Cultural Adaptation of Scalable Psychological Interventions: A New Conceptual Framework
Open accessAbstract
The worldwide mental health treatment gap calls for scaling-up psychological interventions, which requires effective implementation in diverse cultural settings. Evidence from the field of global mental health and cultural clinical psychology indicates cultural variation in how symptoms of common mental disorders are expressed, and how culturally diverse groups explain the emergence of such symptoms. An increasing number of studies have examined to what extent cultural adaptation enhances the acceptability and effectiveness of psychological interventions among culturally diverse groups. To date, this evidence is inconclusive, and there is a lack of studies that dismantle the multiple types of modifications involved in cultural adaptation. Based on empirical evidence from ethnopsychological studies, cultural adaptation research, and psychotherapy research, the present paper offers a new conceptual framework for cultural adaptation that lays the groundwork for future empirical research. The cultural adaptation framework encompasses three elements: i) cultural concepts of distress; ii) treatment components; and iii) treatment delivery. These three elements have been discussed in literature but rarely tested in methodologically rigorous studies. Innovative research designs are needed to empirically test the relevance of these adaptation elements, to better understand the substantial modifications that enhance acceptability and effectiveness of psychological interventions. Using a theory-driven approach and innovative experimental designs, research on cultural adaptation has the potential not only to make psychological treatments more accessible for culturally adverse groups, but also to further advance empirical research on the basic question about the “key ingredients” of psychotherapy. The phenomenology of common mental disorders, as well as mind-body concepts, vary across cultures. Cultural adaptation may enhance the acceptability and effectiveness of psychological interventions. There is a lack of empirical evidence on the substantial modifications in cultural adaptation. Theory-driven, experimental approaches are needed in cultural adaptation research. The phenomenology of common mental disorders, as well as mind-body concepts, vary across cultures. Cultural adaptation may enhance the acceptability and effectiveness of psychological interventions. There is a lack of empirical evidence on the substantial modifications in cultural adaptation. Theory-driven, experimental approaches are needed in cultural adaptation research.
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According to Heim et al [33], PM+ requires many adaptations to fit a given context before testing or implementing PM+ in that setting.
“According to Heim et al [33], PM+ requires many adaptations to fit a given context before testing or implementing PM+ in that setting.”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [33]
The Cultural Adaptation of Psychological Interventions section discusses adapting treatments to cultural context, but says different interventions likely do not require the same level of adaptation. The Treatment Delivery section says there is no evidence establishing how much adaptation is necessary. Neither passage establishes that PM+ requires many adaptations before it can be tested or implemented. (LLM, conf=0.84)
Experimental — accuracy not yet measuredExisting literature emphasizes that the success of digital technologies in mental health is dependent upon their alignment with sociopolitical conditions and cultural contexts.
“Existing literature emphasizes that the success of digital technologies in mental health is dependent upon their alignment with sociopolitical conditions and cultural contexts.”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [33]
The Treatment Delivery section discusses cultural preferences for internet-based interventions and says that literacy and socioeconomic status may matter when adapting delivery. It does not establish that the success of digital mental-health technologies depends on alignment with sociopolitical conditions; the Abstract describes evidence for the benefits of cultural adaptation as inconclusive. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFailure to align with these factors often results in reduced user engagement and higher attrition rates.
“Failure to align with these factors often results in reduced user engagement and higher attrition rates.”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [33]
The Treatment Components section says a culturally congruent explanatory model may be relevant to treatment engagement, which supports the engagement concern only tentatively. The Treatment Delivery section says evidence is insufficient to establish whether such adaptations enhance acceptance, and no passage found reports higher attrition rates. The claim overstates a possible relationship as an outcome that often occurs. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCultural and religious beliefs may shape participants' expectations and attitude towards an offer.
“Cultural and religious beliefs may shape participants’ expectations and attitude towards an offer [66].”
From Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial (2024) · cites this paper as [66]
There is no scientific consensus on what aspects of treatment are essential to culturally adapt.
“Nevertheless, there is no scientific consensus on what aspects of treatment are essential to culturally adapt (Heim and Kohrt, 2019).”
From Investigating the potential of a novel internet-based cognitive behavioural intervention for Dari and Farsi speaking refugee youth: A feasibility study (2022) · cites this paper as Heim and Kohrt, 2019
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“According to Heim et al [33], PM+ requires many adaptations to fit a given context before testing or implementing PM+ in that setting.”
Perry, A., Gardener, C., Shieh, J., Hồ, Q. T., Doan, A., & Bhui, K. (2024) · Transcultural Psychiatry · doi:10.1177/13634615241228071 · Cited by 7 · see citing works
Dominguez-Rodriguez, A., Herdoiza-Arroyo, P. E., González-Ramírez, L. P., Martínez-Arriaga, R. J., Villarreal-Zegarra, D., Santos da Silva, A. C., González-Cantero, J. O., Vargas Salinas, V. S., S. Mensorio, M., Cisneros Hernández, A. A., et al. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1279847 · Cited by 3 · see citing works
Torre, C. (2023) · London School of Economics and Political Science (LSE) · doi:10.21953/lse.00004557
- Authors
- Heim, E., & Kohrt, B. A.
- Affiliations
- University of Zurich (CH)
- George Washington University (US)
- Venue
- Clinical Psychology in Europe
- Published
- 2019-12-17
- Volume
- 1
- Issue
- 4
- ISSN
- 2625-3410 (ISSN-L)
- OpenAlex
- W2996499765
- Cited by
- 191
- References
- 72
- Citations by year
- 2026: 34 · 2025: 27 · 2024: 51 · 2023: 21 · 2022: 27 · 2021: 19 · 2020: 12
- FWCI
- 29.18
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Clinical Psychology in Europe (publishedVersion, cc-by)
- PsychOpen Gold (Leibniz Institute for Psychology) (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- ZooKeys (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Europe’s Journal of Psychology (submittedVersion, cc-by)
- SERVAL (Université de Lausanne) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Science Foundation
- King's College London
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (169780)
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London
- Medical Research Council (MR/R023697/1)
- National Institute of Mental Health (K01MH104310, R21MH111280)
- Topics
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cultural adaptation, psychological intervention, global mental health, conceptual framework, cultural concepts of distress, treatment components, treatment delivery, acceptability, effectiveness, common mental disorders, phenomenology of mental disorders
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