cultural adaption of cbt for afghan refugees in europe

Latest Developments in Cultural Adaptation of CBT for Afghan Refugees

Authors and Publication Details

• Schahryar Kananian, Annabelle Starck, Ulrich Stangier.

• Published in Clinical Psychology in Europe, 2021.

• DOI: 10.32872/cpe.5271.

Background

• 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.

Methodology of Adaptation

Adaptation Description

• Detailed processes of adapting CA CBT, including methods and rationale for protocol changes, were evaluated against proposed reporting criteria.

Target Population

• 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.

Culturally Specific Components

Idioms of Distress

• 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.

Adaptation Stages

• Five stages were followed:

  • Information gathering

  • Preliminary adaptation design

  • Testing adaptations

  • Refinement

  • Cultural adaptation trials

Key Findings

Effectiveness and Acceptance

• 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.

Group Therapy Benefits

• The group format of CA CBT facilitates community building and reduces isolation among participants.

Documentation of Adaptation Processes

Challenges in Documentation

• Although adaptation steps were documented, the team did not completely capture the decision-making process for modifications.

Importance of Expert Involvement

• The adaptation team had leading experts with substantial experience working with refugees, guiding the adaptation through their previous findings and practices.

Conclusions

Significance of Standardized Procedures

• The article emphasizes the need for thorough compliance and documentation in future adaptations to enhance cultural sensitivity in mental health interventions for refugees.

Future Directions

• Encourages standardized criteria to improve evidence-based practices in culturally adapted therapy for diverse refugee populations.