Since 2015, WHO and partners - MoPH Lebanon; University of Zurich; Frei Universität Berlin; VU University Amsterdam; International Medical Corps; AFMM (Association Francophone pour les Malades Mentaux); Abaad; Embrace; UNHCR; local academics and clinicians; and Fondation d’Harcourt - have collaborated to develop Step-by-Step (Step-by-Step) for people in Lebanon, including Syrians in Lebanon.
Step-by-Step is an innovative approach to reducing the suffering and disability associated with mental health issues that can be used in countries of all income levels, for populations that can access the internet. Step-by-Step, is a brief (5 session) intervention for depression. Step-by-Step adopts a predominantly behavioral activation therapeutic approach that is delivered in the form of an illustrated story with an interactive component. It also uses psychoeducation, relaxation techniques, positive self-talk, and garnering social support. It has been carefully designed and comprehensively adapted for use in Lebanon (including refugees residing in Lebanon). Step-by-Step is delivered as guided self-help, with trained non-specialist “e-helpers”, providing phone or message-based support to Step-by-Step users for around 15 minutes a week. The effectiveness of Step-by-Step has been evaluated in randomized controlled trials (RCTs) with Lebanese and other populations residing in Lebanon (funded by Fondation d’Harcourt), and a parallel trial with Syrians in Lebanon (funded by R2HC). Step-by-Step was found to be effective in reducing depression, impaired functioning, posttraumatic stress, anxiety, and increasing subjective well-being in both trials. These effects were found to continue 3 months after participants had finished the intervention. These results show that a guided digital intervention can be effective in treating depression in adverse contexts. Currently, Step-by-Step is implemented as a service in Lebanon with support of Fondation d’Harcourt, to identify a sustainable implementation model for the intervention in Lebanon. WHO is currently preparing Step-by-Step for release as an open access package for adaptation and implementation elsewhere.