intervention as well as cash grants, whereas those in the control group received only cash grants. The study, conducted with 235 SME entrepreneurs, found that CBT leads to improvements in mental health outcomes in the short run. Meaningful and statistically significant improvements in mental health were achieved, with improvements persisting and increasing beyond the immediate post‐intervention period. Three months after the intervention, based on analysis of pooled data across two follow‐up rounds (at five weeks and three months post‐intervention), entrepreneurs in the treatment group experienced statistically significant reduction in the intensity and prevalence of depression and anxiety symptoms (measured by the Patient Health Questionnaire Anxiety and Depression Scale) and higher levels of well‐being (measured by the WHO‐5 Well‐Being Index) compared with the control group. The effect was marked for those experiencing mild/moderate levels of depression and anxiety, indicating the clinical value of such low touch early interventions. Overall, the study demonstrates that empirical research through Randomized Control Trials (RCTs) can be conducted in challenging, FCV settings through appropriate rapid training of local researchers and non‐specialist providers (NSPs) at a low cost, yielding scalable programmatic and policy level lessons.

2. Why Focus on the Mental Health and Well‐Being of SME Entrepreneurs?

# 2.1 Global Literature Review

It is widely recognized that SMEs are a lifeline for job creation and economic growth in developing countries, including those affected by fragility, conflict, and violence (FCV). However, SME entrepreneurs deal with unusually high levels of uncertainty and experience cognitive resource depletion, which have high psychological and physical health costs (Fernet and others 2016; Monsell 2003). Studies show that individuals with a leadership predisposition and independent work arrangements, including entrepreneurs, tend to be more vulnerable to stress, alienation, loneliness, emotional turmoil, and burnout (Rokach 2014; Akisal and others 2005). Given the co‐ morbidity of stress prevalence with physical and mental health conditions, the risk of rising health care costs due to job stress for entrepreneurs can be significant (Buttner 1992; Jamal 1997; Jamal and Badawi 1995; Lewin‐Epstein and Yuchtman‐Yaar 1991).

Compared to large enterprises, SME entrepreneurs are at a greater risk for depression, anxiety, and other mental health conditions (Akande 1994; Ang 1991; Boyd and Gumpert 1983; Cocker, Martin, Scott, Venn, and Sanderson 2013). SME entrepreneurs lacking diversified capital, stable sources of income, or delegation opportunities tend to suffer from more stress and anxiety compared with their peers in salaried jobs or those working in larger firms. The high cognitive burden experienced by SME entrepreneurs can lead to weakened psychological health that can hinder their capacity to decide and act, thereby increasing counter‐productive work behaviors. This can result in lower sales turnover over the long run (Akende 1994; Dewe and Guest 1990; Harris and others 1999).

In FCV contexts, t <mark>he combination of regular business‐related entrepreneurial stressors with the uncertainties in the external environment can amplify poorer psychological outcomes and hamper business performance (Saraf and others 2018).</mark> The high levels of unpredictability, 4