Development, Cultural Adaptation, and Evaluation of a School-Based Cognitive Behavioural Therapy (CBT) Intervention for Ghanaian Basic Schools

Project Description This project outlines the development, cultural adaptation, and phased implementation of a school-based Cognitive Behavioral Therapy (CBT) intervention tailored for Basic Schools in Ghana. Guided by Rathod et al.’s (2015) framework for Culturally Adapted CBT (CaCBT), the study is structured into multiple iterative phases: Information Gathering – to understand local idioms of distress, mental health needs, and contextual factors affecting intervention delivery in Ghanaian school settings. Review Studies – to guide the cultural adaptation process using local literature, stakeholder consultations, and relevant clinical and educational frameworks. Manual Development/Modification – to produce a culturally sensitive, developmentally appropriate CBT manual for use by school-based mental health providers. Pilot Study – to assess the feasibility, acceptability, and cultural relevance of the adapted intervention within selected Basic Schools in Ghana. This OSF registration serves as an open record of the implementation development process. It does not contain final protocols or hypotheses at this stage. Rather, it reflects a flexible, developmental trajectory where methodological details and intervention components will be specified and updated progressively as each stage unfolds. The project addresses the gap in evidence-based, culturally relevant mental health interventions for youth in low-resource school contexts in Ghana. It is designed to support adolescent mental health promotion, reduce psychological distress (e.g., depression and anxiety), and promote adaptive emotion regulation through a community-informed and context-specific CBT framework. All future protocol documents, instruments, ethical approvals, and pilot evaluation outcomes will be uploaded as the study progresses. This project is open for collaboration, review, and adaptation in other similar contexts. Purpose and Rationale Adolescents in Ghana face a range of psychosocial stressors—including academic pressure, family disruption, poverty, stigma, and, for some, exposure to trauma—that contribute to the growing burden of internalizing disorders such as anxiety and depression. However, mental health services remain limited, and culturally appropriate interventions tailored to the sociocultural realities of Ghanaian youth are largely unavailable in school settings. Evidence-based interventions like CBT have demonstrated effectiveness in reducing adolescent emotional distress globally, but standard CBT protocols often reflect Western assumptions about cognition, individualism, and emotional expression. These may not align with Ghanaian cultural values, such as communalism, spirituality, and specific idioms of distress. Therefore, the goal of this research is to adapt CBT in a manner that retains its evidence-based structure while making it culturally appropriate, linguistically accessible, and developmentally responsive for adolescents in Ghana. Phases of the Research The project will be conducted in four interlinked phases: Information Gathering: This phase involves formative research to understand the cultural context of emotional and psychological distress among Ghanaian adolescents. It includes interviews, focus groups, and surveys with students, teachers, parents, and local mental health professionals. The aim is to identify culturally specific beliefs, idioms of distress, coping mechanisms, and treatment preferences. Review Studies and Cultural Guidance: Findings from the first phase will be reviewed alongside existing literature and cultural adaptation frameworks. Expert panels—including psychologists, educators, traditional/religious leaders, and community members—will be engaged to provide culturally grounded feedback. This process will guide adaptation decisions related to language, therapeutic metaphors, examples, and delivery strategies. Manual Development/Modification: Using the information gathered, a culturally adapted CBT (CaCBT) manual will be developed. The adaptation process will preserve core components of CBT (e.g., psychoeducation, cognitive restructuring, behavioral activation) while incorporating culturally relevant content. The manual will also be translated into local languages as needed and designed for delivery by trained school-based facilitators. Pilot Study: The adapted intervention will be piloted in selected Ghanaian basic schools to assess feasibility, acceptability, and preliminary effectiveness. Mixed methods will be used, including: Quantitative assessments (e.g., PHQ-A, GAD-7) to measure changes in symptoms. Qualitative interviews to explore stakeholder experiences. Fidelity and satisfaction measures to evaluate implementation quality. Expected Outcomes A culturally validated, manualized CBT intervention for use in Ghanaian school settings. Increased acceptability and feasibility of school-based mental health interventions among Ghanaian adolescents, teachers, and parents. Reduction in symptoms of depression and anxiety among adolescent participants. Enhanced understanding of how cultural values, beliefs, and idioms of distress influence CBT engagement and outcomes. Strengthened capacity of school-based personnel to deliver structured mental health interventions with minimal reliance on clinical infrastructure. Significance This research has the potential to contribute meaningfully to global mental health literature by providing a model for adapting and implementing CBT in low-resource, culturally diverse school settings. By grounding the intervention in Ghanaian cultural norms and adolescent lived experiences, the project also aims to enhance adolescent resilience, reduce school-related distress, and promote emotional wellbeing. The final CaCBT package may serve as a scalable model for broader application across West African contexts.