Cognitive Processing Therapy (CPT), like many therapies for mental health disorders, has been developed and disseminated in western or first world countries. Will it work for people who are not from these backgrounds? This is an important question considering that at the end of 2019, more than 79 million people across the globe were forcibly displaced due to war, persecution, or violent conflict. Twenty-Six (26) million of these people were refugees (United Nations High Commissioner for Refugees 2020).
CPT has been researched with diverse non-western populations. Often with good effect. This will be outlined below, along with some cautions.
Democratic Republic of the Congo
Judith Bass and colleagues (2013) successfully implemented CPT in the Democratic Republic of the Congo (DRC) with 134 participants. Bass’ team made modifications to account for literacy and cultural differences to western countries. They found that improvements in PTSD and depression symptoms were significantly greater in the therapy group (2.0 at baseline, 0.8 at the end of treatment, and 0.7 at 6 months after treatment) when contrasted with a comparison group receiving individual support.
Judith Bass and her team also completed a long term follow up at 6.3 years. They were able to follow up with 103 of the participants in their original study. At this long-term follow-up, approximately half the group had continued to maintain low symptom scores. They reported that relapse rates for probable PTSD and probable depression and anxiety were 20%.
Iraq – Kurdistan
Similarly, Debra Kaysen and colleagues (2013) adapted CPT for Kurdish torture victims in Iraq. Paul Bolton and team (2014) implemented CPT in Kurdistan, Northern Iraq. They obtained “moderate to strong effects on most outcomes”.
Karen Refugees
Jessica Bernardi and her team (2019) conducted a small pilot study (7 people) of culturally modified cognitive processing therapy for Karen refugees with posttraumatic stress disorder. They found that at posttreatment all participants no longer met PTSD diagnostic criteria for PTSD. However, at 3-month follow-up four participants (57% of sample) had a reliable worsening in PTSD symptoms when compared with their post treatment PTSD symptom levels.
Japan
Yuriko Takagishi and Team (2023) investigated the feasibility, acceptability, and preliminary efficacy of CPT for treating Japanese patients with PTSD. They tested a group of 25 participants and reported on pretreatment, post-treatment, and 6- and 12-month follow-ups. They reported that CPT exhibited large effect sizes for PTSD symptoms. They also described that on average, participants attended13 sessions of CPT and they had CPT a completion rate of 96.0%. Completion rates for CPT and other trauma focused therapies are usually much lower. Yuriko and colleagues suggested that this was indicative of the accept-ability of CPT for Japanese patients.
Summary
In short, there is support for use of CPT with migrant, refugee and culturally diverse populations. However, there is also a need for further research. One pilot study indicates that it did not have a lasting effect. Other studies have shown long term effects six years post therapy.
References
Bass, J. K., Annan, J., McIvor Murray, S., Kaysen, D., Griffiths, S., Cetinoglu, T., Wachter, K., Murray, L. K., & Bolton, P. A. (2013). Controlled trial of psychotherapy for Congolese survivors of sexual violence. The New England journal of medicine, 368(23), 2182–2191. https://doi.org/10.1056/NEJMoa1211853
Bass, J. K., Murray, S. M., Lakin, D. P., Kaysen, D., Annan, J., Matabaro, A., & Bolton, P. A. (2022). Maintenance of intervention effects: long-term outcomes for participants in a group talk-therapy trial in the Democratic Republic of Congo. Global mental health (Cambridge, England), 9, 347–354. https://doi.org/10.1017/gmh.2022.39
Bernardi, J., Dahiya, M., & Jobson, L. (2019). Culturally modified cognitive processing therapy for Karen refugees with posttraumatic stress disorder: A pilot study. Clinical psychology & psychotherapy, 26(5), 531–539. https://doi.org/10.1002/cpp.2373
Bolton, P., Bass, J. K., Zangana, G. A., Kamal, T., Murray, S. M., Kaysen, D., Lejuez, C. W., Lindgren, K., Pagoto, S., Murray, L. K., Van Wyk, S. S., Ahmed, A. M., Amin, N. M., & Rosenblum, M. (2014). A randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraq. BMC psychiatry, 14, 360. https://doi.org/10.1186/s12888-014-0360-2
Kaysen, D., Lindgren, K., Zangana, G. A. S., Murray, L., Bass, J., & Bolton, P. (2013). Adaptation of cognitive processing therapy for treatment of torture victims: Experience in Kurdistan, Iraq. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2), 184–192. https://doi.org/10.1037/a0026053
Takagishi, Y., Ito, M., Kanie, A., Morita, N., Makino, M., Katayanagi, A., Sato, T., Imamura, F., Nakajima, S., Oe, Y., Kashimura, M., Kikuchi, A., Narisawa, T., & Horikoshi, M. (2023). Feasibility, acceptability, and preliminary efficacy of cognitive processing therapy in Japanese patients with posttraumatic stress disorder. Journal of Traumatic Stress, 36, 205–217. https://doi.org/10.1002/jts.22901
United Nations High Commissioner for Refugees (2020). Global trends: forced displacement in 2019. https://www.unhcr.org/5ee200e37.pdf. Accessed 24 Sep 2023.
