Efektivitas Cognitive Behavioral Therapy (CBT) pada Konteks Trauma Perang Timur Tengah
DOI:
https://doi.org/10.55606/termometer.v3i2.4955Keywords:
CBT, Cultural Adaptation, Middle East, PTSD, War TraumaAbstract
This study evaluates the effectiveness of culturally adapted Cognitive Behavioral Therapy (CBT) in the treatment of war trauma in the Middle East through an analysis of 47 studies involving a total of 4,628 participants from 2000 to 2024. The findings indicate that culturally informed CBT interventions have produced a significant therapeutic effect (g = 0.82, 95% CI [0.71, 0.93], p < .001) with a moderate level of heterogeneity (I² = 68%). Furthermore, culturally adapted CBT has been shown to reduce symptoms of Post-Traumatic Stress Disorder (PTSD) by 43.2% (d = 1.24, p < .001), anxiety by 38.7% (d = 0.96, p < .001), and depression by 35.9% (d = 0.88, p < .001). Additionally, moderator analysis revealed that the effectiveness of CBT significantly increases when the therapy integrates traditional healing practices (β = 0.34, p < .01) and involves family members in the intervention process (β = 0.29, p < .01). These findings expand upon previous research by Almoshmosh et al. (2020) and Al-Krenawi & Graham (2000), which merely addressed the effectiveness of standard CBT, and complement the study by Çınaroğlu et al. (2024) by emphasizing the importance of cultural adaptation in trauma psychotherapy practices in the Middle East. Furthermore, the main novelty of this research lies in identifying specific cultural components that enhance the effectiveness of CBT in the Middle East, including the integration of religious values (β = 0.31, p < .01) and the use of local cultural narratives in therapeutic approaches (β = 0.27, p < .01). The researchers assert that this study represents the first empirical affirmation that culturally adapted CBT is more effective than standard CBT in addressing war-related trauma in the Middle East.
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References
Abdul-Hamid, W., Bahadur Karki, C., Hacker Hughes, J., & Morgan, S. (2021). The need for trauma therapy for victims of man-made trauma compared to those of natural disaster, a survey of health professionals. Psychiatria Danubina, 33(suppl 1), 13–17.
Abu-Raiya, H., & Pargament, K. I. (2015). Religious coping among diverse religions: Commonalities and divergences. Psychology of Religion and Spirituality, 7(1), 24.
Al-Krenawi, A., & Graham, J. R. (2000). Culturally sensitive social work practice with Arab clients in mental health settings. Health & Social Work, 25(1), 9–22.
Almoshmosh, N., Jefee Bahloul, H., Barkil-Oteo, A., Hassan, G., & Kirmayer, L. J. (2020). Mental health of resettled Syrian refugees: a practical cross-cultural guide for practitioners. The Journal of Mental Health Training, Education and Practice, 15(1), 20–32.
Alqasir, A. (2024). The Impact of Religious Cultural and Traditional Beliefs and Superstitions in Shaping the Understanding of Mental Disorders and Mental Health Treatment among Arab Muslims (Doctoral dissertation, Victoria University).
Al-Turkait, F. A., & Ohaeri, J. U. (2008). Post-traumatic stress disorder among wives of Kuwaiti veterans of the first Gulf War. Journal of anxiety disorders, 22(1), 18-31.
Ashfaq, A., Esmaili, S., Najjar, M., Batool, F., Mukatash, T., Al-Ani, H. A., & Koga, P. M. (2020). Utilization of mobile mental health services among Syrian refugees and other vulnerable Arab populations—a systematic review. International Journal of Environmental Research and Public Health, 17(4), 1295.
Ayer, L., Venkatesh, B., Stewart, R., Mandel, D., Stein, B., & Schoenbaum, M. (2017). Psychological aspects of the Israeli–Palestinian conflict: A systematic review. Trauma, Violence, & Abuse, 18(3), 322-338.
Basurrah, A., Lambert, L., Setti, A., Murphy, M., Warren, M., Shrestha, T., & Di Blasi, Z. (2021). Effects of positive psychology interventions in Arab countries: a protocol for a systematic review. BMJ open, 11(7), e052477.
Beaini, D., & Shepherd, S. M. (2022). Working with Arab women with PTSD: What do we know? Australian Psychologist, 57(2), 95–104.
Benjamin, L., Gillard, S., Jones Nielsen, J., Costa E. Silva, M., & Sin, J. (2025). Cultural adaptations to the assessment and treatment of trauma experiences among racial and ethnic minority groups: A mixed-methods systematic review and meta-analysis. Trauma, Violence, & Abuse, 15248380251320982.
Bernal, G., & Sáez‐Santiago, E. (2006). Culturally centered psychosocial interventions. Journal of Community Psychology, 34(2), 121-132.
Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009). Cultural adaptation of evidence-based treatments for ethno-cultural youth. Professional Psychology: research and practice, 40, 361-368.
Böttche, M., Wagner, B., Vöhringer, M., Heinrich, M., Stein, J., Selmo, P., ... & Knaevelsrud, C. (2021). Is only one cognitive technique also effective? Results from a randomized controlled trial of two different versions of an internet-based cognitive behavioural intervention for post-traumatic stress disorder in Arabic-speaking countries. European journal of psychotraumatology, 12(1), 1943870.
Bronstein, I., & Montgomery, P. (2011). Psychological distress in refugee children: a systematic review. Clinical child and family psychology review, 14, 44–56.
Chowdhary, N., Jotheeswaran, A. T., Nadkarni, A., Hollon, S. D., King, M., Jordans, M. J. D., ... & Patel, V. (2014). The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review. Psychological medicine, 44(6), 1131-1146.
Çınaroğlu, M. (2024). Islamic Coping, Post Traumatic Stress Disorder (PTSD) and Islam Oriented Trauma Focused Cognitive Behavioral Therapy (IO-TF-CBT) in Post-Kahramanmaraş Earthquake Period. Eskiyeni, (52), 351-376.
Cisler, J. M., & Herringa, R. J. (2021). Post-traumatic stress disorder and the developing adolescent brain. Biological Psychiatry, 89(2), 144-151.
Ellis, B. H., Winer, J. P., Murray, K., & Barrett, C. (2019). Understanding the mental health of refugees: Trauma, stress, and the cultural context. The Massachusetts General Hospital textbook on diversity and cultural sensitivity in mental health, 253–273.
Elrabaa, J. (2024). The Effects of Trauma on Middle Eastern Forced Immigrants and Refugees and Implications for Treatment (Doctoral dissertation, Alliant International University).
Elshamy, F., Hamadeh, A., Billings, J., & Alyafei, A. (2023). Mental illness and help-seeking behaviours among Middle Eastern cultures: A systematic review and meta-synthesis of qualitative data. PLoS One, 18(10), e0293525.
Ennis, N., Shorer, S., Shoval‐Zuckerman, Y., Freedman, S., Monson, C. M., & Dekel, R. (2020). Treating post-traumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma‐focused cognitive behavioural therapies. Journal of Clinical Psychology, 76(4), 587–611.
Eskici, H. S., Hinton, D. E., Jalal, B., Yurtbakan, T., & Acarturk, C. (2023). Culturally adapted cognitive behavioral therapy for Syrian refugee women in Turkey: A randomized controlled trial. Psychological trauma: theory, research, practice, and policy, 15(2), 189.
Fazel, M., & Betancourt, T. S. (2018). Preventive mental health interventions for refugee children and adolescents in high-income settings. The Lancet Child & Adolescent Health, 2(2), 121-132.
Gearing, R. E., Schwalbe, C. S., MacKenzie, M. J., Brewer, K. B., Ibrahim, R. W., Olimat, H. S., ... & Al-Krenawi, A. (2013). Adaptation and translation of mental health interventions in Middle Eastern Arab countries: A systematic review of barriers to and strategies for effective treatment implementation. International journal of social psychiatry, 59(7), 671-681.
Haque, A., & Keshavarzi, H. (2014). Integrating indigenous healing methods in therapy: Muslim beliefs and practices. International Journal of Culture and Mental Health, 7(3), 297-314.
Hendrickx, M., Woodward, A., Fuhr, D. C., Sondorp, E., & Roberts, B. (2020). The burden of mental disorders and access to mental health and psychosocial support services in Syria and among Syrian refugees in neighbouring countries: a systematic review. Journal of Public Health, 42(3), e299-e310.
Hosseini, Z., Syed, H., Raza, Z., Mansouri, M., Magan, I. M., & Awaad, R. (2024). A systematic review of evidence-based interventions for Afghan Refugee Mental Health: A Cultural Adaptation Analysis. Journal of Cross-Cultural Psychology, 55(1), 25–46.
Jordans, M. J., Pigott, H., & Tol, W. A. (2016). Interventions for children affected by armed conflict: a systematic review of mental health and psychosocial support in low-and middle-income countries. Current Psychiatry Reports, 18, 1-15.
Kananian, S., Soltani, Y., Hinton, D., & Stangier, U. (2020). Culturally adapted cognitive behavioral therapy plus problem management (CA‐CBT+) with Afghan refugees: A randomized controlled pilot study. Journal of Traumatic Stress, 33(6), 928-938.
Kayrouz, R., Dear, B. F., Johnston, L., Gandy, M., Fogliati, V. J., Sheehan, J., & Titov, N. (2015). A feasibility open trial of guided Internet-delivered cognitive behavioural therapy for anxiety and depression amongst Arab Australians. Internet Interventions, 2(1), 32–38.
Khoury, B., Rafeh, M., & Dargham, Z. B. (2024). Traditional healing for physical and mental problems in the Arab region: past and current practices. BJPsych International, 21(2), 44–46.
Li, J., Li, J., Yuan, L., Zhou, Y., Zhang, W., & Qu, Z. (2023). Cultural adaptation of trauma-focused cognitive behavioral therapy for trauma-affected children in China. Psychological Trauma: Theory, Research, Practice, and Policy.
Maalouf, F. T., Alamiri, B., Atweh, S., Becker, A. E., Cheour, M., Darwish, H., ... & Akl, E. A. (2019). Mental health research in the Arab region: challenges and call for action. The Lancet Psychiatry, 6(11), 961–966.
Mawar, L., Rahmadi, M. A., Nasution, H., Dewi, I. S., Nasution, R., & Sari, M. (2024). Efek Stres terhadap Pengobatan Asthma. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 86-112.
Mawar, L., Rahmadi, M. A., Nasution, H., Sihombing, N., Nasution, R., & Sari, M. (2024). Peran Kecerdasan Emosional dalam Pengobatan Cystic fibrosis. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 2(4), 60-90.
Miller, K. E., & Rasmussen, A. (2024). War exposure, daily stressors, and mental health 15 years on: implications of an ecological framework for addressing the mental health of conflict-affected populations. Epidemiology and Psychiatric Sciences, 33, e78.
Moore, A., van Loenhout, J. A. F., de Almeida, M. M., Smith, P., & Guha-Sapir, D. (2020). Measuring mental health burden in humanitarian settings: a critical review of assessment tools. Global health action, 13(1), 1783957.
Morina, N., Akhtar, A., Barth, J., & Schnyder, U. (2018). Psychiatric disorders in refugees and internally displaced persons after forced displacement: a systematic review. Frontiers in psychiatry, 9, 433.
Naseh, M., Macgowan, M. J., Wagner, E. F., Abtahi, Z., Potocky, M., & Stuart, P. H. (2020). Cultural adaptations in psychosocial interventions for post-traumatic stress disorder among refugees: A systematic review. Rethinking Social Work Practice with Multicultural Communities, 76–97.
Nasif, J., Din, N. C., AL-Khawaja, M., Alawi, A. F., Al-Khatib, N., Ayash, A., ... & Sze, A. C. S. (2024). Scoping Review for the Adaptation of Cognitive Behavioral Therapy to the Arab Culture. International Journal of Cognitive Therapy, 17(4), 919-945.
Nasution, H., Rahmadi, M. A., Mawar, L., Dewi, I. S., Nasution, R., & Sari, M. (2024). Peran Kepuasan Hidup dalam Pengelolaan Penyakit Systemic Sclerosis. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 195-224.
Nasution, H., Rahmadi, M. A., Mawar, L., Sihombing, N., Nasution, R., & Sari, M. (2024). Hubungan Dukungan Sosial dalam Pengobatan Sklerosis Multipel. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 2(4), 121-151.
Nasution, R., Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., & Sari, M. (2024). Hubungan antara Perasaan Bersalah dan Keberhasilan Pengobatan Lupus. An-Najat, 2(4), 179-206.
Nasution, R., Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., & Sari, M. (2024). Pengaruh Intervensi Emosi Positif pada Pengobatan Fibromyalgia. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 277-302.
Rahmadi, M. A., & Nasution, H. (2022). Adjustment of Students in Islamic Boarding Schools. Budapest International Research and Critics Institute-Journal (BIRCI-Journal), 5(2), 8141-8151.
Rahmadi, M. A., Al Munawar, S. A. H., Syahid, A., Shaleh, A. R., & Nasution, H. (2024). The Dynamics of Personal Adjustment in Quranic Memorization Students: A Mixed-Methods Analysis of Self-Acceptance, Objective Self-Action, and Self-Confidence in Islamic Boarding Schools. International Journal of Medicine and Health, 3(4), 24-53.
Rahmadi, M. A., Nasution, H., Mawa, L., Nasution, R., & Sari, M. (2024). Peran Harapan dalam Kepatuhan Pengobatan Kanker Kolorektal. OBAT: Jurnal Riset Ilmu Farmasi dan Kesehatan, 2(6), 38-64.
Rahmadi, M. A., Nasution, H., Mawar, L., & Sari, M. (2024). Pengaruh Kecemasan Terhadap Kepatuhan Pengobatan Kanker Payudara. Jurnal Medika Nusantara, 2(3), 325-350.
Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., Nasution, R., & Sari, M. (2024). Hubungan Motivasi terhadap Keberhasilan Pengobatan Endometriosis. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 225-253.
Rahmadi, M. A., Syahid, A., Al Munawar, S. A. H., Shaleh, A. R., Nasution, H., & Mawar,
Rahmadi, M. A., Syahid, A., Al Munawar, S. A. H., Shaleh, A. R., Nasution, H., & Mawar, L. (2024). The Construct of Emotional Support in Quranic Memorization Students: A Study on the Dynamic Influence of Reliable Relationships, Trusted Guidance, Psychological Well-being, and Quranic Memorization Achievement. International Journal of Health and Medicine, 1(4), 190-219.
Rassool, G. H. (2015). Islamic counselling: An introduction to theory and practice. Routledge.
Roberts, B., & Browne, J. (2011). A systematic review of factors influencing the psychological health of conflict-affected populations in low-and middle-income countries. Global public health, 6(8), 814–829.
Sari, M., Rahmadi, M. A., Nasution, H., Mawar, L., Dewi, I. S., & Nasution, R. (2024). Hubungan antara Kepuasan Hidup dan Pengobatan Emfisema. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 2(4), 113-144.
Sari, M., Rahmadi, M. A., Nasution, H., Mawar, L., Sihombing, N., & Nasution, R. (2024). Efek Kepuasan Hidup pada Pengobatan Sarcoidosis. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 2(4), 91-120.
Schlechter, P., Rodriguez, I. M., Morina, N., Knausenberger, J., Wilkinson, P. O., & Hellmann, J. H. (2021). Psychological distress in refugees: The role of traumatic events, resilience, social support, and support by religious faith. Psychiatry Research, 304, 114121.
Sim, A. (2018). Developing an empirically-based conceptual model of the intergenerational impact of war: a mixed methods study with Syrian refugees in Lebanon (Doctoral dissertation, University of Oxford).
Soto, A., Smith, T. B., Griner, D., Domenech Rodríguez, M., & Bernal, G. (2018). Cultural adaptations and therapist multicultural competence: Two meta‐analytic reviews. Journal of Clinical Psychology, 74(11), 1907-1923.
Stebnicki, M. A., & CRC, C. (Eds.). (2016). Disaster mental health counselling: Responding to trauma in a multicultural context. Springer Publishing Company.
Taylor, A., Radford, G., & Calia, C. (2023). Cultural adaptations to psychosocial interventions for families with refugee/asylum‐seeker status in the United Kingdom–a systematic review. Child and adolescent mental health, 28(2), 241–257.
Thompson, C. T., Vidgen, A., & Roberts, N. P. (2018). Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: A systematic review and meta-analysis. Clinical Psychology Review, 63, 66–79.
Tol, W. A., Barbui, C., Galappatti, A., Silove, D., Betancourt, T. S., Souza, R., ... & Van Ommeren, M. (2011). Mental health and psychosocial support in humanitarian settings: linking practice and research. The Lancet, 378(9802), 1581–1591.
Turrini, G., Purgato, M., Acarturk, C., Anttila, M., Au, T., Ballette, F., ... & Barbui, C. (2019). Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis. Epidemiology and psychiatric sciences, 28(4), 376-388.
Van Sloten, L. (2024). A Meta-analysis: Building an Evidence Base for Culturally Adapted Cognitive Behavior Therapy (CA-CBT) With Refugees (Doctoral dissertation, D'Youville College).
Williams, M. E., & Thompson, S. C. (2011). The use of community-based interventions in reducing morbidity from the psychological impact of conflict-related trauma among refugee populations: a systematic review of the literature. Journal of immigrant and minority health, 13, 780–794.
Zemestani, M., Mohammed, A. F., Ismail, A. A., & Vujanovic, A. A. (2022). A pilot randomized clinical trial of a novel, culturally adapted, trauma-focused cognitive-behavioural intervention for war-related PTSD in Iraqi women. Behaviour Therapy, 53(4), 656–672.
Zolezzi, M., Alamri, M., Shaar, S., & Rainkie, D. (2018). Stigma associated with mental illness and its treatment in the Arab culture: a systematic review. International Journal of Social Psychiatry, 64(6), 597–609.
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