Adapting psychological treatment

: What works well for Arab-speaking populations both inside and outside of Arab countries?

Abstract

Section A.
Introduction: The present review aimed to synthesise the available qualitative and quantitative research findings exploring the experiences of participants utilising remote psychological tools and interventions outside of the Middle East and North African (MENA) region in non-Arab countries. As large numbers of immigrants arrive in European and other western countries from war-torn countries and regions of conflict, their mental health needs are often difficult to address due to barriers in accessing services. Foremost among the barriers is the language barrier, which can be a very significant obstacle to acquiring
appropriate mental health treatment. Existing research in Arabic-speaking countries suggests that uptake of remote mental health interventions in the Arabic language is promising.

Method: The search strategy spanned four databases with search terms covering four key areas: Psychological intervention, diaspora, remote access, and Arabic-speaking. Ten studies were identified, and they were quality assessed using the Joanna Briggs Institute (JBI) quantitative and qualitative critical appraisal tools (Munn et al., 2020). Following this, a systematic review was carried out.

Results: The following five themes emerged as a result of the review: “cultural and linguistic adaptation”, “intervention format”, “psychological change mechanisms”, “barriers to implementation and engagement”, and “clinical and preventative outcomes”. The remote mental health interventions in Arabic were found to offer some positive elements of feasibility, acceptability and efficacy. However, although the results appeared to be positive, the findings could, in part, be due to methodological shortcomings and biases in the studies.

Conclusion: Overall, the interventions appeared to provide a scalable, cost-effective, and flexible solution to mental health challenges in populations with limited access to usual mental health care. However, their success depends upon ensuring accessibility and cultural adaptation, and addressing barriers such as literacy and access to technology. The quality of future research could be improved by developing more randomised controlled trials, as well as longitudinal studies to examine sustained change.

Section B.
Cognitive Behavioural Therapy (CBT) is widely recommended as the therapy of choice for several common mental health problems in the US, the UK and other Western and developed countries. Studies from Eastern cultures have described the need for cultural adaptation of CBT for local populations. Adaptations for low to middle income countries have taken into account cultural, ethnic and/or religious values underpinning collectivist cultures as opposed to individualistic values, which the development of CBT was originally founded upon.

The present study employed a qualitative design to explore the use of CBT in a low to middle income country through eight semi-structured interviews with Iraqi psychiatrists delivering CBT to a diverse and complex patient population across Iraq. The psychiatrists discussed their views about the appropriateness and adaptability of CBT when applied in a culturally sensitive way. Thematic analysis was used to analyse the qualitative data (Braun & Clarke, 2006), with the following nine master themes emerging: Unmet training and supervision needs, Adaptations to the delivery of CBT, Prevalent presenting difficulties, Application of CBT, Impact of religion, Cultural factors affecting patient engagement, Mechanisms for change, Collaborative working, and Barriers to homework.

Findings are discussed in relation to clinical implications for the psychiatrists and their patients, as well as future considerations for provisions for both psychiatrists and patients to fill the identified gaps. Psychiatrists’ professional needs were identified in relation to ongoing training and supervision. Patient therapy needs were identified in terms of access to Islamic oriented interventions and to family and couples’ interventions.

Date of Award	2025
Original language	English
Awarding Institution	Canterbury Christ Church University