Evaluation of a culturally adapted cognitive behavior therapy-based, third-wave therapy manual

Table 4 Presentation information and strategies used

Participant	Earlier life experiences (traumatic context)	Presenting problem and impact of past	Specific CCC coping, strategies in addition to mindfulness
1	Childhood abuse (by a close family member), age 4 yr, and neglect; judgmental mother - unrealistic academic expectations	Acquiring physical disability (fibromyalgia and chronic pain), triggers sadness, anger, shame and anxiety, and feeling useless	Building a new relationship with the past: Self compassion
2	Childhood abuse. Domestic violence from partners	Anger and cannot cope when feeling unsupported, let down in the present. Unassertiveness	Building a new relationship with the past: Self-compassion; positive; anger work
3	Over-looked academically as a girl; sense of injustice. Sexual abuse by older brother told not to tell (approx 7 years old) told mother, who blamed and chastised her for the act	Unacknowledged in current family leading to disproportionate depression and anger	Emotion management; selfcompassion
4	Punishing and neglectful mother. Anxious childhood	Inability to deal with emotions. Avoidant of relationships	Self-compassion; emotion management
5	Childhood trauma. Father nearly died in car crash when 9 years old. Family preoccupied with impact on sibling	Obsessional thoughts regarding harm to daughter. Avoidance	Arousal management; aspects of self1; self compassion
6	Extreme childhood fear engendered by tales of black magic	Post-natal fears for safety of son. High anxiety. Compensates with controlling pre-emptive and perfectionist behaviors	Arousal management; building a new relationship with the past; emotion management
7	Neglectful and chaotic childhood. Alcoholic father	Avoidance of emotion leading to constant activity and chronic stress. Alcohol	Arousal management; emotion management
8	Multiple deaths of family members coming close together	Obsessive health anxiety	Arousal management; self-compassion; relationship management2
9	Shamed within family as teen for (culturally unacceptable) homosexuality. Physical and emotional abuse by mother. Father left when 3 years old	Envy, anger, relationship and career difficulties. Loneliness copes with perfectionist ideas but behavioral inactivity (fear of failure)	Emotion management; relationship management2
10	Sister preferred. Sexual abuse by ex-partner. Experienced racism at work	Low self-esteem. Perfectionism leading to high stress	Positive anger work; aspects of self; relationship management
11	Childhood trauma - mother left. Sex abuse by a parent at 12 yr. Abusive childhood. Adult trauma - loss of daughter in a road traffic accident. Impact of road traffic accident - reduced memory, increased emotionality and impulse control	Flashbacks. Dissociation. Low self-esteem. Problems with emotions and relationships	Building a new relationship with the past; emotion management; relationship management2
12	Childhood trauma - loving family, experienced war conflict while in Turkey during Kurdish and Turkish conflict - witnessed village members being tortured by soldiers. ‘Reported seeing ‘Jinns’, dead bodies and evil spirits’ - hallucinations? Adult trauma - illegal immigrant for 14 yr - experienced extreme anxiety and feeling under attack from others	Panic, hypervigilance, avoidance of crowds and exercise	Arousal management; emotion management
13	Mental, physical and sexual abuse	Avoidance of emotion. Avoidance of intimacy	Building a new relationship with the past; relationship management2; emotion management; aspects of self1
14	Childhood sexual abuse by a parent between 5 to 12 yr. Experienced 13 yr of mental and physical abuse from husband	Emotionally overwhelmed. Withdrawal and unmotivated, or dysregulated anger	Arousal management; relationship management; self-compassion
15	Emotionally abusing and criticising childhood	Dissociation. Emotional overwhelm and relationship difficulties	Positive anger work; emotion management;self-compassion
16	Migration age 19 yr of age; hostile in-laws. Major health difficulties severely impact marriage	Suicidal and self-harm. Low mood	Arousal management; relationship management; self compassion2
17	Unhappy childhood; migration distress. Breast cancer	Obsessive anger at neighbours leading to conflict	Arousal management positive anger work; emotion management
18	Diagnosed with Autism. Early childhood developmental problems	Social avoidance	Arousal management; behavioral activation; relationship management2
19	Ran away from home age 11 yr. ‘Kicked out’ of family home at the age of 19 yr. Loss of young sibling and felt excluded	Suicidal. Avoidant of emotion	Building a new relationship with the past; self compassion; emotion management
20	Long exploitative and abusive marriage plus racial bullying at work	Stress, chronic hypertension. Relationship difficulties	Arousal management; emotion management; positive anger work; aspects of self1

¹Aspects of self is mindfulness managed subpersonality work.

²Relationship management includes assertiveness.

Mindfulness is the core intervention; it informs the application of the others. Arousal management includes relaxation breathing and lifestyle adjustment emotion management includes facing, expressing and letting go of emotion. CCC: Comprehend, Cope, and Connect.