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Khan N, Butt MG, Awan F, Abid S, Latif M, Aslam M, Naz S, Phiri P, Zadeh Z, Farooq S, Afridi I, Ayub M, Husain N, Javed A, Irfan M, Naeem F. Global mental health commentary: using innovation to create a workforce to deliver and implement culturally adapted CBT in Pakistan. BMJ MENTAL HEALTH 2025; 28:e301389. [PMID: 40037899 DOI: 10.1136/bmjment-2024-301389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 01/08/2025] [Indexed: 03/06/2025]
Abstract
Most low- and middle-income countries (LMICs) have poor or non-existent mental healthcare. Many of LMIC countries allocate less than 1% of their health budgets to addressing mental illness, making large-scale public health interventions not a practical option, at least for the foreseeable future. Psychiatric services are limited to large urban centres, and mental health literacy is low. There is increasing international recognition of the need to build capacity to strengthen mental health systems in LMICs.The aim of this paper is to offer a reflective commentary on our research undertaken over 15 years in Pakistan psychiatric services to create a workforce and culturally adapted cognitive behaviour therapy (CBT) model for LMICs that works for diverse communities served. The exemplar of our work discussed in this article can be used as lessons for developing mental health therapies for LMICs and other countries with diverse communities globally. Our discussion is based largely, if not, on all aspects describing the key barriers and facilitators to implementation of a workable culturally adapted CBT model for use in Pakistan or any similar LMICs. We report on the implementation of culturally adapted CBT in Pakistan over the past 15 years to improve the identified gaps in evidence. We also highlight the successful dissemination strategies our group employed for successful adaption and implementation.
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Affiliation(s)
- Nagina Khan
- Centre for Health Services Studies (CHSS) |Division of Law, Society and Social Justice |School of Social Sciences, University of Kent, Canterbury, UK
| | | | - Falahat Awan
- Dow Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Sadia Abid
- Pakistan Association of Cognitive Therapy, Lahore, Pakistan
| | - Madeeha Latif
- Dow Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Muhammad Aslam
- Pakistan Association of Cognitive Therapy, Lahore, Pakistan
| | - Saiqa Naz
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Peter Phiri
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Zainab Zadeh
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Saeed Farooq
- Faculty of Medicine & Health Sciences, School of Medicine, Keele University, Keele, UK
| | - Iqbal Afridi
- Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | | | | | - Afzal Javed
- Department of Mental Health, Peshawar Medical College, Peshawar, Pakistan
| | - Muhammad Irfan
- Department of Mental Health, Peshawar Medical College, Peshawar, Pakistan
| | - Farooq Naeem
- Psychiatry, CAMH, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Aeschlimann A, Heim E, Killikelly C, Mahmoud N, Haji F, Stoeckli RT, Aebersold M, Thoma M, Maercker A. Cultural adaptation of a self-help app for grieving Syrian refugees in Switzerland. A feasibility and acceptability pilot-RCT. Internet Interv 2025; 39:100800. [PMID: 39902282 PMCID: PMC11788602 DOI: 10.1016/j.invent.2025.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 01/13/2025] [Accepted: 01/16/2025] [Indexed: 02/05/2025] Open
Abstract
Background The global refugee population has significantly increased, with Syrian refugees being one of the largest displaced groups. Bereavement represents a major challenge. However, access to mental health care is limited by structural and cultural barriers. Internet-based interventions (IBIs) offer a promising solution, but most are developed in Western contexts, limiting their cultural relevance. This study aimed to evaluate the acceptability, feasibility, and preliminary efficacy of a culturally adapted self-help IBI for bereaved Syrian refugees in Switzerland. Methods In a mixed-methods pilot randomized controlled trial (RCT), 30 bereaved Syrian refugees were randomly assigned to a 5-week app-based intervention or a waitlist control group. Semi-structured interviews with the intervention group provided qualitative insights on feasibility and acceptability and were analyzed with framework analysis. Quantitative data assessed treatment satisfaction, adherence, and preliminary efficacy on grief, depression, posttraumatic stress disorder (PTSD), anxiety, well-being, disability, post-migration difficulties, and social support. Descriptive statistics were used for feasibility and acceptability, while linear mixed-effects models assessed efficacy. Results High treatment satisfaction, a low dropout rate and adherence of 40 % were found. Qualitative interviews indicated the intervention was relevant and beneficial, further adaptations were suggested. No significant group differences were found on bereavement or secondary outcomes. However, trends indicated reduced grief, anxiety, PTSD, and depression, with improved well-being and social support in the intervention group. Conclusions The results suggest that this culturally adapted IBI is both feasible and acceptable for Syrian refugees. While trends are promising, a larger RCT is needed to investigate efficacy. This intervention shows potential as meaningful support for bereaved Syrian refugees.
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Affiliation(s)
| | - Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Clare Killikelly
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | | | | | | | - Myriam Thoma
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
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Bennion M, Lovell K, Blakemore A, Vicary E, Bee P. Predictors of engagement with between-session work in Cognitive Behavioural Therapy (CBT)-based interventions: a mixed-methods systematic review and "best fit" framework synthesis. Cogn Behav Ther 2025; 54:41-77. [PMID: 38980141 DOI: 10.1080/16506073.2024.2369939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024]
Abstract
Between-session work (BSW) acts as the vehicle to translate skills learnt in therapy sessions into adaptive changes in everyday life, a key goal in Cognitive Behavioural Therapies (CBT). Despite a well-established relationship between engagement with BSW and enhanced treatment outcomes, difficulties completing between-session tasks are common and factors affecting patient engagement with BSW are poorly understood. This mixed-methods systematic review and "best fit" framework synthesis explored predictors of engagement with BSW in CBT-based interventions. Comprehensive searches were conducted across five databases, identifying 59 eligible studies. This combined theory and empirical evidence approach depicted ten predictor themes related to between-session engagement, spanning individual, relational and contextual concepts. While ambiguous findings were generated by existing evidence, several factors emerged as relatively consistent predictors of engagement with BSW: positive patient beliefs regarding BSW and treatment such as perceived helpfulness, and practitioner competency in planning and reviewing BSW, including providing a rationale and addressing difficulties were associated with greater engagement. Conversely, patient in-session resistance, including counter change talk, was an indicator of disengagement between-sessions. The impact of patient symptomology, sociocultural environment, practitioner beliefs and the therapeutic relationship is unclear. The conceptual model presented offers a testable framework for researchers and a guideline for practitioners.
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Affiliation(s)
- Mia Bennion
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Emily Vicary
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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Alnaghaimshi NIS, Awadalla MS, Clark SR, Baumert M. A systematic review of features and content quality of Arabic mental mHealth apps. Front Digit Health 2024; 6:1472251. [PMID: 39723151 PMCID: PMC11668747 DOI: 10.3389/fdgth.2024.1472251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 11/20/2024] [Indexed: 12/28/2024] Open
Abstract
Introduction Anxiety and depression are major causes of disability in Arab countries, yet resources for mental health services are insufficient. Mobile devices may improve mental health care delivery (mental m-Health), but the Arab region's mental m-Health app landscape remains under-documented. This study aims to systematically assess the features, quality, and digital safety of mental m-Health apps available in the Arab marketplace. We also contrast a set of recommended Australian apps to benchmark current strategies and evidence-based practices and suggest areas for improvement in Arabic apps. Methods Fifteen Arab country-specific iOS Apple Stores and an Android Google Play Store were searched. Apps that met the inclusion criteria were downloaded and evaluated using the Mobile App Rating Scale (MARS) and the Mobile App Development and Assessment Guide (MAG). Results Twenty-two apps met the inclusion criteria. The majority of apps showed no evidence of mental health experts being involved in the app design processes. Most apps offered real-time communication with specialists through video, text, or audio calls rather than evidence-based self-help techniques. Standardized quality assessment showed low scores for design features related to engagement, information, safety, security, privacy, usability, transparency, and technical support. In comparison to apps available in Australia, Arabic apps did not include evidence-based interventions like CBT, self-help tools and crisis-specific resources, including a suicide support hotline and emergency numbers. Discussion In conclusion, dedicated frameworks and strategies are required to facilitate the effective development, validation, and uptake of Arabic mental mHealth apps. Involving end users and healthcare professionals in the design process may help improve app quality, dependability, and efficacy.
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Affiliation(s)
- Noorah Ibrahim S. Alnaghaimshi
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
- Department of Computer and Information Science, Al-Majmaah University, Al-Majmaah, Riyadh Region, Saudi Arabia
| | - Mona S. Awadalla
- Specialist Community Mental Health Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Scott R. Clark
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
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McDermott L, Hameed I, Lau-Zhu A. Cultural Adaptations, Efficacy, and Acceptability of Psychological Interventions for Mental Health in Adults with Refugees and Asylum-Seeker Status: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:3758-3776. [PMID: 39096106 PMCID: PMC11545127 DOI: 10.1177/15248380241262262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
People with refugees and asylum seeker status (R/AS) have been forced to leave their home and resettle in new countries due to political unrest, conflict, and violence. This review aimed to describe the nature and extent of cultural adaptations to psychological interventions for adults with R/AS experiencing clinically significant psychological distress, and the acceptability and efficacy of these interventions. A search was conducted in October 2023 and February 2024 across five electronic databases: PsycINFO, Medline, Embase, PubMed, and Cochrane. Eligible studies were randomized controlled trials of psychological interventions conducted in any geographic context. Studies reporting on interventions with minimal adaptations only to facilitate treatment access, with no clear evidence for cultural adaptation, were excluded. Eighteen studies were identified, and cultural adaptations were described in line with the Ecological Validity Model. Studies investigating transdiagnostic interventions, cognitive behavioral therapy (CBT) interventions, and other psychotherapies were synthesized. Analysis and reporting of acceptability were limited across intervention groups, highlighting a need for more robust research in this area. CBT interventions and other psychological therapies were found to be most efficacious with moderate to large effects across validated psychological measures. Small to moderate effect sizes were observed across transdiagnostic interventions. The evidence quality was generally of some concerns. While the evidence requires further developments, the current review provides a timely synthesis of culturally adapted interventions for adults with R/AS to inform intervention development and clinical practice. Strengths, limitations, and recommendations for future research are discussed.
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Affiliation(s)
| | - Ikra Hameed
- University of Oxford, UK
- Oxford Health NHS Foundation Trust, UK
| | - Alex Lau-Zhu
- University of Oxford, UK
- Oxford Health NHS Foundation Trust, UK
- Imperial College London, UK
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Aeschlimann A, Heim E, Hoxha A, Triantafyllidou V, Killikelly C, Haji F, Stoeckli RT, Aebersold M, Maercker A. Cultural adaptation of an internet-based self-help app for grieving Syrian refugees in Switzerland. BMC Public Health 2024; 24:3048. [PMID: 39501191 PMCID: PMC11536621 DOI: 10.1186/s12889-024-20507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 10/24/2024] [Indexed: 11/09/2024] Open
Abstract
BACKGROUND Loss and grief pose significant challenges for victims of armed conflicts, such as Syrian refugees. Internet-based interventions (IBIs) present a promising solution to address this treatment gap and provide adequate support. However, research on grief, grief support, and IBIs remain largely limited to Western cultural contexts, and culturally adapted IBIs for grief are needed. Following the Reporting Cultural Adaptation in Psychological Trials (RECAPT) framework, this study aimed to develop and further adapt a culturally sensitive IBI for bereaved Syrian refugees in Switzerland. METHODS The study employed qualitative methods. Initially, formative research was conducted to create a first version of the intervention, including semi-structured interviews with 10 experts to identify necessary cultural adaptations. The preliminary version of the intervention was then presented to six potential users and three experts to gather feedback on additional cultural adaptations through two iterative feedback rounds. The first round involved semi-structured interviews using a "paper version" of the intervention, followed by a second round with a walk-through think-aloud protocol with a beta version. Data were analyzed using framework analysis. RESULTS The input from various key informants at different stages of development provided valuable feedback on surface and deep structure adaptation, which may enhance treatment adherence, acceptance, and motivation. CONCLUSIONS These findings provide important insights and recommendations for the cultural adaptation of interventions and may help address the treatment gap for bereaved Syrian refugees.
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Affiliation(s)
- Anaïs Aeschlimann
- Department of Psychology, University of Zurich, Binzmühlestrasse 14/17, Zurich, CH-8050, Switzerland.
| | - Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Anna Hoxha
- Department of Psychology, University of Zurich, Binzmühlestrasse 14/17, Zurich, CH-8050, Switzerland
| | - Valentina Triantafyllidou
- Department of Psychology, University of Zurich, Binzmühlestrasse 14/17, Zurich, CH-8050, Switzerland
| | - Clare Killikelly
- Department of Psychology, University of Zurich, Binzmühlestrasse 14/17, Zurich, CH-8050, Switzerland
| | | | | | | | - Andreas Maercker
- Department of Psychology, University of Zurich, Binzmühlestrasse 14/17, Zurich, CH-8050, Switzerland
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Jonathan GK, Armstrong C, Miyares P, Williams J, Wilhelm S. Advancing Psychosocial Treatment for Body Dysmorphic Disorder: A State-of-the-Science Review. Behav Ther 2024; 55:1249-1288. [PMID: 39443065 DOI: 10.1016/j.beth.2024.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 10/25/2024]
Abstract
Body dysmorphic disorder (BDD) is an underrecognized, challenging illness with severe comorbidities, demanding urgent advancements in treatment strategies. This state-of-the-science review describes current research on existing BDD treatments, beginning with a detailed discussion of cognitive-behavioral therapy (CBT), the primary psychosocial intervention for BDD, and its foundational theories. We emphasize the significant progress in the field, including the efficacy of face-to-face CBT, the promising outcomes of digital interventions for broadening access to care, and emerging treatments that warrant further exploration. The review also addresses the critical gap of targeted interventions for youth, considering the diseases' typical onset during adolescence. Our review also sheds light on the significant gap in research dedicated to testing these treatments in underserved communities, stressing the importance of including these populations in research and culturally informed and adapted, if necessary, care. The review concludes with recommendations for future directions, outlining areas for ongoing treatment development and research to expand the scope and efficacy of interventions for BDD.
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Perry A, Gardener C, Shieh J, Hồ QT, Doan A, Bhui K. Investigating the acceptability of a culturally adapted acceptance and commitment therapy group for UK Vietnamese communities: A practice-based feasibility study. Transcult Psychiatry 2024; 61:626-651. [PMID: 38529626 DOI: 10.1177/13634615241228071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy that offers promise for the mental health of minoritised ethnic populations. Given the diversity of those presenting to inner-city services and barriers to accessing appropriate mental healthcare, we sought to develop a culturally syntonic ACT intervention for UK Vietnamese refugee communities in a practice-based partnership project between a National Health Service and local third-sector service in East London. The aim was to explore the feasibility, acceptability and impact of the adapted intervention to inform culturally inclusive clinical practice and future research. We outline key aspects of Vietnamese belief systems and culture, and consider how these might influence the optimisation of group-based ACT. We then present a mixed-method evaluation of the seven-session adapted ACT group for 11 participants (9 male and 5 female, aged between 44 and 73 years). Individual-level change analyses indicated clinically significant improvements in psychological flexibility for the minority of participants and a mixed pattern for impact on well-being. A thematic analysis and descriptive approach examined acceptability, feasibility and narratives of impact. Participants reported positive feedback on group experience, relevance and usefulness, and emergent themes indicate that the group facilitated key acceptance, commitment and behaviour-change processes, promoted social connections and increased engagement in meaningful life activities in relation to new perspectives and values-based action. Limitations are outlined, but overall, findings suggest preliminary support for the potential beneficial effect of the adapted ACT group as a feasible, culturally acceptable therapeutic approach for UK Vietnamese communities that is worthy of further investigation.
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Affiliation(s)
| | | | | | | | | | - Kamaldeep Bhui
- East London NHS Foundation Trust
- University of Oxford
- World Psychiatric Association Collaborating Centre (Research, Training, Policy) Oxford
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Rimal P, Shrestha S, Khatri R, Sapkota S, Swar SB, Basnet M, Sigdel K, Jirel S, Acharya B. Addressing Challenges for Psychotherapy Supervision in Global Mental Health: Experiential Learnings From Rural Nepal. RESEARCH SQUARE 2024:rs.3.rs-4499074. [PMID: 38978610 PMCID: PMC11230512 DOI: 10.21203/rs.3.rs-4499074/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Faculty members and mentors may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health. Methods We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government. Results The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles and gaining competence in navigating different expectations of social structures and family dynamics. Conclusion Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support psychiatrists, supervisors, and trainees based in low- and middle-income countries.
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Naeem F, Phiri P, Husain N. Southampton Adaptation Framework to Culturally Adapt Cognitive Behavior Therapy: An Update. Psychiatr Clin North Am 2024; 47:325-341. [PMID: 38724123 DOI: 10.1016/j.psc.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Cultural values, traditions, and norms influence the practice of psychotherapy. It is now widely accepted that modern evidence-based therapies such as CBT need to be culturally adapted for them to be successfully applied to clients from a non-Western background. There are multiple factors to support cultural adaptations, such as evidence from research and an increase in cultural awareness and globalization. A number of meta-analyses supporting culturally adapted interventions have been published across the globe. A review of these meta-analyses reported that culturally adapted interventions have moderate to high effect sizes in favor of culturally adapted psychological interventions. We provide a brief background on cultural differences and suggest ways to address these differences. We also discuss the current state of science in this area. We also provide a brief description of factors that are generally accepted as important components of culturally adapted interventions. We discuss the Southampton Adaptation Framework widely used to Culturally adapt CBT (SAF-CaCBT). This framework has been used in South Asia, the Middle East, China, England, Africa, and Canada. More than 20 studies have used the framework to adapt CBT culturally. The framework has evolved based on lessons learned from research and consists of 3 major areas of concern: awareness of culture and religion, assessment and engagement, and adjustments in therapy. Each area has 8 subareas to consider when culturally adapting CBT. Finally, we discuss the limitations and barriers in this area and recommendations for future work. There is a need to develop universal guidelines on cultural adaptation as well as areas of adaptation, more research with better methodology and the use of active comparators in the assessment of culturally adapted interventions. There is also a need to further strengthen the evidence base by robust meta analyses.
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Peter Phiri
- Psychology Department, Visiting Academic, University of Southampton, Southampton, England
| | - Nusrat Husain
- Department of Psychiatry, University of Manchester, Manchester, England
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Barber J, Childs AW, Resnick S, Connors EH. Leveraging Measurement-Based Care to Reduce Mental Health Treatment Disparities for Populations of Color. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01364-4. [PMID: 38489017 DOI: 10.1007/s10488-024-01364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Abstract
Disparities in mental health treatment have consistently been documented for clients of color as compared to White clients. Most mental health care disparities literature focuses on access to care at the point of initial engagement to treatment, resulting in a dearth of viable solutions being explored to retain clients in care once they begin. Measurement-based care (MBC) is a person-centered practice that has been shown to improve the therapeutic relationship, make treatment more personalized, and empower the client to have an active role in their care. Problems with therapeutic alliance and treatment relevance are associated with early termination for communities of color in mental health services. However, MBC has not been explored as a clinical practice to address therapeutic alliance and continual engagement for people of color seeking mental health care. This Point of View describes several MBC features that may be able to impact current sources of disparity in mental health treatment quality and provides a rationale for each. Our hope is that the field of MBC and progress feedback will more explicitly consider the potential of MBC practices to promote equity and parity in mental health services of color and will start to explore these associations empirically. We also discuss whether MBC should be culturally adapted to optimize its relevance and effectiveness for communities of color and other groups experiencing marginalization. We propose that MBC has promise to promote equitable mental health service quality and outcomes for communities of color.
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Affiliation(s)
- Jessica Barber
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Veterans Affairs, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT, USA.
| | - Amber W Childs
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sandra Resnick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT, USA
| | - Elizabeth H Connors
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Blomberg O, Svedin F, Farrand P, Brantnell A, von Essen L, Patriksson Karlsson J, Åberg AC, Woodford J. Adaptation of a guided low-intensity behavioral activation intervention for people with dementia in Sweden: a qualitative study exploring the needs and preferences of key stakeholders. BMC Geriatr 2024; 24:113. [PMID: 38291349 PMCID: PMC10826011 DOI: 10.1186/s12877-023-04606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Despite depression being prevalent in people with dementia, contributing to negative health outcomes and placing increased burden on individuals and family members, access to psychological interventions is limited. A potential solution is guided low-intensity behavioral activation, supported by informal caregivers and guided by healthcare professionals. However, it is necessary to adapt interventions to meet the needs and preferences of key stakeholders to enhance acceptability and relevance. Study objectives were to: (1) explore needs and preferences concerning the content and delivery model of the guided low-intensity behavioral activation intervention; and (2) adapt the intervention to ensure cultural appropriateness, relevancy, and acceptability to people with dementia and their caregivers in Sweden. METHODS Semi-structured interviews and focus group discussions were conducted with key stakeholders, including healthcare professionals (n = 18), community stakeholders (n = 7), people with dementia (n = 8), and informal caregivers (n = 19). A draft of the written low-intensity behavioral activation intervention and a description of the proposed intervention delivery model were provided to participants. Open-ended questions explored the perceived relevance of the intervention, alongside needs and preferences concerning content and delivery. A manifest content analysis approach was adopted. RESULTS Content analysis resulted in three categories: Content, Delivery procedures, and Illness trajectory. Results highlighted a need to consider the intervention Content via increased cultural adaptation to the Swedish context, and increasing the inclusiveness of intervention content. Delivery procedures were identified as needing to be flexible given the unpredictable nature of caring for people with dementia, with the provision of additional guidance to informal caregivers supporting the intervention. Illness trajectory was viewed as essential to consider, with the intervention regarded as suitable for those early in the dementia trajectory, alongside a need to reduce workbook text to minimize burden given dementia symptomology. CONCLUSIONS The intervention and proposed delivery model were generally well received by all stakeholders. We were able to identify key adaptations to enhance cultural appropriateness, relevancy, and acceptability for a currently neglected population. Results will inform a feasibility study to explore the feasibility and acceptability of the intervention and study procedures to inform the design of a future superiority randomized controlled trial. TRIAL REGISTRATION/PROTOCOL Not applicable.
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Affiliation(s)
- Oscar Blomberg
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
| | - Frida Svedin
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
| | - Paul Farrand
- Clinical Psychology, Education, Development and Research (CEDAR), Psychology, University of Exeter, Perry Road, EX4 4QG, Devon, UK
| | - Anders Brantnell
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
- Industrial Engineering and Management, Department of Civil and Industrial Engineering, Uppsala University, Uppsala, 751 21, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
| | - Johanna Patriksson Karlsson
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden
| | - Anna Cristina Åberg
- Department of Medical Science, School of Health and Welfare, Dalarna University, Falun, 791 88, Sweden
- Clinical Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, 751 22, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden.
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Naeem F, Khan N, Sohani N, Safa F, Masud M, Ahmed S, Thandi G, Mutta B, Kasaam A, Tello K, Husain MI, Husain MO, Kidd SA, McKenzie K. Culturally Adapted Cognitive Behaviour Therapy (CaCBT) to Improve Community Mental Health Services for Canadians of South Asian Origin: A Qualitative Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:54-68. [PMID: 37376808 PMCID: PMC10867407 DOI: 10.1177/07067437231178958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND South Asian (SA) Canadians are disproportionately affected by higher rates of mood and anxiety disorders. SA Canadians with depression report significant barriers to accessing mental health care and the highest proportion of unmet mental health needs. The Mental Health Commission of Canada (MHCC) advocates for culturally and linguistically relevant services for SA Canadians. Culturally adapted cognitive behavior therapy (CaCBT) has shown to be more effective than standard cognitive behavior therapy (CBT). Adapting CBT for the growing SA population in Canada will ensure equitable access to effective, culturally-appropriate mental health interventions. METHOD The study used a qualitative design to elicit stakeholder consultation via in-depth interviews. This study is reported using the criteria included in Consolidated Criteria for Reporting Qualitative Studies (COREQ). The analysis follows an ethnographic approach and was informed by the principles of emergent design. RESULTS Five themes were identified from the analysis, (i) Awareness and preparation: factors that impact the individual's understanding of therapy and mental illness. (ii) Access and provision: SA Canadians' perception of barriers, facilitators, and access to treatment. (iii) Assessment and engagement: experiences of receiving helpful treatment. (iv) Adjustments to therapy: modifications and suggestions to standard CBT. (v) Ideology and ambiguity: racism, immigration, discrimination, and other socio-political factors. CONCLUSIONS Mainstream mental health services need to be culturally appropriate to better serve SA Canadians experiencing depression and anxiety. Services must understand the family dynamics, cultural values and socio-political factors that impact SA Canadians to reduce attrition rates in therapy.
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nagina Khan
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nazia Sohani
- Immigrant Services, Ottawa Newcomer Health Centre, Ottawa, ON, Canada
| | - Farhana Safa
- Punjabi Community Health Services, Brampton, ON, Canada
| | | | - Sarah Ahmed
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Gary Thandi
- Moving Forward Family Services, Vancouver, Canada
| | - Baldev Mutta
- Punjabi Community Health Services, Toronto, Canada
| | - Azaad Kasaam
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Kamlesh Tello
- Access to Quality Mental Health Services, Mental Health Commission of Canada, Ottawa, ON, Canada
| | | | | | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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14
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Dayes J, Keenan J, Sadza M, Croucher K. Etiquette in the Context of Death and Dying: Communication and Conversation. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231196623. [PMID: 37922522 DOI: 10.1177/00302228231196623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Death, bereavement, and grief are experiences suffused with conflict and disenfranchisement. Intricately connected is 'etiquette' - the sense of 'should' 'must' 'right' 'wrong' 'appropriate' and 'inappropriate' individuals feel in death and bereavement situations. This paper is the first of two answering the question, 'where does etiquette arise in death and bereavement situations and what does this 'look like?'' The theme The etiquette of communication and conversation is described, highlighting the importance of early communication for resolving conflict, what is considered 'appropriate' communication and support, and the social values underpinning these. Data highlighted how the CBT concept of 'shoulding and musting' manifests in death and bereavement situations, gave insight into etiquette's role in disenfranchising grief through shaping conversations, and offered suggestions for bereavement support. Though the term 'etiquette' may be misleading out of context, the concept resonated with the bereaved community and provided language to discuss the nuances of their experiences.
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Affiliation(s)
- Jennifer Dayes
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Joseph Keenan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Michal Sadza
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Karina Croucher
- Archaeological and Forensic Sciences, University of Bradford, Bradford, UK
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15
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Day S. Frameworks for cultural adaptation of psychosocial interventions: A systematic review with narrative synthesis. DEMENTIA 2023; 22:1921-1949. [PMID: 37515347 PMCID: PMC10644683 DOI: 10.1177/14713012231192360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Psychosocial dementia interventions may be less effective when used with populations for whom they were not initially intended. Cultural adaptation of interventions aims to increase effectiveness of interventions by enhancing cultural relevance. Use of theoretical frameworks may promote more systematic cultural adaptation. The aim of this review was to provide a comprehensive synthesis of published cultural adaptation frameworks for psychosocial interventions to understand important elements of cultural adaptation and guide framework selection. METHOD Five scientific databases, grey literature and reference lists were searched to January 2023 to identify cultural adaptation frameworks for psychosocial interventions. Papers were included that presented cultural adaptation frameworks for psychosocial interventions. Data were mapped to the framework for reporting adaptations and modifications to evidence-based interventions, then analysed using thematic synthesis. RESULTS Twelve cultural adaptation frameworks met inclusion criteria. They were mostly developed in the United States and for adaptation of psychological interventions. The main elements of cultural adaptation for psychosocial interventions were modifying intervention content, changing context (where, by whom an intervention is delivered) and consideration of fidelity to the original intervention. Most frameworks suggested that key intervention components must be retained to ensure fidelity, however guidance was not provided on how to identify or retain these key components. Engagement (ways to reach and involve recipients) and cultural competence of therapists were found to be important elements for cultural adaptation. CONCLUSIONS Comprehensive frameworks are available to guide cultural adaptation of psychosocial dementia interventions. More work is required to articulate how to ensure fidelity during adaptation, including how to identify and retain key intervention components.
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Affiliation(s)
- Sally Day
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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16
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Kotera Y, Kirkman A, Beaumont J, Komorowska MA, Such E, Kaneda Y, Rushforth A. Self-Compassion during COVID-19 in Non-WEIRD Countries: A Narrative Review. Healthcare (Basel) 2023; 11:2016. [PMID: 37510457 PMCID: PMC10378945 DOI: 10.3390/healthcare11142016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic impacted people's mental health negatively worldwide, including in non-WEIRD (Western, Educated, Industrialised, Rich and Democratic) countries. Self-compassion, kindness and understanding towards oneself in difficult times have received increasing attention in the field of mental health. Self-compassion is strongly associated with good mental health in various populations. This narrative review aimed to synthesise the evidence on self-compassion and mental health in non-WEIRD countries during the COVID-19 pandemic. MEDLINE and PsycINFO were searched for empirical studies. Self-compassion was consistently associated with positive mental health in non-WEIRD countries too. However, how, and to what degree, each component of self-compassion impacts mental health remains to be evaluated across different cultures. Future research such as multi-national intervention studies, or component network meta-analysis, is needed to advance our understanding of how self-compassion improves mental health in different populations.
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Affiliation(s)
- Yasuhiro Kotera
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
| | - Ann Kirkman
- College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
| | - Julie Beaumont
- College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
| | | | - Elizabeth Such
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
| | - Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo 060-8638, Hokkaido, Japan
| | - Annabel Rushforth
- College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
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17
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Jarvis GE, Kirmayer LJ. Global migration: Moral, political and mental health challenges. Transcult Psychiatry 2023; 60:5-12. [PMID: 36919356 DOI: 10.1177/13634615231162282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Global migration is expected to continue to increase as climate change, conflict and economic disparities continue to challenge peoples' lives. The political response to migration is a social determinant of mental health. Despite the potential benefits of migration, many migrants and refugees face significant challenges after they resettle. The papers collected in this thematic issue of Transcultural Psychiatry explore the experience of migration and highlight some of the challenges that governments and healthcare services need to address to facilitate the social integration and mental health of migrants. Clinicians need training and resources to work effectively with migrants, focusing on their resilience and on long-term adaptive processes. Efforts to counter the systemic discrimination and structural violence that migrants often face need to be broad-based, unified, and persistent to make meaningful change. When migrants are free to realize their talents and aspirations, they can help build local communities and societies that value diversity.
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Affiliation(s)
- G Eric Jarvis
- Division of Social & Transcultural Psychiatry, McGill University.,Culture and Mental Health Research Unit, Institute for Community & Family Psychiatry. Jewish General Hospital, Montreal
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University.,Culture and Mental Health Research Unit, Institute for Community & Family Psychiatry. Jewish General Hospital, Montreal
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18
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Silveus SA, Schmit MK, Oliveira JT, Hughes LE. Meta‐analysis of culturally adapted cognitive behavioral therapy for anxiety and depression. JOURNAL OF COUNSELING AND DEVELOPMENT 2023. [DOI: 10.1002/jcad.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Sarah A. Silveus
- Hazelden Betty Ford Graduate School of Addiction Studies Center City Minnesota USA
| | - Michael K. Schmit
- Hazelden Betty Ford Graduate School of Addiction Studies Center City Minnesota USA
| | - Joy Teles Oliveira
- Department of Counseling & Human Services University of North Texas‐Dallas Dallas Texas USA
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Phiri P, Clarke I, Baxter L, Zeng YT, Shi JQ, Tang XY, Rathod S, Soomro MG, Delanerolle G, Naeem F. Evaluation of a culturally adapted cognitive behavior therapy-based, third-wave therapy manual. World J Psychiatry 2023; 13:15-35. [PMID: 36687373 PMCID: PMC9850872 DOI: 10.5498/wjp.v13.i1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/25/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Recommendations for psychotherapy have evolved over the years, with cognitive behavioral therapy (CBT) taking precedence since its inception within clinical guidelines in the United Kingdom and United States. The use of CBT for severe mental illness is now more common globally.
AIM To investigate the feasibility and acceptability of a culturally adapted, CBT-based, third-wave therapy manual using the Comprehend, Cope, and Connect approach with individuals from a diverse population presenting to primary and secondary healthcare services.
METHODS A pilot study was used to assess the feasibility and acceptability of the manualised intervention. Outcome measures were evaluated at baseline, post-intervention and 12 wk-follow up. 32 participants with mental health conditions aged 20-53 years were recruited. Assessments were completed at three time points, using Clinical Outcomes in Routine Evaluation (CORE), Hospital Anxiety and Depression Scale (HADS), Bradford Somatic Inventory and World Health Organization Disability Assessment Schedule 2.0 (WHODAS). The Patient Experience Ques-tionnaire was completed post-treatment.
RESULTS Repeated measures of analysis of variance associated with HADS depression, F (2, 36) = 12.81, P < 0.001, partial η2 = 0.42 and HADS anxiety scores, F (2, 26) = 9.93, P < 0.001, partial η2 = 0.36; CORE total score and WHODAS both showed significant effect F (1.25, 18.72) = 14.98, P < 0.001, partial η2 = 0.5. and F (1.29, 14.18) = 6.73, P < 0.001, partial η2 = 0.38 respectively.
CONCLUSION These results indicate the effectiveness and acceptability of the culturally adapted, CBT-based, third-wave therapy manual intervention among minoritized groups with moderate effect sizes. Satisfaction levels and acceptability were highly rated. The viability and cost-effectiveness of this approach should be explored further to support universal implementation across healthcare systems.
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Affiliation(s)
- Peter Phiri
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Isabel Clarke
- Department of Italk, Southern Health NHS Foundation Trust, Southampton SO50 9FH, United Kingdom
| | - Lydia Baxter
- Department of Italk Step 3, Southern Health NHS Foundation Trust, Southampton SO51 9FH, United Kingdom
| | - Yu-Tian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Jian-Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
- National Center for Applied Mathematics Shenzhen, Shenzhen 518055, Guangdong Province, China
| | - Xin-Yuan Tang
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Shanaya Rathod
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Mustafa G Soomro
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Health Care Science, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Farooq Naeem
- Centre for Addition and Mental Health, University of Toronto, Toronto ON M5S, Canada
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20
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Karat BG, Narikuzhy S, Bonato S, Sanches M, Ahmed S, Liang L, Husain MI, Husain MO, Farooq S, Ayub M, Kidd SA, Mckenzie K, Ali F, Naeem F. The Effectiveness of Cognitive Behavioral Therapy Interventions on Depression and Anxiety in the Adult East Asian and Related Diaspora Populations: a Meta-analysis. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Azad AH, Khan SA, Ali I, Shafi H, Khan NA, Umar SA. Experience of psychologists in the delivery of cognitive behaviour therapy in a non-western culture for treatment of substance abuse: a qualitative study. Int J Ment Health Syst 2022; 16:55. [PMID: 36443829 PMCID: PMC9703777 DOI: 10.1186/s13033-022-00566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Psychotherapy is the preferred form of treatment for psychological disorders worldwide. Cognitive behaviour therapy (CBT) is one of the most widely used psychotherapies due to its proven efficacy for psychological disorders, including substance abuse. However, CBT was developed in the West according to the culture of developed countries. Therefore, it requires cross-cultural adaptation for non-Western countries. Pakistan is one of the developing non-Western countries where substance use disorders are increasing at an alarming rate. Despite the proven efficacy of CBT for substance use disorders, there is a dearth of its utilization in Pakistan. Therefore, in the present study, in-depth qualitative interviews were conducted with CBT practitioners in Pakistan to understand barriers and challenges in this regard. The study was a part of a broader project aimed at cultural adaptation of CBT for people with substance use disorders (SUDs) in Pakistan. METHODS In-depth qualitative interviews were conducted with CBT practitioners (N = 8) working in rehabilitation centres and hospitals in Islamabad, Pakistan. Thematic content analysis was conducted to develop core themes from the data. RESULTS CBT for SUDs requires some adjustments according to Pakistani culture for successful utilization. The challenges in providing CBT for SUDs revolved around three main themes, i.e., the mental health system, societal practices, and therapeutic issues, and 10 subthemes. CONCLUSION In order to utilize the benefits of CBT for SUDs in Pakistan, cultural adaptation is necessary as an initial step. However, its delivery requires stringent modifications in the health care system to address these challenges.
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Affiliation(s)
- Abrar Hussain Azad
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan
| | - Shahzad Ali Khan
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan
| | - Ijaz Ali
- Community Medicine, Mohi-Ud-Din Islamic Medical College, Mirpur, Azad Kashmir Pakistan
| | - Hina Shafi
- Community Medicine, Mohi-Ud-Din Islamic Medical College, Mirpur, Azad Kashmir Pakistan
| | - Nisar Ahmed Khan
- Community Medicine, Abbottabad International Medical College, Abbottabad, Pakistan
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22
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Kananian S, Kip A, Schumm H, Giesebrecht J, Nicolai A, Schade-Brittinger C, Reese JP, Weise C, Mewes R, Morina N, Ehring T, Stangier U. Culturally adapted cognitive behavioural group therapy for mental disorders in refugees plus problem solving training (ReTreat): study protocol for a multicentre randomised controlled trial. BMJ Open 2022; 12:e061274. [PMID: 36368748 PMCID: PMC9660581 DOI: 10.1136/bmjopen-2022-061274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Since a high proportion of refugees in Germany suffer from mental disorders, culturally adapted treatments are needed that target a broad range of symptoms. There is much evidence for the efficacy of culturally adapted cognitive behavioural therapy (CA-CBT). Given the promising results of CA-CBT, the combination with problem solving training (CA-CBT+) represents a novel approach that potentially improves the refugees' ability to cope actively with psychosocial problems. This randomised controlled trial evaluates the efficacy of 12-session outpatient CA-CBT+ compared with to treatment as usual (TAU) in a sample of refugees suffering from at least one DSM-5 disorder. METHODS AND ANALYSIS The present study will be carried out as two-group randomised trial with 1:1 individual allocation to either (1) culturally adapted cognitive behavioural therapy in a group setting (CA-CBT+) or (2) TAU. The study takes place at four sites in Germany, randomising in total 138 adult refugees with at least one primary DSM-5 diagnosis to the treatment conditions. In CA-CBT+ the patients receive 12 sessions of 120 min duration over the course of 12 weeks providing psychoeducation, meditation and other techniques of emotional regulation, stretching and problem solving training. The primary outcome is treatment response operationalised by a clinically significant change in General Health Questionnaire (GHQ-28) score. Follow-up visits will take place 3 and 9 months after the end of the intervention. Secondary outcomes include changes in psychopathological symptoms, somatic symptoms and quality of life. Intention-to-treat analysis will be performed. Adverse and serious adverse events will be analysed. Further, healthcare usage and economic outcomes will be assessed and analysed. Primary and secondary outcomes will be analysed using appropriate statistical methods. ETHICS AND DISSEMINATION The study has been approved by the Ethics Commission of the German Psychological Society (ref: StangierUlrich2019-1018VA). Results will be disseminated via presentations, publication in international journals, and national outlets for clinicians. Furthermore, intervention materials will be available, and the existing network will be used to disseminate and implement the interventions into routine healthcare. TRIAL REGISTRATION NUMBER DRKS00021536.
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Affiliation(s)
- Schahryar Kananian
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ahlke Kip
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Münster, Munster, Germany
| | - Hannah Schumm
- Department of Clinical Psychology and Psychotherapy, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | | | - Anica Nicolai
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Jens-Peter Reese
- Healthcare Research and Public Health, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
| | - Cornelia Weise
- Clinical Psychology, Philipps-Universität Marburg, Marburg, Germany
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Thomas Ehring
- Department of Psychology, Ludwig Maximilians University Munich, Munchen, Germany
| | - Ulrich Stangier
- Department of Psychology, University of Frankfurt, Frankfurt, Germany
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23
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Huang YT, Leung VWY, Craig SL, Chui CHK. Cultural consideration for cognitive-behavioural therapy for sexual minority young people in Chinese societies: Perspectives from practitioners and target users. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2277-e2286. [PMID: 34845775 DOI: 10.1111/hsc.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/21/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
Although cognitive-behavioural therapy has demonstrated effectiveness in improving mental health outcomes for sexual minority young people (SMYP), existing interventions are primarily designed and evaluated in Western contexts, and their acceptability and responsiveness to culturally relevant issues in the Chinese contexts is uncertain. This study aimed to address this gap by exploring how a manualised community-based cognitive-behavioural intervention (AFFIRM) could be culturally reconsidered for SMYP in Taiwan and Hong Kong and suggest recommendations for future adaptation. Following an empirical, community-based participatory approach, qualitative data were collected between August and September 2018 through five focus groups with 15 SMYP and 18 frontline practitioners in Taiwan and Hong Kong. Thematic analysis revealed that at the surface structural level, translation and examples, and promotion strategies can be fine-tuned to better fit the Chinese context. On the deep structural level, self-differentiation and a pragmatic plan to come out to parents were identified as two concerns of cultural importance for Chinese SMYP. This study exemplifies an empirical, collaborative approach to identifying areas of cultural adaptation for mental health intervention for SMYP in the Chinese cultural milieu. The rationale and strategy for adapting existing intervention protocols to accommodate divergent cultural values are described.
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Affiliation(s)
- Yu-Te Huang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
| | - Vivian W Y Leung
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Cheryl H K Chui
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong
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24
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Cultural adaptation of cognitive behaviour therapy for depression: a qualitative study exploring views of patients and practitioners from India. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, culture can influence engagement and treatment efficacy of CBT. Several attempts have been made in Asian countries to develop a culturally adapted CBT for depression. However, research in the Indian context documenting the views on cultural influence of CBT is limited. The present study is an attempt to explore the views of patients and therapists in India by following an evidence-based approach that focuses on three areas for adaptation: (1) awareness of relevant cultural issues and preparation for therapy; (2) assessment and engagement; and (3) adjustments in therapy techniques. Semi-structured interviews with three consultant clinical psychologists/therapists, a focused group discussion with six clinical psychologists, and two patients undergoing CBT for depression were conducted. The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The results highlight therapists’ experiences, problems faced, and recommendations in all three areas of adaptation. The findings highlight the need for adaptation with understanding and acknowledging the culture differences and clinical presentation. Culturally sensitive assessment and formulation with minor adaptation in clinical practice was recommended. Therapists emphasised the use of proverbs, local stories and simplified terminologies in therapy. The findings will aid in providing culturally sensitive treatment to patients with depression in India.
Key learning aims
(1)
To understand the views of Indian patients and therapists based on their experience of CBT.
(2)
To understand the need for cultural adaptation of CBT in India.
(3)
To understand the adaptations by therapists while using CBT in clinical practice.
(4)
To gain perspective on how CBT can be culturally adapted to meet the needs of the Indian population.
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25
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Cognitive vulnerabilities and Depression: A Culture-Moderated Meta-Analysis. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10299-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Goldin D, Maltseva T, Scaccianoce M, Brenes F. Holistic Psychosocial Approaches in the Care of Hispanic Victims of Trauma: An Overview. J Holist Nurs 2022; 41:7-16. [PMID: 35234058 DOI: 10.1177/08980101221083162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The collapse of the Champlain Towers South (CTS), a condominium in Miami, Florida, left a diverse group of survivors and healthcare clinicians tasked with finding ways of coping with the disaster. Within seconds, the CTS collapse became a global tragedy due to the coastal neighborhood's rich international mix of residents. Although this tragedy impacted communities across globe, a large population of Hispanic victims lived in CTS that were deeply affected. Culturally adaptive interventions and holistic healthcare for Hispanic individuals are highly relevant because Hispanic Americans represent one of the fastest growing demographic groups in the United States. To reach, engage, and address the needs of Hispanic victims, this article provides an overview of psychosocial factors that influence Hispanic victims with trauma and discusses holistic psychotherapeutic approaches in nursing care that can be applied to improve victims' well-being. Culture is an important consideration in health; therefore, this article highlights and operationalizes culturally tailored holistic nursing care that draws from the physical, mental, emotional, and spiritual dimensions of health and well-being that can be used in clinical settings with Hispanic clients who have experienced trauma.
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Affiliation(s)
- Deana Goldin
- 5450Florida International University, 15803Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida, USA
| | - Tatayana Maltseva
- 5450Florida International University, 15803Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida, USA
| | - Monica Scaccianoce
- 5450Florida International University, 15803Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida, USA
| | - Francisco Brenes
- 5450Florida International University, 15803Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida, USA
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Wood L, Jacobsen P, Ovin F, Morrison AP. Key Components for the Delivery of Cognitive Behavioral Therapies for Psychosis in Acute Psychiatric Inpatient Settings: A Delphi Study of Therapists' Views. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac005. [PMID: 39144781 PMCID: PMC11205890 DOI: 10.1093/schizbullopen/sgac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Cognitive Behavioral Therapy for psychosis (CBTp) is a psychological therapy recommended for people with psychosis which can start in the acute phase. However, there is not consensus on how CBTp should be delivered in an acute mental health inpatient setting. This study aimed to gain consensus from therapists on how CBTp should be delivered in this context. A 2-stage Delphi study was conducted to establish consensus on what the core components are of inpatient CBTp from the perspective of therapists who are experts in the field. Forty-five therapists took part in 2 rounds of rating statements on the areas of engagement and feedback, assessment and model, formulation, change strategies, homework, and principles and values. A final list of 114 statements were included, which were rated as essential or important by ≥80% of respondents. The delivery of inpatient CBTp is dependent on several adaptations to traditional CBTp including indirect work, being more flexible with session content and delivery, and making adaptations to the restrictive environment. These recommendations could inform training, competency frameworks, and delivery of CBTp in inpatient settings.
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Affiliation(s)
- Lisa Wood
- Division of Psychiatry, University College London, London, UK
- Acute and Rehabilitation Directorate, North East London NHS Foundation Trust, Essex, UK
| | | | - Felicia Ovin
- Acute and Rehabilitation Directorate, North East London NHS Foundation Trust, Essex, UK
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Naeem F, Tuck A, Mutta B, Dhillon P, Thandi G, Kassam A, Farah N, Ashraf A, Husain MI, Husain MO, Vasiliadis HM, Sanches M, Munshi T, Abbott M, Watters N, Kidd SA, Ayub M, McKenzie K. Protocol for a multi-phase, mixed methods study to develop and evaluate culturally adapted CBT to improve community mental health services for Canadians of south Asian origin. Trials 2021; 22:600. [PMID: 34488853 PMCID: PMC8419942 DOI: 10.1186/s13063-021-05547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Canadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”. South Asian Canadians are disproportionately impacted by the social determinants of health, and this can result in high rates of mood and anxiety disorders. These factors can negatively impact mental health and decrease access to care, thereby increasing mental health inequities. Cognitive Behavioural Therapy (CBT) in its current form is not suitable for persons from the non-western cultural backgrounds. Culturally adapted Cognitive Behavioural Therapy (CaCBT) is an evidence-based practice. CaCBT is more effective than standard CBT and can reduce dropouts from therapy compared with standard CBT. Thus, CaCBT can increase access to mental health services and improve outcomes for immigrant, refugee and ethno-cultural and racialized populations. Adapting CBT for growing SA populations in Canada will ensure equitable access to effective and culturally appropriate interventions. Methods The primary aim of the study is to develop and evaluate CaCBT for Canadian South Asian persons with depression and anxiety and to gather data from stakeholders to develop guidelines to culturally adapt CBT. This mixed methods study will use three phases: (1) cultural adaptation of CBT, (2) pilot feasibility of CaCBT and (3) implementation and evaluation of CaCBT. Phase 1 will use purposive sampling to recruit individuals from four different groups: (1) SA patients with depression and anxiety, (b) caregivers and family members of individuals affected by anxiety and depression, (c) mental health professionals and (d) SA community opinion leaders. Semi-structured interviews will be conducted virtually and analysis of interviews will be informed by an ethnographic approach. Phase 2 will pilot test the newly developed CaCBT for feasibility, acceptability and effectiveness via quantitative methodology and a randomized controlled trial, including an economic analysis. Phase 3 will recruit therapists to train and evaluate them in the new CaCBT. Discussion The outcome of this trial will benefit health services in Canada, in terms of helping to reduce the burden of depression and anxiety and provide better care for South Asians. We expect the results to help guide the development of better services and tailor existing services to the needs of other vulnerable groups. Trial registration ClinicalTrials.gov NCT04010890. Registered on July 8, 2019
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.
| | - Andrew Tuck
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Baldev Mutta
- Punjabi Community Health Services, Toronto, Canada
| | | | - Gary Thandi
- Moving Forward Family Services, Vancouver, Canada
| | | | - Nimo Farah
- Somerset West Community Health Centre, Ottawa, Canada
| | - Aamna Ashraf
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Science, Université de Sherbrooke, Research Center Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Montreal, Canada
| | - Marcos Sanches
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Tariq Munshi
- Department of Psychiatry, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | | | | | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | | | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.,Wellesley Institute, Toronto, Canada
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Classen B, Tudor K, du Preez E, Day E, Ioane J, Rodgers B. An Integrative Review of Contemporary Perspectives on Videoconference-Based Therapy-Prioritising Indigenous and Ethnic Minority Populations in the Global South. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 6:545-558. [PMID: 33898737 PMCID: PMC8058578 DOI: 10.1007/s41347-021-00209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/14/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
An integrative literature review was undertaken as a means of drawing together contemporary perspectives on the outcomes and affordances of videoconference-based therapy. This review was conducted in a way which placed emphasis on the need for mental healthcare strategies which are mindful of the cultural and social needs of indigenous and ethnic minority populations, particularly those situated in the Global South. The review was undertaken using an inverse funnelling approach which sought to prioritise literature on videoconference-based therapy literature which specifically focused on indigenous and ethnic minority populations. A series of general and population specific searches across relevant health databases were supplemented by a simultaneous search of Google Scholar. The PICOS search tool was used in developing the search terms, and data was processed using an inductive approach to thematic analysis. A final dataset of 43 articles were included in the review. This body of literature encompassed an international range of studies and included perspectives informed by quantitative, qualitative and mixed methods research. Four key themes were identified across the reviewed literature: indigenous and ethnic minority populations, therapeutic relationships, clinical outcomes and technical and logistical considerations. Based on our findings, there is reason to believe that videoconference-based therapy can be made to be just as effective as offline, face-to-face modes of delivery. However, research into the efficacy, impact and cultural implications of this technology in relation to indigenous and ethnic minority populations represents a significant gap within contemporary literature.
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Affiliation(s)
- Ben Classen
- Auckland University of Technology, Auckland, New Zealand
| | - Keith Tudor
- Auckland University of Technology, Auckland, New Zealand
| | | | - Elizabeth Day
- Auckland University of Technology, Auckland, New Zealand
| | - Julia Ioane
- Auckland University of Technology, Auckland, New Zealand
| | - Brian Rodgers
- Auckland University of Technology, Auckland, New Zealand
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Iheanacho T, Nduanya UC, Slinkard S, Ogidi AG, Patel D, Itanyi IU, Naeem F, Spiegelman D, Ezeanolue EE. Utilizing a church-based platform for mental health interventions: exploring the role of the clergy and the treatment preference of women with depression. Glob Ment Health (Camb) 2021; 8:e5. [PMID: 34026236 PMCID: PMC8127631 DOI: 10.1017/gmh.2021.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 01/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middle-income countries. The healthy beginning initiative (HBI) is a congregation-based platform that uses this approach to train church-based lay health advisors to conduct mental health screening in community churches and link people to care. This paper explores the potential for a clergy-delivered therapy for mental disorders on the HBI platform and identifies the treatment preferences of women diagnosed with depression. METHODS We conducted focus group discussion and free-listing exercise with 13 catholic clergy in churches that participated in HBI in Enugu, Nigeria. These exercises, guided by the positive, existential, or negative (PEN-3) cultural model, explored their role in HBI, their beliefs about mental disorders, and their willingness to be trained to deliver therapy for mental disorders. We surveyed women diagnosed with depression in the same environment to understand their health-seeking behavior and treatment preferences. The development of the survey was guided by the health belief model. RESULTS The clergy valued their role in HBI, expressed understanding of the bio-psycho-socio-spiritual model of mental disorders, and were willing to be trained to provide therapy for depression. Majority of the women surveyed preferred to receive therapy from trained clergy (92.9%), followed by a psychiatrist (89.3%), and psychologist (85.7%). CONCLUSION These findings support a potential clergy-focused, faith-informed adaptation of therapy for common mental disorders anchored in community churches to increase access to treatment in a resource-limited setting.
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Affiliation(s)
| | - Ujunwa Callista Nduanya
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Psychiatry, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | | | | | - Echezona E. Ezeanolue
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, USA
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Effectiveness of a culturally adapted cognitive behavioural therapy-based guided self-help (CACBT-GSH) intervention to reduce social anxiety and enhance self-esteem in adolescents: a randomized controlled trial from Pakistan. Behav Cogn Psychother 2020; 48:503-514. [PMID: 32450939 DOI: 10.1017/s1352465820000284] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social anxiety is common among adolescents in Pakistan and is associated with low self-esteem. Among the recommended treatments, cognitive behavioural therapy (CBT) is effective, and self-help approaches are encouraged. AIM To determine the effectiveness of culturally adapted CBT-based guided self-help (CACBT-GSH) intervention, using a manual 'Khushi aur Khatoon', for treating social anxiety when added to treatment as usual (TAU) compared with TAU only. METHOD A total of 76 adolescents with social anxiety aged 13-16 years from six schools in Multan, Pakistan were recruited into this randomized controlled trial. Participants were divided into intervention and control groups in a 1:1 ratio. Social anxiety, self-esteem and fear of negative evaluation were assessed through the Liebowtiz Social Anxiety Scale for children and adolescents, the Rosenberg Self-Esteem Scale and the Brief Fear of Negative Evaluation, respectively, at baseline and at the end of the study. Guided self-help using culturally adapted CBT (CACBT)-based self-help manual (eight sessions, one session per week) was provided to the intervention group. The effect of the CACBT-GSH intervention was analysed with ANCOVA. RESULTS There was a statistically significant difference between the intervention and the control groups in favour of intervention. Participants in the intervention group showed reduced symptoms of social anxiety (p < .001), fear of negative evaluation (p < .001) and enhanced self-esteem (p < .001). CONCLUSION The study demonstrated the effectiveness of CACBT-based guided self-help intervention in treating social anxiety and addressing the symptoms associated with it.
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Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural Adaptation of CBT. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractCognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working with diverse populations. Contributors to this special issue of theCognitive Behaviour Therapisthave tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. Here, I briefly summarize and discuss the papers in this special issue. I start with a systematic review of CBT for social anxiety across cultures. Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Three papers discuss the issues of gender and sexuality when using CBT, while another three papers focus on refugees, asylum seekers and the homeless, and two papers describe the application of CBT with religious populations. Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Collectively, papers in this special issue provide us with sufficient evidence that cultural considerations play a vital role when using CBT, offer practical suggestions for improving cultural competence and most importantly, can catalyse future research. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers.
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