Schahryar Kananian, Annabelle Starck, Ulrich Stangier.
Published in Clinical Psychology in Europe, 2021.
DOI: 10.32872/cpe.5271.
Culturally adapted cognitive-behavioral therapy (CA CBT) is a validated intervention for refugees, integrating psychoeducation, problem-solving, meditation, and stretching exercises.
There are currently no standardized procedures for adapting psychological interventions to cultural contexts.
The paper illustrates the adaptation process of CA CBT for Afghan refugees through various trials, highlighting both successes and limitations.
Detailed processes of adapting CA CBT, including methods and rationale for protocol changes, were evaluated against proposed reporting criteria.
Afghan refugees speaking Farsi and Dari were identified as the target population, with considerations for cultural similarities and differences among Afghan, Iranian, and Syrian refugees.
A review highlighted culturally relevant expressions of distress, such as 'asabi' (nervous agitation) and 'gham' (sadness).
Qualitative interviews with Afghan refugees revealed additional idioms and concerning personal interpretations of their symptoms.
Five stages were followed:
Information gathering
Preliminary adaptation design
Testing adaptations
Refinement
Cultural adaptation trials
CA CBT aims to develop resilience and emotional regulation, addressing multiple psychological difficulties.
Despite high psychological distress among Afghan refugees, acceptance and familiarity with traditional CBT show low engagement levels, linked to potential cultural conflicts.
The group format of CA CBT facilitates community building and reduces isolation among participants.
Although adaptation steps were documented, the team did not completely capture the decision-making process for modifications.
The adaptation team had leading experts with substantial experience working with refugees, guiding the adaptation through their previous findings and practices.
The article emphasizes the need for thorough compliance and documentation in future adaptations to enhance cultural sensitivity in mental health interventions for refugees.
Encourages standardized criteria to improve evidence-based practices in culturally adapted therapy for diverse refugee populations.