Adaptation of cognitive processing therapy for treatment of torture victims: Experience in Kurdistan, Iraq

Objective: Most empirically based therapies (EBTs) for mental health disorders have been developed and disseminated in high resource countries, despite the strong need for mental health treatment in low resource countries. The present study describes the process of implementing an EBT in Kurdistan, Iraq-in this case, Cognitive Processing Therapy (CPT), an empirically supported treatment for posttraumatic stress disorder (PTSD) that was originally developed in the United States. Method: The adaptation process included addressing training needs of therapists with little to no training in cognitive-behavioral or manualized treatments and tailoring CPT for the high rates of illiteracy in the client population and the specific beliefs and structures of Kurdish culture. The adaptation process was iterative, occurring throughout training and early implementation and incorporating feedback from multiple sources. Result: The process of training was longer and included more hands-on practice of therapy skills than in the United States. Although the therapy itself did not require major changes, simplification of content and modification of some of the CPT themes was necessary to better fit the Kurdish culture. CPT seemed to be well tolerated by clients and their symptoms appeared to improve. Conclusions: Results suggest that it is feasible to train counselors with little formal mental health training in CPT and to adapt CPT to culture that is qualitatively different from the population on which it was initially developed. The general strategies and process described in this paper may provide a framework useful for adapting other EBTs for other low and medium resource settings.