Armed conflicts and other humanitarian crises impact mental health and psychosocial wellbeing. In contexts of overwhelming need and overstretched government health systems, nongovernmental organisations may play important roles. In this paper, we reflect on the role of Nepali nongovernmental organisations in providing mental health and psychosocial support services.

In this article, we suggest guidelines that should be followed in order to create a culturally sensitive cognitive behavioural therapy among refugees and in global contexts more generally, so as to maximise efficacy and effectiveness. These guidelines can be followed to design culturally sensitive cognitive behavioural therapy studies, or what might be called ‘contextually sensitive cognitive behavioural therapy’, among refugees or other cultural groups in a given global location, and the guidelines can be used to evaluate such studies.

Complex situations following war and natural disasters have a psychosocial impact not only on the individual, but also their family, community and the larger society. Fundamental changes in the functioning of the family and community can be observed as a result of these impacts. At the family level, the dynamics of single parent families, lack of trust among members, changes in significant relationships and child rearing practices are seen. Communities tend to be more dependent, passive, silent, without leadership, mistrustful and suspicious.

We have long outgrown the capacity of the accepted clinical models of trauma, and a paradigm shift in our thinking is long overdue. The data on traumatic stress were posited from a certain cognitive-behavioural viewpoint, with particular emotional components based almost in their entirety on western, mostly white individuals seeking treatment for posttraumatic stress disorder, and focusing on that time frame. As such, mechanisms such as fear and emotional conditioning theory and the ways traumas are encoded in memory only partially explain trauma response.