Cultural Adaptation of CBT for Afghan Refugees in Europe: A Retrospective Evaluation.

Background: Culturally adapted CBT (CA CBT) is a well-evaluated, culture-sensitive intervention for refugees that utilizes psychoeducation, problem solving training, meditation, and stretching exercises. However, there is a lack of standard procedures for adapting psychotherapeutic interventions to a specific cultural context. Our working group adapted CA CBT for Afghan refugees at two different stages, which yielded promising results from a pilot trial and an RCT with a waitlist control group. This article aimed to illustrate the ongoing adaptation process of CA CBT for Afghan refugees over the course of several trials and to highlight potential limitations by evaluating how systematic adaptations were performed. Method: The adaptation process of CA CBT was described in detail, including the methods and rationale for changes to the protocol. This process was analyzed according to a new set of proposed reporting criteria. Results: According to the defined target population and based on multiple research strategies, culturally-specific components, such as the rationales for interventions, metaphors, and idioms of distress, were adapted. Relevant surface adaptations were implemented. However, although the steps of our adaptation process corresponded with the reporting criteria, some of the adaptation processes did not follow explicit criteria but resulted from implicit judgments. Conclusion: In the future, compliance with and the documentation of adaptation processes following explicit guidelines are crucial for the transfer of evidence-based approaches for managing the diversity of refugee populations.