Is CBT effective for poor households? Two recent papers (evaluated by The Unjournal) with contrasting results

By david_reinstein @ 2023-04-17T20:46 (+38)

This is a linkpost to https://unjournal.pubpub.org/pub/cashtransfersmetrics/

(Second link: Barker et al)

Two more Unjournal Evaluation sets are out. Both papers consider randomized controlled trials (RCTs) involving cognitive behavioral therapy (CBT) for low-income households in two African countries (Kenya and Ghana). These papers come to very different conclusions as to the efficacy of this intervention.

These are part of Unjournal's 'direct NBER evaluation' stream.

1. Barker et al, 2022

“Cognitive Behavioral Therapy among Ghana's Rural Poor Is Effective Regardless of Baseline Mental Distress”

^[1]

From anonymous evaluator 1:

This paper uses a field experiment to explore the impact of a 12-week CBT program among poor households in rural Ghana. The authors find that the CBT program increases mental and physical well-being, as well as cognitive and socioemotional skills and downstream economic outcomes.

2. Haushofer et al, 2020

The Comparative Impact of Cash Transfers and a Psychotherapy Program on Psychological and Economic Well-being, Johannes Haushofer, Robert Mudida and Jeremy P. Shapiro. 2020. Originally published as NBER Working Paper 28106

Evaluation summary, linking to individual evaluations from Hannah Metzler and an anonymous evaluator

From anonymous evaluator 2:

This paper studies the economic and psychological effects of providing two different interventions to low-income households in rural Kenya: a program in Cognitive Behavioral Therapy (CBT, a well-established form of psychotherapy) and an unconditional cash transfer. The authors use a randomized controlled trial with a 2-by-2 design to estimate the effect of each intervention alone and of both interventions combined. ...

Strikingly, the authors find no effect of the therapy program on any of their primary economic or psychological outcomes. /.. Unsurprisingly given the null effect of therapy, the combination of cash and therapy has similar effects to cash alone.

Thoughts

The evaluations of both papers are largely positive, and both appear credible. I hope that this open evaluation of each paper is a helpful input into a more direct comparison of these, as well as possible integration into a larger meta-analysis.^[2]

Thanks

Thanks to the four evaluators of these papers, who did strong and in-depth work, as well as to the evaluation managers (Hansika Kapoor and Anirudh Tagat), and others on the Unjournal team (especially Annabel Rayner and Gavin Taylor).