تکنیک های پذیرش و ذهن آگاهی اعمال شده برای پناهنده و جمعیتهای اقلیت قومی با اختلال استرس پس از حادثه: نمونه هایی از فرهنگی اقتباس CBT

In this article we illustrate how we utilize acceptance and mindfulness techniques in our treatment (Culturally Adapted CBT, or CA-CBT) for traumatized refugees and ethnic minority populations. We present a Nodal Network Model (NNM) of Affect to explain the treatment's emphasis on body-centered mindfulness techniques and its focus on psychological flexibility. We explain the definition of mindfulness that guides our treatment, and we outline a typology of mindfulness states and show how many of the techniques in our treatment can be analyzed by these categories. We argue that acceptance and mindfulness are therapeutic for refugees and minority populations for several reasons. These include their increasing psychological flexibility, decreasing somatic distress, decreasing rumination, serving as emotion regulation techniques, decreasing the attentional bias to threat, and forming part of a new adaptive processing mode (which in CA-CBT centers on psychological flexibility). We describe the specific ways we teach acceptance and mindfulness with Latino and Southeast Asian refugee populations and present case examples of the treatment of a traumatized Latino and Cambodian patient.

We refer to our manualized 14-session treatment for traumatized refugees and ethnic minority populations as culturally adapted CBT, or CA-CBT (which might also be called culturally adapted flexibility-focused therapy, or CA-FT, for reasons that will be clear below). The treatment emphasizes emotion regulation techniques such as acceptance and mindfulness techniques. In CA-CBT, acceptance and mindfulness techniques are important parts of the anxiety, trauma, and anger protocols, with these protocols being practiced at the beginning of almost all sessions (see Table 1 for an overview of the treatment); and a mindfulness technique is taught at the end of every session that is further practiced on the way home (often this is multisensorial mindfulness, i.e., attending to one or more channels of sensorial experiencing: auditory, such as ambient sounds, and visual, such as certain visual images like the movements of leaves in the wind). Our treatment has been shown to be effective for traumatized ethnic minority (Latino) and refugee (Cambodian and Vietnamese) groups as compared to a waitlist condition (Hinton et al., 2004 and Hinton et al., 2005) and applied muscle relaxation (Hinton, Hofmann, Rivera, Otto, & Pollack, 2011).

In this article we discussed how acceptance and mindfulness techniques can be successfully used with minority and refugee populations, using examples from CA-CBT, and explained why these techniques should be efficacious (e.g., through the the discussion of the NNM and the typology of mindfulness states). The techniques increase psychological flexibility, decrease somatic distress, decrease rumination, serve as emotional regulation techniques, decrease the attentional bias to threat, and form part of a new adaptive processing mode characterized by psychological flexibility. We have used these acceptance and mindfulness techniques in several controlled trials with Latino and Southeast Asian refugee populations (Hinton et al., 2011a, Hinton and Lewis-Fernández, 2010, Hinton et al., 2004 and Hinton et al., 2005). In this article we provided examples of treatment adaptations of acceptance and mindfulness for Latino and Southeast Asian patients, but these techniques can be adapted for other groups. For the culture in question one needs to determine the local terms to express the idea of distancing/decentering and multisensorial awareness, the best culture-based means to demonstrate mindfulness such as mindful sipping of a favored drink in that culture, cultural imagery that might be used to express the idea of loving-kindness, and local examples of flexibility primers.