Treating posttraumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma‐focused cognitive behavioral therapies

Ennis, Naomi; Shorer, Shai; Shoval-Zuckerman, Yael; Freedman, Sara; Monson, Candice M.; Dekel, Rachel

doi:10.1002/jclp.22909

Cited by 40 publications

(31 citation statements)

References 46 publications

(189 reference statements)

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“…For example, studies are needed to investigate whether time and/or funding constraints are preventing shared decision making with Magidson et al (2015); Bolton et al (2014 Myers et al (2018Myers et al ( , 2019) This study findings are novel in documenting community stakeholder involvement during specific phases of the ADAPT-ITT model to adapt EBIs to prevent trauma or prevent/treat problems among trauma survivors. This systematic review responds to calls for developing the science of adaptations (Baumann & Cabassa, 2020) and extends previous work that summarized community stakeholder involvement during adaptation process broadly (Ennis et al, 2020;Movsisyan et al, 2019). Our findings are consistent with other reports suggesting the need for improved community stakeholder involvement during the application of adaptive models of trauma-focused behavioral therapies (Ennis et al, 2020) and more specifically application of the ADAPT-ITT model to advance trauma science.…”

Section: Discussionsupporting

confidence: 88%

A systematic review of community stakeholder involvement during application of the ADAPT-ITT model to adapt trauma interventions for new populations.

Cavanaugh¹,

Wismar²

2022

Psychological Trauma: Theory, Research, Practice, and Policy

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Objectives: Adapting evidence-based interventions for new populations and involving community stakeholders in the adaptation process is important for improving the dissemination and efficacy of interventions aimed to prevent trauma or prevent/treat problems among trauma survivors. Yet, little is known about community stakeholders' involvement during the adaptation process. This systematic review aims to do the following: (a) identify studies applying the ADAPT-ITT model to adapt interventions for preventing trauma or preventing/treating problems among trauma survivors, (b) examine both the presence/ absence of community stakeholders' involvement, and (c) identify innovative community stakeholder involvement during application of this model. Method: Six databases were searched for related studies. Data was extracted about community stakeholders' involvement during specific phases of the ADAPT-ITT model that allowed for greater community stakeholder involvement. One phase involves stakeholders providing suggested intervention modifications during what is called a "theater test." Results: Thirty-two studies that described the adaptation of 19 interventions were identified. Most studies involved community stakeholders during the needs assessment and theater tests (83%). Few studies described community stakeholders as sharing decision making about which intervention to use for the new population (18%). Approximately half (44-50%) reported community stakeholders either received training on the adapted intervention or facilitated the adapted interventions during testing phase. Innovative strategies included using community stakeholder advisory boards to guide intervention selection and modifications. Conclusions: Findings suggest the need for improving community stakeholder involvement throughout the application of the ADAPT-ITT model to advance trauma science and provide examples of innovative strategies for doing so. Clinical Impact StatementFindings underscore the need for researchers and community stakeholders (e.g., community service providers) to work more collaboratively throughout the application of the ADAPT-ITT model to adapt interventions to prevent trauma or prevent/treat problems among trauma survivors. Collaborations are especially needed during the decision about which evidence-based trauma intervention is needed to be considered for the new population.

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Section: Discussionsupporting

confidence: 88%

A systematic review of community stakeholder involvement during application of the ADAPT-ITT model to adapt trauma interventions for new populations.

Cavanaugh¹,

Wismar²

2022

Psychological Trauma: Theory, Research, Practice, and Policy

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“…The overall results suggest that the implementation of TF-CBT is feasible without a tremendous amount of adaptation. In line with other studies on cultural adaptations to trauma-focused treatments, therapists also made changes in the conceptualization of the trauma's effects such as spiritual approaches (Ennis et al, 2020), and tailored materials and language (e.g. usage of meta phors) to the target group.…”

Section: Discussionmentioning

confidence: 92%

“Same same or adapted?” Therapists’ feedback on the implementation of trauma-focused cognitive behavioral therapy with unaccompanied young refugees

Unterhitzenberger

Haberstumpf

Rosner

et al. 2021

Clin. Psychol. Eur.

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Background Rates of trauma exposure and posttraumatic stress disorder (PTSD) are high among refugee youth. Although there is a vast evidence base on effective trauma-focused interventions for children and adolescents, there is only limited understanding of how to adapt these interventions for oftentimes severely traumatized young refugees. This study aims to investigate adaptations undertaken during trauma-focused cognitive behavioral therapy (TF-CBT) in a pilot study with unaccompanied refugee minors (URMs). Method Written answers on five questions given by N = 9 therapists on N = 16 TF-CBT cases were analysed qualitatively using Mayring’s content analysis. The questions were on (1) additional techniques used in the sessions, (2) obstacles to TF-CBT treatment, (3) cultural factors considered and most helpful components for (4) patient and (5) therapist. The categories were built inductively and analysed descriptively. Results In addition to the regular TF-CBT components, added content mostly concerned the so-called “crisis of the week”, meaning a more lengthy discussion of struggles and concerns in their daily lives. Few obstacles in treatment were reported, and little cultural factors had to be considered. The implementation of a trauma narrative and the agenda provided by the manual were frequently reported as helpful. Conclusion The results of this study indicate that the manualized evidence-based treatment TF-CBT can be used in the culturally heterogeneous population of URMs with minor adaptations. These findings can contribute to future research as well as clinical practice with URMs.

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“…(Gnaulati, 2019 ; Gutner, Gallagher, Baker, Sloan, & Resick, 2016 ) Implementing the skills training in affect and interpersonal regulation (STAIR) protocol, designed for individuals who have experienced chronic trauma, prior to PE may enhance overall treatment effects. (Cloitre et al, 2010 ) In addition, cultural adaptions of PE for treating PTSD symptoms in African Americans that explicitly incorporate in vivo and imaginal exposures to racial discrimination may reduce drop out (Ennis et al, 2020 ; Williams et al, 2014 ) and are essential to the efficacy of the intervention for populations disproportionally affected by trauma and racial discrimination (Owen, Tao, Leach, & Rodolfa, 2011 ; Turner et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Racial discrimination and posttraumatic stress: examining emotion dysregulation as a mediator in an African American community sample

Mekawi

Watson‐Singleton

Kuzyk

et al. 2020

European Journal of Psychotraumatology

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Background : African Americans experience more severe and chronic posttraumatic stress disorder (PTSD) symptoms compared to other racial groups, and thus it is important to examine factors that are relevant for the aetiology of PTSD in this population. Although racial discrimination has been implicated as an exacerbating factor in the development and maintenance of PTSD, relatively less is known about mechanisms through which this process may occur. Objective : The purpose of this study was to examine one such mechanism, emotion dysregulation, in two independent samples of African American adults. Method : Trauma-exposed participants were recruited in a large, urban community hospital setting (initial sample n = 1,841; replication sample n = 294). In the initial sample, participants completed a unidimensional measure of emotion dysregulation and self-reported PTSD symptoms based on the DSM-IV. In the replication sample, participants completed a multidimensional measure of emotion dysregulation and a diagnostic interview of PTSD symptoms based on the DSM-5. Mediation analyses were used to test our hypotheses. Results : Across both samples, results indicated that racial discrimination was indirectly associated with PTSD symptoms through emotion dysregulation (even when trauma load was added as a covariate). Conclusions : Taken together, these results provide strong evidence that the association between racial discrimination and PTSD symptoms may be partially explained by the association between racial discrimination and worse emotion dysregulation. These findings elucidate the impact of racist incidents on mental health and identify modifiable emotion regulatory processes that can be intervened upon to enhance the psychological and social wellbeing of African Americans.

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Treating posttraumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma‐focused cognitive behavioral therapies

Cited by 40 publications

References 46 publications

A systematic review of community stakeholder involvement during application of the ADAPT-ITT model to adapt trauma interventions for new populations.

A systematic review of community stakeholder involvement during application of the ADAPT-ITT model to adapt trauma interventions for new populations.

“Same same or adapted?” Therapists’ feedback on the implementation of trauma-focused cognitive behavioral therapy with unaccompanied young refugees

Racial discrimination and posttraumatic stress: examining emotion dysregulation as a mediator in an African American community sample

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