Culturally adapted CBT (CA-CBT) for traumatised indigenous South Africans (Sepedi) : a randomised pilot trial comparing CA-CBT to applied muscle relaxation

In South Africa, there is a high rate of events such as criminal violence, stress and sexual assault, particularly in lower socio-economic status (SES) communities. Problems are particularly acute amongst indigenous groups. In spite of the great need for interventions for those having experienced these events, little information is available to guide treatment choices. The goal of this randomised controlled trial was to test the efficacy and feasibility of culturally adapted CBT (CA-CBT) compared to applied muscle relaxation (AMR) for traumatised South Africans belonging to the Sepedi cultural group. Twenty patients with post-traumatic stress disorder (PTSD) completed the study. In the completer analysis, we found that CA-CBT offered substantial benefits over AMR, as seen in large effect sizes for PTSD (d = 2.11) as well as anxiety symptoms (d = 2.41), depressive symptoms (d = 2.25), and culturally salient somatic symptoms and syndromes (d = 1.41). The intent-to-treat analysis showed smaller but still large effect sizes for all measures: PTSD (d = 1.27), associated anxiety symptoms (d = 1.38), depressive symptoms (d = 1.30), and culturally salient somatic symptoms and syndromes (d = .99). Our study suggests that CBT can be successfully adapted for South African indigenous groups.
Key implications for practice

• This study shows the efficacy and acceptability of CBT in a randomised controlled pilot trial of an understudied group in great need of treatment compared to an active treatment condition (applied muscle relaxation (AMR)).
• This is the first study to show efficacy of CBT for PTSD in any South African indigenous group and suggests that CBT may be successfully adapted for that group, with large effect sizes compared to AMR.
• CA-CBT, which emphasises the treatment of somatic sensations, yoga-like stretching and meditation techniques to promote emotional and psychological flexibility, may be effective in treating indigenous South Africans.