Culturally sensitive CBT for refugees: Key dimensions

Abstract

In increasingly multicultural societies, cognitive behavioral therapy (CBT) needs to be made appropriate for diverse groups. Refugees with mental health difficulties present particular therapeutic challenges that include complex trauma, different cultural traditions, and ongoing stress. The current chapter outlines how a contextually sensitive CBT can be developed for such refugee groups. It outlines key dimensions of culturally sensitive CBT, which can be therapeutically implemented among refugees in order to maximize efficacy and effectiveness. These guidelines can be followed to design culturally sensitive CBT studies among refugees, or what might be called "contextually sensitive CBT, " and the guidelines can be used to evaluate such studies. Some examples of these key dimensions of care are the following: assessing and addressing key local complaints (e.g., somatic symptoms, spirit possession, and syndromes like "thinking a lot"); incorporating into treatment key local sources of recovery and resilience (e.g., CBT-compatible proverbs and techniques in that culture). Another example of a key dimension of care is making CBT techniques more tolerable and effective for the cultural group through various means: by using a phased approach, by utilizing culturally appropriate framing of CBT techniques (using local analogies), by making positive re-associations to problematic sensations during interoceptive exposure (e.g., to traditional games), and by using trauma-type exposure as an opportunity to practice emotion regulation. We describe such concepts as explanatory model bridging, cultural grounding, and contextual sensitivity.