Cultural Adaptation of Trauma-Focused Cognitive Behavioral Therapy for Trauma-Affected Children in China

Objective: Trauma-focused cognitive behavioral therapy (TF-CBT) developed in the United States is one of the most widely used interventions for children with posttraumatic stress disorder. However, little information was provided about the cultural adaptation process when it was used in other countries. It was seldom adopted in East Asia. Furthermore, few studies adapted TF-CBT as a school-based intervention. This study was aimed at exploring the cultural fitness of TF-CBT in China and documenting the adaptation process. Method: In the present study, feedback from stakeholders, including seven mental health practitioners, ten caregivers, eight school staffs, and forty-five children, was collected through focus groups or individual interviews. The adaptations were made for TF-CBT based on these people's feedback. Results: The results showed that it was necessary to make adaptations of TF-CBT. Even though most of the core components were culturally appropriate, some culturally specific factors were found, including the resistance to parental involvement, the lack of children's intentions and abilities to seek support, the difficulty in children's cognitive coping, and the strong stigmatization toward TF-CBT in communities. The present study made corresponding adaptations. It developed an adapted version of intervention "power up children's psychological immunity" based on TF-CBT. The new version of intervention included seven group sessions and three to five individual sessions. Conclusion: Cultural adaptation is crucial to promote the acceptance of TF-CBT among stakeholders, including trauma-affected children, caregivers, school principals, class teachers, and mental health practitioners. The adapted intervention may promote the implementation of it in China.