The displaced population continues to grow with the increase in ongoing wars and humanitarian crises across the world. Of the estimated 114 million forcibly displaced people, 36.4 million are refugees (UNHCR, 2023). Children account for nearly 50% of the refugee population, despite only accounting for one third of the global population. Research suggests that refugee children are likely to show symptoms of a variety of mental health conditions, including post-traumatic stress disorder, depression and anxiety (Pacione et al., 2013).
Due to the complex and unique needs of the refugee youth population, it is often harder for this population to engage in mental health services (Alto et al., 2021). There has been an increase in attempts to provide culturally adapted mental health support, with research aiming to make mental health intervention more accessible. Culturally Adapted CBT considers cultural background, language and values. There is a limited but growing body of research to suggest that there are increased benefits to culturally adapted interventions.
Acculturation refers to the process in which people from different cultural backgrounds interact with one another (Tan et al., 2020). There are various strategies which are part of the acculturation process: assimilation, integration, marginalisation, and segregation (Berry, 1997). The acculturation strategies that people use impact how minorities adapt and function within a dominant society (Tan et al., 2020). This is important to consider as acculturation can be challenging for refugees due to their likelihood of experiencing trauma (Buchanan et al., 2017). Therefore, acculturation-informed intervention could be beneficial when supporting the refugee youth population.
Methods
A systematic review was undertaken in adherence to guidelines set by PRISMA. Researchers initially included broad eligibility criteria to ensure all relevant studies, including acculturation, Culturally Adapted CBT and refugee youth populations, were included, and seventeen scientific databases were searched. Criteria for the review:
- Participants needed to be under 18 or over 18 in refugee families
- Intervention could be any kind of Culturally Adapted CBT intended to improve refugee mental health/wellbeing that has been informed by acculturation
- Qualitative and Quantitative included
The purpose of this was to find published and unpublished studies that were conducted between 1950 and April 2022. The review also searched grey literature and used citation searching; however, the search and screening were completed in 2022, so newer evidence was not included.
Results
Studies identified were screened by two independent reviewers. Of the 1,675 studies identified, further screening took place, and 5 studies were identified to meet criteria for this review. Due to the specific nature of Culturally Adapted CBT being informed by acculturation, 13 studies were flagged but not included. The total participants of the studies were 523 participants and all were between 11-18 years old. The origin of the participants varied, with only two of the studies specifying the participants’ country of origin. Participants experienced a range of mental health and wellbeing challenges, including trauma, behavioural issues, discrimination and emotional regulation challenges. The studies aimed to evaluate acculturation-informed Culturally Adapted CBT’s effectiveness in improving participants’ mental health and wellbeing. To do this, a comparison pre- and post-intervention was obtained through several outcome measures. Four interventions were designed as school/after-school programmes; the fifth was delivered across school and community settings. Two studies included mixed migrant populations rather than exclusively refugees, which limits how confidently the findings can be generalised to refugee youth.
Of the five studies included, each used a variety of outcome measures to assess mental health and wellbeing. Results indicated that in most of the studies, PTSD related symptoms decreased significantly. Depression symptoms decreased in the two studies that measured them; however, in one study (Ellis et al.), this decrease wasn’t significantly different between lower- and higher-intensity services. In the one study that measured anxiety symptoms (Kira et al.), these significantly decreased post-intervention. There were also findings to suggest that there were increases in overall functioning, as measured by the Child and Adolescent Functional Assessment Scale. These are pre–post improvements, not evidence of comparative effectiveness as none of the included studies had a control group. Therefore, it’s important to keep in mind those changes cannot confidently be attributed to the interventions alone.
Despite being acculturation-informed interventions, only two of the studies specifically measured this. In acculturation measures, it was indicated that the intervention was associated with an increase in participants’ acculturation-related resilience. All the studies included did outline how the intervention used was informed by acculturation. For example, all interventions took place in school settings, as this is where many of the challenges with acculturation are based for young people. There was consideration of acculturation-related needs, targets through specific acculturation groups, using community resources and cultural support. The review also notes that none of the studies assessed the quality/fidelity of their cultural adaptations, and the interventions varied considerably, making it difficult to identify which components were helpful.
Conclusions
This systematic review aimed to pull together the studies that have used acculturation-informed Culturally Adapted CBT in reducing mental health symptoms and overall psychological wellbeing for refugee young people. This review contributes to the emerging evidence base on acculturation-informed Culturally Adapted CBT, although its effectiveness remains uncertain. Each study included found improvements for participants that received intervention. These studies used Culturally Adapted CBT, which includes adaptations such as use of translators, clinicians with migrant experience and consideration of cultural values. It was ensured that acculturation was considered through delivery in a school setting, working with participants’ families and helping strengthen support networks within the community.
Strengths and limitations
This review is the first to look at acculturation-informed culturally adapted CBT for refugee youth and families, according to the authors’ knowledge. Its broad search across 17 databases and use of independent screening are strengths, although the final evidence base was only five studies. It highlights the lack of research into this area, especially considering that the process of acculturation has been shown to have a big impact on refugee youth’s mental health (Keles et al., 2018).
As there were few studies to choose from, there are limitations of the studies that were picked for this review. For example, none of the studies has a control group. This is important as it makes it harder to conclude the findings were due to the intervention. The lack of acculturation-specific measures in most of the studies used means that we cannot understand what aspects of acculturation impacted participants’ outcomes. There was also no comparison with interventions that were not acculturation-informed, so it is hard to know what the benefits are of using acculturation-informed culturally adapted CBT compared to culturally adapted CBT alone. The lack of stringent research methodology weakens the findings somewhat regarding acculturation-informed interventions.
The interventions delivered in the studies took place over a varying amount of time, ranging from 12 weeks to 6 years. It is hard to determine whether the improvements were due to time passing or the interventions. Refugees may experience more acculturation the longer that they live somewhere else; it would have been helpful to understand more about the impact of time v. intervention delivered.
Despite some of the limitations of the studies used in the review, it provides a jumping-off point into acculturation-informed research. The review indicates that there are promising findings in this area and has given suggestions for future research to continue to strengthen the initial findings of these studies.
Implications for practice
This review highlights emerging, but limited, evidence on acculturation-informed Culturally Adapted CBT interventions for the refugee youth population. What this does well is recognising that there are complex challenges faced by this population and that there are several factors that impact their wellbeing and mental health. I liked the idea that acculturation-informed interventions are holistic and consider the impact of moving to a new place, alongside any other mental health symptoms. I feel it is important to understand how resettlement impacts this population’s psychological wellbeing. The studies offer examples of acculturation-informed aspects of treatment that can be considered in the delivery of Culturally Adapted CBT within my own work, such as involvement of family members and the use of staff members who speak their language. In practice, use these findings to inform collaborative, individualised care; not to assume that all young people from migrant backgrounds need the same adaptations. Ask each young person and family about language preferences, cultural identity, resettlement stressors and existing supports, and use trained interpreters where needed.
Working as a cognitive behavioural therapist within a children’s service, I don’t often work with this population, as within my NHS trust there is a refugee-specific service. However, I do often work with young people from a range of different cultural backgrounds, with parents who might not have been born in this country. It made me reflect on the role of acculturation for the young people I see, as it can be challenging for them to balance being born in England with potentially different cultural values and expectations. This can have an impact on their psychological wellbeing, alongside the mental health symptoms that they experience. I was interested to think more about the ways in which acculturation-informed interventions could be used, not just for refugee populations, but for a wide range of migrant populations.
One of the most useful clinical implications of the studies used in these reviews is the importance of delivering interventions within a school setting. Within the NHS, support can often be offered within a building in the community that is separate from spaces that young people might already access. There is a wide body of research that tells us that refugees, asylum seekers and migrants experience barriers to accessing mental health support (Bilican et al., 2025), including financial difficulties and issues with service delivery. By offering intervention within schools, this potentially limits some of these barriers for refugee youths and their families. This paper made me reflect on these barriers for this vulnerable population and how often NHS services can only be accessed through a community healthcare building. More flexible approaches to service delivery may help address barriers to engagement and improve access to support for refugee young people.
From a clinical perspective, it was impactful to understand more about acculturation-informed intervention and the benefits that it has for this group of people. Although further research should be undertaken to learn more about how we can continue to inform interventions that are beneficial for the complexities that come with being a refugee, this review feels like an important start. The unsettled geopolitics of the modern world means there are going to be more young refugees; this has implications for public health around the world. Despite this review focusing on refugees specifically, I felt that it has clinical implications for any person of a different cultural background. It has reinforced my understanding and brought new ideas, such as acculturation, to my awareness.
Future studies should include adequately powered controlled designs, measure acculturation and adaptation fidelity directly, report outcomes over follow-up, and examine which components work for whom.
Statement of interests
Niamh Brannigan is a Cognitive Behavioural Therapist. She has no conflicts of interest to declare.
Editor
The blog was edited by Dr Dafni Katsampa.
Links
Primary paper
Clara Calia and Soraya Mamiche Afara (2026). Acculturation and Culturally Adapted CBT for Refugee Youth and Families—A Systematic Review. Journ Child Adol Trauma.
Other references
Alto, M. E., Bantelman, E., Manly, J. T., Hathaway, A., Knight, S., Frounfelker, R. L., & Petrenko, C. (2021). The Development of a Mental Health Program for Unaccompanied Minors in the United States. International Journal for the Advancement of Counselling, 44(1), 164–196
Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology: An International Review, 46(1), 5–34.
Bilican, S., Irfan, M., Cox, A., Salaets, H., Sabbe, M., & Schoenmakers, B. (2025). Access to mental healthcare for refugees, asylum seekers and migrants: an umbrella review of barriers. BMJ open, 15(6)
Buchanan, Z. E., Abu-Rayya, H. M., Kashima, E., & Paxton, S. J. (2017). The Interconnection between Acculturation and Subjective and Social Wellbeing among Refugee Youth in Australia. Journal of Refugee Studies, 30(4), 511–529.
Keles, S., Friborg, O., Idsøe, T., Sirin, S., & Oppedal, B. (2018). Resilience and acculturation among unaccompanied refugee minors. International Journal of Behavioral Development, 42(1), 52–63.
Pacione, Measham, T., & Rousseau, C. (2013). Refugee Children: Mental Health and Effective Interventions. Current Psychiatry, Reports, 15(2), 341–349
Tan, Y. W., Burgess, G. H., & Green, R. J. (2020). The effects of acculturation on neuropsychological test performance: A systematic literature review. Clinical Neuropsychologist, 35(3), 541–571.
UNHCR (United Nations High Commissioner for Refugees) (2023b). Mid-Year Trends 2023. UNHCR: The UN Refugee Agency.
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