Cultural Adaptations In Psychosocial Interventions for Post-Traumatic Stress Disorder Among Refugees: A Systematic Review

Drawing on 11 randomized controlled trials conducted between 2008 and 2018, this systematic review examines culturally adapted psychosocial interventions for post-traumatic stress disorder (PTSD) among adult refugees, with implications for trauma-informed care in diverse and displacement-affected contexts. The review employed a systematic, computer-based search of PsycINFO, Applied Social Sciences Index and Abstracts (ASSIA), PILOTS, and Web of Science core collections, using keywords related to refugees, PTSD, intervention, and evaluation, in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Two authors independently screened titles, abstracts, and full texts, conducted data extraction, and assessed study quality using the Cochrane risk of bias tool.

Findings highlight that refugees experience disproportionately high rates of PTSD, underscoring the need for trauma-informed care approaches that are not only clinically effective but also culturally responsive and contextually grounded. Among the interventions reviewed, eye movement desensitization and reprocessing (EMDR) demonstrated the strongest and most consistent evidence of effectiveness. More limited support was found for narrative exposure therapy (NET), as well as cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT).

A key contribution of this review is the identification of cultural adaptations across three domains: context, content, and evaluation. Contextual adaptations included delivering interventions in community settings or refugee camps and utilizing lay counselors or community members. Content adaptations involved tailoring interventions to local cultural norms through language translation, culturally relevant metaphors, gender-matching of therapists, and incorporation of community practices. Evaluation adaptations primarily focused on translating and modifying assessment tools to enhance cultural validity and comprehension. Despite the widespread use of these adaptations, limited evidence exists linking specific cultural modifications to improved outcomes, highlighting an important gap in the literature.

These findings carry important implications for social work practice. As frontline service providers working directly with refugees, social workers play a critical role in implementing trauma-informed, culturally responsive interventions. This requires not only adapting evidence-based practices to diverse cultural contexts but also attending to broader structural and post-migration stressors that shape mental health outcomes. The review calls for more rigorous research on the mechanisms through which cultural adaptations influence effectiveness and emphasizes the need for holistic, context-sensitive approaches that integrate refugees’ social, economic, and cultural realities into trauma-informed care frameworks.