Painhunting Therapy for Interpersonal Loss-Related Depression

Painhunting LLP72 enrolled

Overview

This pilot randomized controlled trial evaluates the efficacy of Painhunting therapy, a brief structured psychotherapy, for adults with significant interpersonal loss and comorbid depressive symptoms in Kazakhstan. Seventy-two participants will be randomly assigned to receive either immediate Painhunting therapy (3 sessions over 3-4 weeks) or a 4-week waitlist control condition. Therapy is delivered in-person in Astana or remotely via secure video conferencing (Zoom). Therapy sessions will be delivered by five trained Painhunting practitioners under the supervision of the Principal Investigator. The primary outcomes are changes in depression severity (PHQ-9) and complicated grief symptoms (ICG) from baseline to post-treatment. Secondary outcomes include anxiety, PTSD symptoms, and functional disability. All waitlist participants receive treatment after the waiting period.

Interpersonal loss, including experiences such as relationship dissolution, betrayal, abandonment, or the death of a close person, is a significant psychological stressor that can lead to persistent emotional distress, depressive symptoms, and functional impairment. A subset of individuals exposed to interpersonal loss develops prolonged or complicated grief reactions accompanied by depressive symptoms and difficulties in emotional regulation. Painhunting therapy is a structured psychotherapeutic approach designed to identify emotionally significant past incidents associated with current psychological distress and to facilitate emotional processing of these experiences. Preliminary evidence from a case series study (Paper 1) and a thematic analysis of mechanisms of change (Paper 2) suggests potential therapeutic benefits, but controlled evidence is currently lacking. This randomized pilot trial uses a waitlist-controlled design with stratified block randomization, blinded outcome assessment, and a pre-registered analysis plan to provide initial controlled evidence regarding the efficacy of Painhunting therapy for individuals experiencing depressive symptoms related to interpersonal loss. The study is coordinated from Astana, Kazakhstan. Therapeutic sessions are conducted either in person or via secure video conferencing. The study is conducted in Russian and Kazakh, with participants selecting their preferred language at enrollment and being assigned to a therapist fluent in that language.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: Age 18 to 65 years * PHQ-9 score of 8 or higher * ICG score of 25 or higher * Interpersonal loss occurring between 6 and 120 months prior to enrollment * Willing to accept randomization * Proficient in Russian or Kazakh * Able to provide informed consent Exclusion Criteria: * Active suicidal ideation with intent or plan (PHQ-9 item 9 score of 2 or higher, confirmed by clinical interview), with referral to appropriate crisis services if excluded * Current psychotic symptoms * Active substance use disorder (moderate-severe) * Currently receiving psychotherapy * Bereavement by suicide * Cognitive impairment precluding consent * Psychiatric medication initiated within prior 8 weeks

Outcomes

Primary Outcomes

Change in PHQ-9 (Patient Health Questionnaire-9) Score

Self-report measure of depression severity (range 0-27). Higher scores indicate more severe depression.

Time frame: Baseline (T0) to post-treatment/end of wait (T2, approximately week 4)

Change in ICG (Inventory of Complicated Grief) Score

Self-report measure of complicated grief symptoms (range 0-76). Scores of 25 or higher indicate clinically significant complicated grief.

Time frame: Baseline (T0) to post-treatment/end of wait (T2, approximately week 4)

Secondary Outcomes

Change in GAD-7 Score (Anxiety)

Change in Generalized Anxiety Disorder-7 (GAD-7) Score Self-report measure of anxiety severity (range 0-21). Higher scores indicate more severe anxiety

Time frame: Time Frame: Baseline (T0) to post-treatment/end of wait (T2, approximately week 4)

Change in PCL-5 Score (PTSD Symptoms)

Change in PTSD Checklist for DSM-5 (PCL-5) Score Self-report measure of PTSD symptoms (range 0-80). Higher scores indicate more severe PTSD symptoms.

Time frame: Baseline (T0) to post-treatment/end of wait (T2, approximately week 4)

Change in WHO-DAS 2.0 12-Item Score (Functional Disability)

Change in World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS 2.0) 12-item Score Measure of functional disability (range 12-60). Higher scores indicate greater disability.

Time frame: Baseline (T0) to post-treatment/end of wait (T2, approximately week 4)

Maintenance of Treatment Gains in PHQ-9 and ICG Scores

Maintenance of treatment gains as measured by change in Patient Health Questionnaire-9 (PHQ-9) and Inventory of Complicated Grief (ICG) scores from post-treatment (T2) to 3-month follow-up (T3). PHQ-9 is a self-report measure of depression severity (range 0-27), with higher scores indicating more severe depression. ICG is a self-report measure of complicated grief symptoms (range 0-76), with higher scores indicating more severe grief.

Time frame: Post-treatment (T2) to 3-month follow-up (T3, approximately week 16)

Painhunting Therapy for Interpersonal Loss-Related Depression

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts