(session 12). Finally, mindfulness was implemented in a more spiritual way (sessions 5, 7, 9), since meditation as a Buddhist tradition is not accepted in Islamic culture.

3.. Instructions to alter specific interventions in CA-CBT {#S0003}
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Religious references to the Quran were deleted because two participants were of Christian belief and three Muslim participants declared that they do not practice their faith. Also, some of the participants reported bad memories and distress in association with their religion. This was adapted in advance, after the religiosity was administered throughout the pre-assessment.The metaphor of the inner child was replaced by the metaphor of an alarm system. The reason for this was the comparison of the mental problems of adults with fears of a little child, which might cause irritation due to thethe seven participants who completed treatment, three participated in 11, two in 10, and two in eight sessions. Drop-outs were not related to exposure components such as hyperventilation experiment; both drop-outs occurred prior to the exposure session. Significant barriers to participation and continuous attendance, however, were time overlap with regular German lessons and appointments as well as attorneys and counsellors due to official processing of asylum status, and so too increased distress and fear of being deported. Promoters of attendance were having native-speaking therapists and assessors facilitate communication, as compared to work with interpreter. Treatment was also facilitated by having therapists with knowledge about housing conditions and the asylum procedure; this created understanding of the participants, resulting in increased trust and openness towards the treatment.

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