Culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan: feasibility randomized controlled trial.

BACKGROUND: Cognitive behaviour therapy (CBT), self-help and guided self-help interventions have been found to be efficacious and cost effective for victims of trauma, but there are limited data from low- and middle-income countries on culturally adapted interventions for trauma. AIMS: To investigate the feasibility and acceptability of culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan. METHOD: This randomized controlled trial (RCT) recruited 50 participants from shelter homes in Karachi and randomized them to two equal groups. The intervention group received GSH in nine sessions over 12 weeks. The control group was a waitlist control. The primary outcomes were feasibility and acceptability. Secondary outcomes included Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHO DAS 2). Assessments were carried out at baseline and at 12 weeks. RESULTS: Out of 60 clients who met DSM-5 criteria for post-traumatic stress disorder (PTSD), 56 (93.3%) agreed to participate in the study. Retention to the intervention group was excellent, with 92% (23/25) attending more than six sessions. Statistically significant differences were noted post-intervention in secondary outcomes in favour of the intervention. CONCLUSIONS: A trial of CatCBT GSH was feasible and the intervention was acceptable to Pakistani women who had experienced domestic violence. Furthermore, it may be helpful in improving symptoms of PTSD, depression, anxiety and overall functioning in this population. The results provide a rationale for a larger, confirmatory RCT of CatCBT GSH.

Transcultural adaptation of cognitive behavioral therapy (CBT) in Asia.

BACKGROUND: Cognitive behavior therapy (CBT) is an evidence based therapy and is now recommended by national organizations in many high income countries. CBT is underpinned by the European values and therefore for it to be effective in other cultures it needs to be adapted. AIMS: This paper describes an evidence based approach to culturally adapt CBT in Asian context, areas of focus for such adaptation and lessons learned. METHODS: An environmental scan of the literature, description of local CBT associations and perspectives from these organizations. RESULTS: Cultural adaptation of CBT focuses on three main areas; 1 awareness of culture and related issues, 2 assessment and 3 adjustment in therapy techniques. CONCLUSIONS: The last decade has seen an increase in culturally adapted CBT in Asia, however, more work needs to be done to improve access to CBT in Asia.