culturally-adapted-cbt-the-evolution-of-psychotherapy-adaptation-frameworks-and-evidence

Invited Paper

Title: Culturally Adapted CBT

• Authors: Farooq Naeem, Sana Sajid, Saiqa Naz, Peter Phiri

• Affiliations: Centre for Addiction and Mental Health/University of Toronto, University of Southampton, Sheffield Health and Social Care NHS Foundation Trust.

• Corresponding Author: Farooq Naeem

• Received: 2 March 2022; Revised: 25 January 2023; Accepted: 26 January 2023

Abstract

• Cultural adaptations in psychotherapy increasingly gain attention amid globalization and heightened cultural awareness.

• This paper reviews historical adaptation frameworks, evaluates evidence on culturally adapted interventions, and suggests research directions.

• Over twenty adaptation frameworks exist, yet consensus on effective elements remains elusive.

• Despite cognitive behavioral therapy (CBT) being widely utilized, comprehensive reviews specifically addressing culturally adapted CBT are lacking.

Key Learning Aims

1. Outline current frameworks for culturally adapted therapies and highlight literature gaps.

2. Present an overview of culturally adapted psychotherapies with a focus on CBT efficacy.

3. Discuss the necessity of culturally adapted CBT and recommend comprehensive guidelines for development.

Introduction

• Culture influences how individuals engage with their environment, significantly affecting their psychological experiences.

• Various adaptations of psychological interventions, particularly CBT, have arisen to align treatment with cultural influences.

• CBT has shown high effectiveness in treating a diverse range of disorders. The model has undergone numerous adaptations, particularly aimed at enhancing its applicability in non-Western contexts.

The Need for Cultural Adaptation

• Culture consists of distinct features shaping beliefs and practices, affecting mental health engagement.

• Global migration trends necessitate mental health services that are culturally sensitive.

• Standard CBT may not adequately serve non-Western populations due to its Western-centric design.

• Cultural adaptation entails systematically modifying interventions to fit specific cultural contexts, enhancing engagement.

Frameworks for Culturally Adapting Psychotherapies

• Various frameworks for cultural adaptation have been proposed, each offering unique perspectives and elements for success.

Examples:

1. Social Cognitive Framework (López et al., 1989) - Awareness of cultural issues evolves through three stages: unawareness, heightened awareness, and cultural sensitivity.

2. Ecological Validity Model (Bernal et al., 1995) - Identifies 8 key areas for successful cultural adaptations, including language and conceptual content.

3. Cultural Adaptation Process Model (Domenech-Rodriguez & Wieling, 2005) - Emphasizes collaboration between development teams and community stakeholders.

Evidence of Effectiveness

• Numerous systematic reviews indicate the significant positive impact of culturally adapted interventions on mental health outcomes across various populations.

• Challenges remain, including methodological discrepancies and the need for a cohesive understanding of effective adaptation strategies.

Discussion

• Despite the progress in culturally adapting interventions, there remain significant gaps in the literature regarding standardized practices and comprehensive reviews, particularly for CBT.

• A universally accepted framework is essential to guide clinicians and researchers in developing culturally tailored interventions.

Recommendations

1. For Researchers: Focus efforts on refining cultural adaptation frameworks ensuring they accommodate specific ethnic contexts.

2. For Trainers and Supervisors: Continuous training should enable clinicians to remain culturally competent.

3. For Commissioners: Routine evaluations of mental health services must include aspects of cultural competence.

Conclusion

• Culturally adapted CBT has shown promise in improving therapeutic outcomes for minority ethnic populations. Future developments must address limitations in current practices, enhance research methodologies, and incorporate stakeholder perspectives.