urdu DAS-35 demonstrated preliminary reliability and evidence of convergent and discriminative validity. However, support for the original seven-factor structure was limited. Cultural factors may influence the expression and organization of dysfunctional attitudes, suggesting the need for item revision or alternative factor structures.

From Victim to Agent: CBT-Driven Behavioral Change and Reduction in psychological impact of Intimate Partner Violence among women in Pakistani shelter homes

Tue, 30 Jun 2026 00:00:00 +0000

Introduction: Domestic violence is a prevalent public health and human rights concern that affects psychological functioning. The present study compared the effectiveness of Group CBT and CBT-based Self-Help interventions in reducing the severity of intimate partner violence (IPV) and enhancing psychological well-being of women living in shelter homes in Karachi.

Method: 200 women exposed to IPV with elevated anxiety and depression scores were randomly allocated to Group CBT (n = 100) or CBT-based Self-Help (n = 100). Assessment tools included the HITS and the AKUADS scales at baseline and post intervention. The Group CBT condition underwent 10 structured sessions over 5 weeks, inclusive of psychoeducation, cognitive restructuring, behavioral activation, problem-solving, assertiveness training and communication skills. The Self-Help group was given a structured manual on CBT.

Results: The results suggest that both interventions significantly reduced IPV severity and psychological distress. The reductions in IPV severity (d = 3.57) were larger for the Group CBT intervention than for the Self-Help intervention (d = 1.46). Between-group analysis results showed Group CBT to be superior for post-intervention results (p < .001). There was a moderate correlation between a decrease in IPV severity and anxiety and depression symptoms (r = .42, p < .001).

Conclusion: Results indicate that although both interventions are effective, Group CBT is more effective in decreasing IPV severity and psychological distress. The study underscores the importance of group-based culturally-adapted CBT interventions as a scalable and effective intervention to support IPV survivors in low resource settings.

Efficacy of Cognitive Behavior Therapy for the Treatment of Persistent Depressive Disorder with Early Onset

Rida Nishat — Tue, 30 Jun 2026 00:00:00 +0000

Current case study describes the application of cognitive behavior therapy (CBT) to a 21-year-old female client presenting with persistent depressive disorder with early onset. The client reported loss of interest in daily activities, inability to feel pleasure, disturbed social relationships, and emotional dysregulation. She attributed her difficulties to a toxic family environment characterized by parental conflict, emotional neglect, and critical feedback. Assessment using the Beck Depression Inventory revealed a score of 26 (moderate depression) at baseline. Treatment consisted of 16 sessions incorporating relaxation exercises, behavioral activation, cognitive restructuring, and assertiveness training. Session records, case formulation, and therapeutic techniques are presented to enable clinicians to replicate the treatment approach with similar presentations in the South Asian context. Post-treatment BDI score was 11 (minimal depression), representing a 57.7% improvement.

Cognitive Behavioral Therapy for Generalized Anxiety Disorder with Agoraphobic Avoidance: A Clinical Case Report

Muneeba Amin — Tue, 30 Jun 2026 09:25:08 +0000

This case report describes the application of cognitive behavioral therapy (CBT) with a 44-year-old married male from Karachi, Pakistan, presenting with Generalized Anxiety Disorder, panic-like physiological symptoms and agoraphobic avoidance. The client reported excessive worry, disturbed sleep, irritability, low mood, fear of public places and public transport and reduced occupational and social functioning. Assessment was based on clinical interview, CBT assessment, DSM-5-TR diagnostic criteria, the Beck Anxiety Inventory and the Generalized Anxiety Disorder-7. The client obtained a score of 34 on the Beck Anxiety Inventory, indicating moderate anxiety and a score of 17 on the GAD-7, indicating severe anxiety. A formulation-based CBT intervention was delivered over 15 sessions through an online psychotherapy format. Treatment included psychoeducation, relaxation training, sleep hygiene, activity scheduling, mindfulness, grounding, thought monitoring, cognitive restructuring, downward arrow technique, Socratic dialogue, graded exposure, behavioral experiments, problem solving and relapse prevention. Improvement was observed in the client’s understanding of anxiety, ability to identify and challenge automatic thoughts, willingness to face avoided situations and confidence in managing physiological symptoms. The case highlights the clinical value of individualized CBT for anxiety presentations involving chronic worry, panic-like symptoms and avoidance within a Pakistani cultural context.