Transdiagnostic culturally adapted CBT with Farsi-speaking refugees: a pilot study

Abstract

Background: Approximately half of all asylum seekers suffer from trauma-related disorders requiring treatment, among them Posttraumatic Stress Disorder (PTSD), depression, anxiety, and somatic symptoms. There is a lack of easily accessible, low-threshold treatments taking the cultural background into account. Culturally Adapted CBT (CA CBT) is a well evaluated, transdiagnostic group intervention for refugees, using psychoeducation, meditation, and Yoga-like exercises. Objective: An uncontrolled pilot study with male Farsi-speaking refugees from Afghanistan and Iran was conducted to investigate feasibility with this ethnic group; a group for which no previous CBT trials have been reported. Method: The participants were nine Farsi-speaking, male refugees with M.I.N.I./DSM-IV diagnoses comprising PTSD, major depressive disorder, and anxiety disorders. Treatment components were adapted to the specific cultural framework of perception of symptoms, causes, ideas of healing, and local therapeutic processes. Before and after 12 weeks of treatment, the primary outcome was assessed using the General Health Questionnaire (GHQ-28). Secondary outcome measures were the Posttraumatic Checklist, Patient Health Questionnaire, Somatic Symptom Scale, World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Affective Style Questionnaire (ASQ), and Emotion Regulation Scale (ERS). Results: Seven participants completed treatment. In the completer analysis, improvements were found on almost all questionnaires. Large effect sizes were seen for the GHQ-28 (d = 2.0), WHOQOL-BREF scales (d = 1.0–2.3), ASQ tolerating subscale (d = 2.2), and ERS (d = 1.7). With respect to feasibility, cultural adaptation seemed to be a crucial means to promote effectiveness. Conclusion: CA CBT may reduce general psychopathological distress and improve quality of life. Improvement in emotion regulation strategies may mediate treatment effects. More support should be provided to enhance coping with the uncertainty of asylum status and stressful housing conditions. CA CBT appears to be a promising transdiagnostic treatment, serving as an initial low-threshold therapy in a stepped care approach.

Prevalence of prolonged grief disorder in a sample of female refugees

“…Yet, these studies have been conducted on non-refugee populations. Other promising approaches could be writing exercises as already used by Kalantari and colleagues in bereaved Afghani refugees [51] or an adaption of culturally adapted CBT as seen in Hinton and colleagues [52].…”

A five-day inpatient EMDR treatment programme for PTSD: pilot study

“…The trauma-informed yoga was added to the programme to enhance emotional regulation skills and stress regulation by means of bodily control during the intensive treatment (Kananian, Ayoughi, Farugie, Hinton, & Stangier, 2017; Yehuda et al, 2017). The protocol was adapted from ‘Trauma-sensitive yoga’ (Emerson & Hopper, 2011) and the ‘Yoga for the mind’ programme (Mason, 2011).…”

Culturally Adapted Cognitive Behavioral Therapy Plus Problem Management (CA‐CBT+) With Afghan Refugees: A Randomized Controlled Pilot Study

“…A previous pilot study by our group in a sample of Afghan refugees also showed promising results, with a significant reduction of general psychopathological distress (Kananian et al, 2017). A major limitation of this pilot was its lack of a control group.…”

“…A power analysis was calculated using G * Power (Faul et al, 2007) and based on an F test model. We based the calculation on the primary outcome of the initial pilot trial of culturally adapted CBT (Kananian et al, 2017) and prior trials by Hinton et al (2005Hinton et al ( , 2011, which yielded a Hedges' g effect size of 2.5 and Cohen's d effect sizes of 3.8 and 3.0, respectively. For the comparison of the treatment condition and the randomized waitlist control condition, we expected a Cohen's d effect size of 2.0 or an f value of 1.…”