Group-Based Cognitive Behavioral Therapy Training Improves Mental Health of SME Entrepreneurs : Experimental Evidence from Conflict-Affected Areas of Pakistan

Mental health, well-being, and lasting economic outcomesare intimately connected. However, in geographies markedby fragility, conflict, and violence (FCV), entrepreneursof small and medium size enterprises (SMEs) experiencechronic stress and poor mental health on a regular basis.These issues can hamper performance and quality of lifefor the entrepreneurs, and can dampen the benefits ofexisting financial and business assistance programs. Fewproven rigorous interventions are known. This study teststhe hypothesis that a five-week group Cognitive BehavioralTherapy (CBT) training called Problem Management Plusfor Entrepreneurs (PM+E), in combination with financialassistance, could be more effective at reducing psychologicalstressors of SME entrepreneurs in FCV contextsthan financial assistance alone. Meaningful and statisticallysignificant improvements in mental health were achieved,with improvements persisting and increasing beyond theimmediate post-intervention period. Based on analysis ofpooled data across two follow-up rounds (at five weeks andthree months post-intervention), entrepreneurs in the treatmentgroup experienced statistically significant reductionin the intensity and prevalence of depression and anxietysymptoms (measured by the Patient Health QuestionnaireAnxiety and Depression Scale) and higher levels ofwell-being (measured by the World Health OrganizationWell-Being Index) compared with the control group. Theeffect was marked for those experiencing mild/moderatelevels of depression and anxiety, suggesting the clinicalvalue of such low touch interventions. Overall, the studydemonstrates that empirical research through RandomizedControl Trials (RCTs) can be conducted in challenging,FCV settings through appropriate rapid training of localresearchers and non-specialist providers (NSPs) at a lowcost, yielding scalable programmatic and policy level lessons.