Publication date: Dec 01, 2025

Background: Brief psychological interventions in low-and-middle-income-countries (LMICs) have been typically tested against usual or enhanced usual care (EUC). This design precludes understanding of the role of non-specific factors in influencing outcomes. Objective: This study evaluated an adapted version of WHO’s Problem Management Plus (gPM+), titled Coping with COVID, against an active control condition to reduce anxiety and depression during the COVID-19 pandemic. Methods: In this two-arm, single-blind, randomised controlled trial, young adults aged 18-24 years who screened positive for COVID-19 related psychological distress in Bengaluru (India) were randomly allocated to either Coping with COVID (n = 91) or non-directive Supportive Counselling (SC; n = 92) groups. Coping with COVID was a 6-sesion, group-based programme that taught coping strategies for stress. SC was a 6-sesion, group-based programme that offered non-directive support. The primary outcomes were anxiety and depression as measured by the Hospital Anxiety and Depression Scales (HADS) assessed at baseline, post-intervention, 2-months (primary outcome timepoint), and 6-months after treatment. Secondary outcomes included generalised worry, positive wellbeing, pandemic-related stress, and suicidal ideation. Results: Between October 2021 and December 2022, 183 participants were enrolled into the trial. Relative to SC, Coping with COVID did not lead to significant reductions in anxiety (mean difference 0. 24 [95% CI, -1. 01,1. 48], p>. 05), or depression (mean difference .03 [95% CI, -1. 19, 1. 26], p>. 05). Similarly, there were no significant differences between conditions for all secondary outcomes. Conclusions: The findings suggest that the benefits of strategies that comprise transdiagnostic scalable psychological interventions may not surpass non-specific factors in driving symptom reduction. Clinical implications: There is a need to further evaluate the role of non-specific factors in scalable psychological programmes because focusing on these may have implications for ease of training and implementation. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621001064897.

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