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Cultural Relevance and Acceptability of Cognitive Behavioral Therapy Techniques Adapted by AI or a Human Psychologist: Experimental Study
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
Department of Psychology, Stockholm University, Stockholm, Sweden; School of Psychology, Korea University, South Korea, Seoul, Republic of Korea.
Luleå University of Technology, Department of Health, Education and Technology, Health, Medicine and Rehabilitation. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden; Department of Behavioral Sciences and Learning, Linköping University, Linköping, Östergötland, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Östergötland, Sweden; HEI-Lab: Digital Human-Environment Interaction Labs, Universidade Lusófona, Lisbon, Portugal.ORCID iD: 0000-0003-4753-6745
2026 (English)In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 10, article id e91056Article in journal (Refereed) Published
Abstract [en]

Background:Evidence-based psychological interventions are usually not accessed by marginalized groups such as refugees. Culturally adapted psychological interventions have reported larger effect sizes than nonadapted psychological interventions. However, the cultural adaptation of interventions is a lengthy process, entailing a challenge. One potential solution to overcome this challenge is the use of artificial intelligence (AI).

Objective:The aim of this study was to investigate and compare the perceived cultural relevance and acceptability of 2 common cognitive behavioral therapy (CBT) techniques when translated and culturally adapted by AI versus a human psychologist.

Methods:In a 2×2 factorial design, the text generator type (AI vs human psychologist) and the CBT technique (cognitive restructuring vs behavior modification) were compared. CBT technique texts translated and culturally adapted either by AI or by a human psychologist were blindly rated using the Cultural Relevance Questionnaire and the Theoretical Framework of Acceptability. Raters were Arabic-speaking refugees and immigrants, aged between 18 and 69 years, residing in Sweden, Denmark, and Germany. Raters were randomly allocated to 1 of 4 conditions. Each condition consisted of 2 stimuli. Two-factor between-subject design analyses were used to analyze the data.

Results:A significant main effect of the text generator domain type (P=.02; η²=0.045) was found in the first rating, with texts adapted by the AI domain perceived as more culturally relevant than those adapted by the human domain. No significant main effect of the CBT technique was found in the first rating (P=.10; η²=0.022). There were no differences in the second rating. Regarding acceptability, no significant main effects of text generator domain type (P=.09; η²=0.024) or the CBT technique (P=.88; η²=0.001) were found in either of the ratings.

Conclusions:CBT technique materials adapted by AI may be perceived as similarly culturally relevant as those adapted by a human psychologist. This finding implies the potential to accelerate the cultural adaptation of psychological interventions. However, AI still needs to be used with caution and in accordance with rigorous safety standards and robust frameworks.

Place, publisher, year, edition, pages
JMIR Publications Inc. , 2026. Vol. 10, article id e91056
Keywords [en]
cognitive behavioral therapy, ethnopsychotherapy, artificial intelligence, AI, cultural adaptation, immigrant, refugee
National Category
Applied Psychology Psychology (Excluding Applied Psychology)
Research subject
Psychology
Identifiers
URN: urn:nbn:se:ltu:diva-118950DOI: 10.2196/91056ISI: 001771353300018PubMedID: 42081826Scopus ID: 2-s2.0-105042299131OAI: oai:DiVA.org:ltu-118950DiVA, id: diva2:2083829
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Fulltext license: CC BY

Available from: 2026-07-03 Created: 2026-07-03 Last updated: 2026-07-03Bibliographically approved

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Andersson, Gerhard

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