An Integrative Adapt Therapy (IAT) for Common Mental Health Symptoms and Resilience amongst Chin, Kachin, Rohingya Refugees living in Malaysia

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Promoting the mental health and psychosocial wellbeing of refugees is a global public health priority. Yet questions remain about the cultural and contextual relevance and effectiveness of psychotherapies applied for specific mental health problems encountered amongst this population. First, the range of mental health problems is wide encompassing co-morbid disorders and forms of distress, yet most interventions focus on the limited outcome of post-traumatic stress disorder (PTSD). Second, western derived methods of intervention draw heavily on cognitive behavioural techniques which on their own may be culturally and contextually alien and more broadly, are not directly congruent with the experiences of refugees. Third, recruitment to studies rarely reflects a systematic approach to identifying persons in need in the community. Finally, interventions tend to be focused on psychopathology (symptoms of distress) rather than on building the capacity for positive adaptation based on an understanding of the psychosocial disruptions that refugees continue to confront following exposure to conflict and displacement. This RCT intervention is innovative in allowing all eligible refugees from a defined catchment area to participate and on focusing specifically on building adaptive capacity based on an established psychosocial model (ADAPT) amongst Burmese refugees (members of the Chin, Kachin, and Rohingya communities) in Malaysia. Specifically, the study will test the efficacy of Integrated ADAPT therapy (IAT), a novel approach that is grounded in the refugee experience rather than on a set of "imported" cognitive behavioural techniques applied to treat traumatic stress in western settings. Our team has spent the past two years in intensive engagement with the communities and relevant stakeholders, using extensive community consultation to ensure the feasibility, acceptability and safety of the project, as well as its contextual and cultural relevance. We have built a strong consensus amongst all stakeholders concerning the value and acceptability of the project. The procedure has has been fully manualized, and preliminary training of potential therapists has been very well received. The comparison group will receive CBT as outlined hereunder. Integral to the study is a process for immediate translation and dissemination based on a policy and practice protocol (TPPP), a process that will be greatly facilitated by the extensive engagement, consultation and interaction process that has taken place over the preceding two years with all stakeholders relevant to the communities in which the study will be implemented