The December 2020 British Association for Behavioural and Cognitive Psychotherapies (BABCP) Article of the Month is from Behavioural and Cognitive Psychotherapy and is entitled “Culturally adapted trauma-focused CBT-based guided self-help (CatCBT GSH) for female victims of domestic violence in Pakistan: feasibility randomized controlled trial” by Madeeha Latif, M. Ishrat Husain, Mirrat Gul, Saiqa Naz, Muhammad Irfan, Muhammad Aslam, Falahat Awan, Ayesha Sharif, Shanaya Rathod, Saeed Farooq, Muhammad Ayub and Farooq Naeem

This is the first evaluation of a culturally adapted trauma-focused CBT based self-help from a low middle income country.  There is sufficient evidence to suggest that culturally adapted CBT can significantly improve clinical outcomes. However, the availability of CBT remains limited due to limited resources. Low and middle income countries spend very low amounts of their budgets on mental health.  Stigma, lack of knowledge of mental health problems and their treatment and limited availability of mental health services are other significant barriers in access to mental health care. The problem is further compounded by the fact that nearly 75% of the world’s population lives in low- and middle-income countries. We must find innovative solutions if we are to meet the needs of these populations. Low-intensity therapy, self-help and guided self-help might be the way forward for large numbers of those affected. As smart phones are commonly available in low- and middle-income countries, self-help interventions can be easily digitized and made available for wider use at very low cost.

The group producing this paper has pioneered techniques in cultural adaptation of CBT. Their mixed methods approach to develop and test CBT for mental health problems has been used in South Asia, Middle East, China, Morocco, England and Canada. Based on their experiences of culturally adapting interventions, they developed, adapted and tested self-help manuals for depression, anxiety and stress. Using the same methodology they developed a culturally adapted self-help manual using trauma-focused CBT BASDI Ki Kahani.   

Low- and middle-income countries have only limited support available for female victims of domestic violence. Very limited research is available on culturally adapted psychosocial interventions for trauma victims in low- and middle-income countries. For this study, the authors tested their self-help manual in female victims of domestic violence. There is a need to further this work with larger scale randomized controlled trials as well as development of online versions of this intervention to improve access to it.

There is scope for this research to inform how female victims of domestic violence can be supported in Western countries where there are long waits to access treatment and a need for more culturally sensitive care.

Note from Paul Salkovskis, Editor, BCP

The BABCP is committed to helping those impacted by disadvantage in its various forms, not least by supporting the development, validation and dissemination of accessible interventions for people experiencing mental health problems. Accessibility requires us to go beyond dissemination and linguistic translation to adaptation, and this paper is an exemplar of such an approach, applied to a serious and pervasive problem throughout all communities. As such it provides a strong foundation for both the application of an empirically grounded approach and for further research capable of translation to a wide range of settings.