Common Elements Treatment Approach (CETA)

About This Program

Target Population: Children/adolescents ages 7-17 and their caregivers

For children/adolescents ages: 7 – 17

For parents/caregivers of children ages: 7 – 17

Program Overview

Common Elements Treatment Approach (CETA) is a multiproblem, flexible, approach that includes cognitive-behavioral elements to address symptoms of anxiety, depression, traumatic stress, substance misuse, interpersonal violence, and other related issues (e.g., medical adherence, relationship problems). CETA can be used with youth (7–17) and adults (18+) and can be provided in a variety of settings (e.g., community clinics, schools, healthy clinics). Administered by professional or lay providers, CETA can be used for prevention or treatment.

Program Goals

The goals of Common Elements Treatment Approach (CETA) are:

  • Reduce symptoms of anxiety.
  • Reduce symptoms of depression.
  • Reduce symptoms of traumatic stress.
  • Reduce symptoms of substance misuse.
  • Reduce symptoms of interpersonal violence.
  • Increase adherence to medical regimes.
  • Increase adherence to functioning.
  • Increase adherence to well-being.

Logic Model

The program representative did not provide information about a Logic Model for Common Elements Treatment Approach (CETA).

Essential Components

The essential components of Common Elements Treatment Approach (CETA) include:

  • Nine common elements:
    • Engagement & Education:
      • Psychoeducation on typical behavioral and mental health related problems and techniques (e.g., normalization of such feelings) designed to:
        • Decrease stigma.
        • Increase treatment buy-in.
        • Provide clients with information on how services can help them with their problems.
    • Cognitive Coping and Restructuring (Think Differently):
      • Help clients to change unhelpful thoughts (e.g., “Things will never get better”).
        • Teach clients that although there are some situations in life that they cannot change, they can change how they think about the situation in order to feel better and not get “stuck” in unhelpful emotional and behavioral patterns.
    • Behavioral Activation:
      • Help clients change their daily behaviors in order to feel better:
        • People in stressful situations often stop taking care of themselves and engaging in enjoyable activities.
        • Help clients to engage in everyday, small enjoyable activities to increase their mood.
    • Confronting Fears & Trauma Memories:
      • Help clients talk about trauma memories:
        • Gradual exposure to traumatic memories is designed help the client to be able to think about the memory without high distress.
        • The aim is for the client to get to control the memories, instead of having the memories control them (e.g., nightmares, flashbacks).
    • Safety Assessment & Planning:
      • Assess safety issues (e.g., how severe or serious is this safety issue?)
      • Safety planning which is designed to:
        • Reduce the likelihood of harm to the client and/or others.
        • Empower the client with ways keep themselves (or others) safe.
    • Substance Abuse Intervention:
      • Assess current substance use.
      • Help the client learn strategies to meet their substance reduction goals.
      • Utilize nonjudgmental language and motivational interviewing techniques to help the client make desired changes.
    • Problem-Solving:
      • Involves the following steps:
        • Define the problem
        • Set a goal
        • List and evaluate solutions
        • Pick a solution
        • Create steps to test out the chosen solution.
      • Problems can feel overwhelming and impossible to solve, this element is designed to:
        • Increase client’s feelings of agency.
        • Decrease unhelpful emotions (e.g., frustration, sadness) around the situation.
    • Anxiety Management:
      • Help the client to be able face feared object/places gradually for fears that are safe to face and interfere with daily functioning (e.g., not going someplace out of fear).
      • Learn to relax one’s body when feeling tense or uncomfortable through learning multiple techniques (e.g., deep breathing, imagery).
    • Caregiver Skills:
      • For caregivers of youth who are showing some behavioral problems
      • Skills are chosen based on the problems and include:
        • Positive praise
        • Consequences
        • Special time/attention
        • Selective attention
        • Many other behavioral management strategies

Program Delivery

Child/Adolescent Services

Common Elements Treatment Approach (CETA) directly provides services to children/adolescents and addresses the following:

  • Depression, anxiety, traumatic stress, behavior problems, substance misuse, safety risk (suicide, homicide, interpersonal violence), poor well-being, poor functioning

Parent/Caregiver Services

Common Elements Treatment Approach (CETA) directly provides services to parents/caregivers and addresses the following:

  • Caregivers of youth with depression, anxiety, traumatic stress, substance misuse, safety risk (suicide, homicide, interpersonal violence) and behavioral problems

Recommended Intensity:

Weekly, 60-minute sessions

Recommended Duration:

Typically 6-12 sessions, but is individualized to need.

Delivery Settings

This program is typically conducted in a(n):

  • Community Daily Living Setting
  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)
  • Shelter (Domestic Violence, Homeless, etc.)
  • Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

Common Elements Treatment Approach (CETA) includes a homework component:

Clients are provided weekly homework to practice the skills learned in session.

Languages

Common Elements Treatment Approach (CETA) has materials available in languages other than English:

Arabic, Burmese, Russian, Spanish, Ukrainian

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Space for private sessions (this could be at the center or elsewhere), trained counselors/supervisors, access to computers and/or communication devices for ongoing supervision

Manuals and Training

Prerequisite/Minimum Provider Qualifications

At least a 10th grade education with ability to speak, read, and write in the local language

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Murray, L., Dorsey, S. Metz, K., & Skavenski, S. (2020). The Common Elements Treatment Approach for Adults. Johns Hopkins University.

Murray, L., Dorsey, S. Metz, K., & Skavenski, S. (2021). The Common Elements Treatment Approach for Children. Johns Hopkins University.

A copy of the manual can be requested from the developer.

Training Information

There is training available for this program.

Training Contacts:
Training Type/Location:

Please email the training contacts above for information about how training is obtained. In-person, virtual, or hybrid trainings are available.

Number of days/hours:

8- to 10-day provider training. Supervisors are typically trained during this time as well.

Relevant Published, Peer-Reviewed Research

Murray, L. K., Hall, B. J., Dorsey, S., Ugueto, A. M., Puffer, E. S., Sim, A., Ismael, A., Bass, J., Akiba, C., Lucid, L., Harrison, J., Erikson, A, & Bolton, P. A. (2018). An evaluation of a Common Elements Treatment Approach for youth in Somali refugee camps. Global Mental Health, 5, Article e16. https://doi.org/10.1017/gmh.2018.7

Type of Study: One-group pretest–posttest study
Number of Participants: 38

Population:

  • Age — Child: Mean=11.21 years; Caregiver: Mean=41.24 years
  • Race/Ethnicity — 100% Somali
  • Gender — Child: 44.44% Female; Caregiver: 82.86% Female
  • Status — Participants were children in Somali refugee camps with internalizing, externalizing, and posttraumatic stress (PTS) symptoms.

Location/Institution: Three refugee camps in the Somali region of Ethiopia: Kebri Beyah, Sheder, and Aw Barre, all near Jijiga town in the Ogaden region of eastern Ethiopia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on: (1) an evaluation of a Common Elements Treatment Approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention. Measures utilized include the Child Behavior Checklist (CBCL)/ Youth Self Report (YSR), the Post Traumatic Stress Disorder Symptom Scale Interview format (CPSS-I), and the Orphans and Vulnerable Children Wellbeing Tool. Results indicated that children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing, externalizing, and posttraumatic stress, and improvements in well-being. Limitations include the small sample size, lack of randomization, lack of control group, records of what elements were done in each session were based on a verbal report from the lay counselor to the local supervisor and then onto the trainer, the qualitative interviews yielded relatively brief responses from youth and caregivers, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Murray, L. K., Dorsey, S., Haroz, E., Lee, C., Alsiary, M. M., Haydary, A., Weiss, W. M., & Bolton, P. (2013). A common elements treatment approach for adult mental health problems in low- and middle-income countries. Cognitive and Behavioral Practice, 21(2), 111-123. https://doi.org/10.1016/j.cbpra.2013.06.005

Contact Information

Laura Murray, PhD (Developer)
Agency/Affiliation: Johns Hopkins University
Website: cetaglobal.org
Email:
Kristie Metz, PhD
Agency/Affiliation: Johns Hopkins University
Email:

Date Research Evidence Last Reviewed by CEBC: July 2021

Date Program Content Last Reviewed by Program Staff: November 2021

Date Program Originally Loaded onto CEBC: December 2021