Cross-cultural adaptation of the Window to Hope: a psychological intervention to reduce hopelessness among U.S. veterans with traumatic brain injury

Brain Inj. 2014;28(10):1238-47. doi: 10.3109/02699052.2014.916419. Epub 2014 Jun 19.


Primary objective: To conduct a cross-cultural adaptation of Window to Hope (WtoH), a treatment to reduce hopelessness after traumatic brain injury (TBI), from the Australian civilian context to that of U.S. Veterans.

Research design: Three-stage mixed-methods approach.

Methods: Stage 1: Consensus conference with stakeholders to revise the manual. Stage 2: Pilot study of the revised manual with US Veterans to examine acceptability, feasibility and fidelity. Stage 3: Review of results with consensus conference attendees and further revisions.

Results: Stage 1: Conference attendees reached 100% consensus regarding changes made to the manual. Stage 2: Qualitative results yielded themes that suggest that participants benefitted from the intervention and that multiple factors contributed to successful implementation (Narrative Evaluation of Intervention Interview, User Feedback Survey-Modified, Post-Treatment Interviews). Therapists achieved 100% treatment fidelity. Quantitative results from the Client Satisfaction Questionnaire-8 suggest that the intervention was acceptable. Stage 3: The culturally adapted manual was finalized.

Conclusions: RESULTS of this study suggest that the revised WtoH manual is acceptable and feasible. US therapists exhibited adherence to the protocol. The three-stage methodology was successfully employed to cross-culturally adapt an intervention that is well-suited for a Phase II randomized controlled trial among US military Veterans.

Keywords: Cognitive behaviour therapy; mental health; suicide prevention.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Australia
  • Brain Injuries / complications*
  • Brain Injuries / psychology
  • Brain Injuries / rehabilitation
  • Clinical Protocols
  • Cognitive Behavioral Therapy* / methods
  • Cross-Cultural Comparison
  • Evidence-Based Medicine
  • Feasibility Studies
  • Female
  • Humans
  • Ill-Housed Persons / psychology*
  • Ill-Housed Persons / statistics & numerical data
  • Male
  • Pilot Projects
  • Self-Injurious Behavior / etiology*
  • Self-Injurious Behavior / prevention & control
  • Self-Injurious Behavior / psychology
  • Suicidal Ideation
  • Suicide Prevention*
  • Time Factors
  • Treatment Outcome
  • United States
  • Veterans / psychology*