Understanding Cognitive-Emotional Patterns Through a CBT Framework in the Context of War Zones: A Case Study on Mental Health Delivery to a Syrian Adult Refugee by a Trainee Psychologist

Abstract

Background: This single-case study was conducted within the sociopolitical context of ongoing conflict and instability in Lebanon. It explored the cognitive and emotional functioning of a Syrian adult female patient exposed to cumulative adversity, including displacement, early trauma, and interpersonal stressors. The study aimed to examine how prolonged adversity contributed to emotional distress and how the patient responded to cognitive behavioral therapy (CBT).

Method: The patient was under the care of a clinical psychologist in training (CPT) at a university medical center in Beirut, Lebanon. Weekly CBT-based sessions were conducted using psychoeducation, cognitive restructuring, and behavioral strategies adapted to her sociocultural context. Reflexive thematic analysis was applied to therapy transcripts, reflective diaries, and clinical notes to identify key psychological patterns and therapeutic responses.

Results: Thematic analysis tackled three overarching themes and eight subthemes. These included: (1) Development of Core Beliefs Rooted in Early Trauma, (2) Coping and Appraisal of Stressors, and (3) Patient Responses to CBT – Shifts in Appraisal, Agency, and Emotional Regulation. The patient’s psychological distress was shaped by longstanding beliefs of helplessness and emotional suppression, compounded by repeated stressors and instability. Despite this, she demonstrated psychological progress through CBT, including increased insight, improved emotion regulation, and development of expressive communication.

Conclusion: The study underscores the complexity of delivering mental health care in conflict-affected settings, where instability is a chronic condition. It highlights the value of culturally responsive CBT models and therapist reflexivity in addressing patient needs. Findings emphasize the importance of integrating lived experience into therapeutic practice and affirming patient autonomy in culturally sensitive care.