Theoretical background, first stage development and adaptation of a novel Integrative Adapt Therapy (IAT) for refugees

Abstract

Aims Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar. Methods A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia. Results The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia. Conclusions IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.

An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: A randomized controlled trial

“…IAT. A detailed description of the theoretical foundations and cultural adaptation of IAT has been published elsewhere [20].…”

“…The IAT program involved 6 weekly 45-minute sessions. As indicated, IAT is grounded on the 5 psychosocial pillars of the ADAPT model [20]. Refugees participating in IAT are encouraged to reflect on past and ongoing experiences related to the disruptions of the psychosocial foundations of their societies, their families, and their personal lives as they transitioned through the trajectory of mass conflict, upheaval, displacement, flight, and resettlement.…”

“…For example, in the session focusing on cognitive reappraisal, a refugee who reported feelings of guilt and shame following sexual assault was taught cognitive reappraisal techniques to address these maladaptive thoughts and feelings. A fuller account of the distinctive features of IAT compared to other CBT-derived treatments are detailed in our background papers [20,21].…”

“…We have previously documented the systematic process of developing, adapting, and piloting IAT amongst refugees in Malaysia [20] and amongst Rohingya refugees displaced to Cox's Bazaar, Bangladesh [30].…”

“…IAT therefore aims to improve mental health by promoting adaptive capacity and resilience [17][18][19]. For example, in treating a torture survivor [20], the counsellor may elect to focus on Pillar III, in which the emphasis is on addressing feelings of injustice and related symptoms of explosive anger. By understanding the genesis of these problems, the survivor becomes motivated to learn evidence-based techniques to manage their aggressive tendencies, thereby improving their sense of control, interpersonal relationships, and mental health [21].…”