Table 4.
Feasibility, Challenges, and Treatment Adaptations.
| Author/s (year) | Adaptations Related to Culture, Context, and Ongoing Threat | Challenges Due to the Ongoing Threat |
|---|---|---|
| Bryant et al. (2011) | Thai meditation techniques encouraged rather than simply focusing on Western methods of relaxation. Modifying cognitive restructuring to recognize the realistic threats of possible terrorist attacks, to accept a level of risk to allow everyday activities such as buying food in the local market. |
Recruitment to the study was terminated prematurely due to increased terrorist attacks and health workers being targeted. |
| Hinsberger et al. (2017, 2020) | Added content on engaging in violence, exposure sessions were extended to include perpetrator events. Abandoned the narration element to facilitate participants’ trusts and openness. |
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| Bonilla-Escobar et al. (2018) | In Buenaventura, most surveys were conducted in a local church for security reasons. | — |
| Wagner et al. (2012); Knaevelsrud et al. (2015) | Treatment duration was set up to be longer than the original protocol. Most participants did not finish their treatment, took almost twice as long (on average 12 weeks) compared to participants in a Western context to complete treatment. More directive therapeutic stance as the healthcare professionals were seen as authoritative who gave expert advice in their culture. Refusal to give explicit advice might be seen as incompetence or indecisiveness. Participants were explicitly asked not to mention names of places or people to increase trust as some were worried about the risk of political infiltration and confidentiality of the data (worry that the website may be supported by intelligence agencies). Use of quotes and metaphors from the Koran by the therapists. |
Research coordinators could not travel to Iraq due to security concerns. |
| Dawson et al. (2018) | Elements of prolonged exposure therapy were used including the construction of a chronological narrative of the children’s life. The narrative component also reviewed historical elements such as family’s history, wider community and province to help understand the context of the traumatic events they experienced in their life. | The study was terminated prematurely due to local authorities shutting the study down, as the political unrest caused suspicion of Western activities in the region. The researchers were forced to leave the region. |
| Barron et al. (2013) | — | Counselor dropout in the study due to self-reported trauma, highlighting the challenge of conducting research in war zones |
| Barron et al. (2016) | — | — |
| Bass et al. (2013); Kaysen et al. (2020) | A psychoeducation session addressing how beliefs about sexual assault impact on women’s social status. Simplifying the jargons, use of verbal and pictorial rather than handwritten assignments due to high rate of illiteracy. Removal of two behavioral assignments to focus on the cognitive elements of the treatment. Adapting the language to Swahili and the therapy was named “mind and heart therapy” rather than CPT. | — |
| Zaghrout-Hodali et al. (2008) | Did not include elicitation of positive and negative cognitions, nor a validity of cognition rating scale or body scan unlike the original protocol, however, did not explain reasoning behind this. | — |
| Thabet et al. (2005) | The authors stated the intervention was adjusted to the ongoing political conflict context but did not further elaborate. | — |
| Mpande et al. (2013) | — | — |
| Orang et al. (2018) | Participation kept secret from partners. Allocated one to two sessions to work on issues related to safety, such as encouragement to seek help from police, lawyers, coping skills, safety planning, and human rights education. A short discussion of IPV occurrence in the past week at the beginning of each session to gauge readiness for the narrative exposure. |
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| Dinmohammadi et al. (2021) | — | — |
| Tiwari et al. (2005) | Participation was kept secret from partners. The research team suggested the women might establish a code with trusted friends and neighbors. |
Note. CPT = cognitive processing therapy; IPV = intimate partner violence.