Role of culture in treatment for abnormal psychology

How does culture affect the treatment for MDD

1. compliance to treatment

2. internal model of illness

3. culturally sensitive treatment

How does culture affect compliance to treatment

when the patient and therapist belong to different cultural backgrounds, patients may fail to follow the therapist's prescription because they clash with the patient's culturally pre-determined beliefs about mental illness

what is a supporting study for compliance to treatment

Kinzie et al

for compliance to treatments, what evidence does it show

that cultural perceptions of antidepressant medication influences the rates of compliance with treatment among southeast asian patients in US clinics

for compliance to treatments, what was the sample used

41 depressed south east asian patients

- they underwent long term treatment in US clinics

what did researchers examine for in Kinzie et al (compliance to treatments)

they examined the level of tricyclics in the patient's blood

for compliance to treatments (kinzie et al), what did the results of the blood tests show

no detectable levels of tricyclics in 61% of the patients

- indicating a high incidence of non-compliance

for Kinzie et al (compliance to treatment), what did the researchers explain for the results

it might have been the result of social stigma associated with taking antidepressants

- social attitudes towards authority might have also caused patients to pretend that they are following the prescription

for Kinzie et al (compliance to treatment), what improved the rates of compliance

an open discussion about the patient's cultural beliefs like the problems and benefits of anti-depressants

for kinzie et al (compliance to treatment), what does the higher rates of compliance as a result of open discussion suggest

that an open discussion to the client's cultural belief's may positively affect treatment

what is another supporting study for compliance to treatment

Kirmayer et al

what does kirmayer et al suggest

that clinical negotiations may improve response to treatment in culturally diverse setting

in Kirmayer et al, why are clinical negotiations important

since the cultural background of a person may lead individuals to interpret their symptoms differently and even psychological treatment

in kirmayer et al, what is the aim of the negotiation

to establish a common interpretation of the symptom and frame it in culturally appropriate and acceptable terms

in kirmayer et al, what is the role of the clinician

to gain an understanding of the patient's cultural background and make communication as culturally appropriate as possible

what is the internal model of illness

how the patient's perceive the illness internally

why is the internal model of illness important

it mediates all treatment efforts

for the internal model of illness, what can a psychiatrist do

they can be culturally sensitive by striving to understand the patient's internal model and adjust interventions accordingly

for internal models of illness in traditional communities, what can be done

their internal model of illness could be taken into account for to develop versions of CBT for local needs and values

what is a supporting study for internal model of illness

Naeem et al

what did Naeem et al (internal model of illness) show

that it is possible to design a culturally sensitive version of CBT for local use in developing cultures like Pakistan

what was the aim of Naeem et al

to develop a culturally sensitive CBT programme and assess its effectiveness in the developing world

what research method did Naeem et al use

qualitative research study

interviews and field notes

what was the sample used in Naeem et al

9 patients attending a psychiatric clinic in Pakistan

In Naeem et al, what were patients asked about in interviews

thoughts on illness and course of the treatment

in Naeem et al, what language were the interviews conducted in

Urdu language

In Naeem et al, what was done after compiling the transcripts and field notes

an inductive content analysis was applied to derive common themes emerging in the patient's subjective interpretations

what is an inductive content analysis in Naeem et al

an analysis of content to identify common themes and develop theories

what were the four themes that emerged in Naeem et al

1. patient's perception of depression

2. patient's belief's about the cause of depression

3. modes of referral for help

4. knowledge about the treatment for depression

In the themes from Naeem et al, what were the patients' perception of depression

- tended to mention physical/somatic symptoms rather than mental symptoms

- did not use 'depression' as a labels and used expressions such as "illness" or "poor sleep" or "tension"

In the themes from Naeem et al, what were the patients' beliefs about the cause of depression

attributed their illness to "problems in the environment", "thinking too much" or "worries"

In the themes from Naeem et al, what were the patients' modes of referral for help

majority were referred to clinic by their relatives

In the themes from Naeem et al, what were the patients' knowledge about the treatment for depression

believed that they could be cured by "good quality medicine" or magicians

what was the conclusion of Naeem et al

- based on these accounts, the authors were able to develop a culturally sensitive version of CBT that took local needs into account

- used the language appropriate for the context and focused on re-interpreting somatic symptoms as signs of depression

In Naeem et al, why was the use of qualitative data a strength

- gives data that is rich and can increased insight into the patient's subjective experience

- important to understand how culture plays a role in the treatment (etic approach)

In Naeem et al, why was the use of inductive content analysis a strength

allowed researchers to analysis interviews and develop themes that emerged that appeared important in understanding culture and depression

In Naeem et al, how did the researchers ensure credibility

method triangulation

interviews, field notes from observations, similar themes

How can culturally sensitive treatments be designed

top-down

bottom-up

In culturally sensitive treatments, what are top-down adaptations

superficial changes such as language used

In culturally sensitive treatments, what are bottom up adaptations

deeper changes where research is fundamental

for the development of culturally sensitive treatments, who suggested using what

Bernal et al suggested using a ecological validity framework

in culturally sensitive treatment, what is a ecological validity framework

used to design culturally sensitive treatments by taking into account 8 areas such as language or culture

what is a supporting study for the ecological framework in developing culturally sensitive treatments

Griner and Smith

In culturally sensitive treatments, what did Griner and Smith show

that cultural adaptations are effective especially when they specifically target a particular cultural group

what was the research method of Griner & Smith

meta analysis of 76 students

only studies that had a quantitative estimate of effectiveness were included

what types of cultural adaptations were used in research studies in Griner and Smith

- consultations with individuals familiar with the client's culture

- cultural sensitivity training for staff

- inclusion of cultural values in intervention

In Griner and Smith, what was the total sample from the research studies

25,000

what were the results of Griner and Smith

- moderately strong benefit of culturally adapted interventions

- benefit was 4x stronger for same-race groups of clients than mixed race groups of clients

- therapy was more effective when therapist spoke client's native language than when the therapist spoke english

what was the conclusion of Griner and Smith

cultural adaptations carried out for specific sub-populations (groups of clients) are much more effective than making treatment more culturally flexible in general

In Griner and Smith, what is publication bias and why is this being controlled for beneficial

publication bias: tendency to publish studies that support their aim and hypothesis

examined consistency of results, which would have shown a standardised difference between chosen studies

what are some other limitations of Griner and Smith

- danger of researcher bias when choosing which studies to include

- publishing bias or file drawer effect

why is the use of meta-analysis a strength in Griner and Smith

examine the consistency of the results - also known as the effect size - the standardized difference between the results among the chosen studies.

• Helps researchers to compare data from a much larger sample than is usually possible in a single study. Provides further credibility of the results.