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Culturally Adapted Cognitive Behavioral Therapy Plus Problem Management (CA‐CBT+) With Afghan Refugees: A Randomized Controlled Pilot Study
Author(s) -
Kananian Schahryar,
Soltani Yasaman,
Hinton Devon,
Stangier Ulrich
Publication year - 2020
Publication title -
journal of traumatic stress
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.259
H-Index - 134
eISSN - 1573-6598
pISSN - 0894-9867
DOI - 10.1002/jts.22615
Subject(s) - psychoeducation , randomized controlled trial , cognitive behavioral therapy , distress , clinical psychology , general health questionnaire , refugee , quality of life (healthcare) , anxiety , cognitive therapy , mental health , psychology , psychopathology , psychiatry , medicine , cognition , intervention (counseling) , psychotherapist , surgery , archaeology , history
Culturally adapted cognitive behavioral therapy (CA‐CBT) is a well‐evaluated, transdiagnostic group intervention for refugees that uses psychoeducation, meditation, and stretching exercises. In the current study, we added problem‐solving training to CA‐CBT and evaluated this treatment (i.e., CA‐CBT+) in a randomized controlled pilot trial with a sample of Farsi‐speaking refugees. Participants ( N = 24) were male refugees diagnosed with DSM‐5 PTSD, major depressive disorder, and anxiety disorders who were randomly assigned to either a treatment or waitlist control (WLC) condition. Treatment components were adapted both to the specific cultural background and the current social problems of asylum seekers. Assessments were performed pretreatment, 12‐weeks posttreatment, and 1‐year follow‐up. The primary treatment outcome was the General Health Questionnaire (GHQ‐28); secondary outcome measures included the Posttraumatic Stress Disorder Checklist, Patient Health Questionnaire, Somatic Symptom Scale, World Health Organization Quality of Life, and Emotion Regulation Scale. Eleven of 12 participants were randomized to CA‐CBT+ completed treatment. Based on intent‐to‐treat data, large between‐group effect sizes were seen at posttreatment in the GHQ‐28, d = 3.0, and for most secondary outcome measures. Improvements for individuals in the treatment group decreased at 1‐year follow‐up, but effect sizes demonstrated continued large improvements on all measures as compared to pretreatment levels. In summary, CA‐CBT+ led to large improvements in general psychopathological distress and quality of life, which were maintained in the long term. In addition, the dropout rate was very low, with delivery in group format. Thus, problem‐solving training appears to be a promising addition to CA‐CBT.