The effectiveness and acceptability of culturally adapted cognitive behavioural therapy for traumatised refugees and asylum seekers: A systematic review

Abstract

Despite the extent of traumatisation experienced by refugee groups, uptake of evidence-based interventions such as cognitive behavioural therapy (CBT) remain low with high dropout rates. While this has been linked to cultural differences in help seeking and how illness is understood, little is known about how effective or acceptable cultural adaptations to CBT (CA-CBT) are. Conduct a systematic review of the types of CA-CBT delivered to refugee groups and evaluate their effectiveness and acceptability. We searched six databases for CA-CBT delivered to refugee groups experiencing depression or post-traumatic stress disorder (PTSD). Effectiveness was evaluated using both quantitative outcome measures and qualitative data. Dropout rates were collected as a proxy measure of acceptability. The types of cultural adaptations used were also described. Findings are presented using narrative synthesis. We include 13 studies that made cultural adaptations to the delivery format or content of CA-CBT. Linguistic adaptations and including culturally relevant emotion regulation strategies were most common. Results showed significant decreases in PTSD symptom severity in all but one study, and significant decreases in depression outcomes across all studies. Dropout rates was nine percent among all participants. Findings from qualitative studies indicated reduced distress whereas cultural adaptation increased trust in treatment. There is initial evidence supporting the effectiveness and acceptability of CA-CBT. However, more research is required to establish best practices for adapting CBT to different cultures. Methodologically rigorous tests are needed to determine if CA-CBT effectively meets the needs of forcibly displaced populations.