Effectiveness of Brief Psychotherapies (Meaning-Centered Therapy, Dignity Therapy, and Cognitive Behavioural Therapy) in Improving Treatment Adherence and Psychosocial Outcomes Among Patients with Multidrug-Resistant Tuberculosis: A Prospective Intervention Study from Nigeria

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Background: Multidrug-resistant tuberculosis (MDR-TB) causes profound psychological and existential distress. Evidence for targeted psychotherapies in low-resource settings is limited. Objective: To evaluate the efficacy of Meaning-Centered Psychotherapy (MCP), Dignity Therapy (DT), and Cognitive Behavioural Therapy (CBT) against a waitlist control on psychological, existential, and quality of life outcomes in MDR-TB patients. Methods: A randomised controlled trial was conducted with 280 patients assigned to MCP (n=70), DT (n=70), CBT (n=70), or a waitlist control (n=70). The Hospital Anxiety and Depression Scale (HADS), FACIT-Sp-12, Patient Dignity Inventory (PDI), and WHOQOL-BREF were used at baseline, post-intervention, and 6-month follow-up. Data were analysed using a 4 (Group) x 3 (Time) mixed-model ANOVA. Results: A significant time × group interaction (p<0.001) was found for all outcomes. All therapy groups showed significant improvements from baseline to post-intervention and follow-up (p<0.001), unlike the control group. MCP and DT led to significantly greater improvements in spiritual well-being (FACIT-Sp-12) and reductions in dignity-related distress (PDI) compared to CBT. All active interventions improved anxiety, depression, and quality of life comparably. Conclusion: MCP, DT, and CBT are efficacious for MDR-TB patients' distress. Existential therapies offer specific benefits for spiritual well-being and dignity, advocating for their integration into holistic care.

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