the role of culture in treatment

cultural factors influence compliance with treatment

• cross-cultural differences in how symptoms of mental disorders are experienced & presented, can influence how effective the treatment is

  • evidence that suggests that treatment may be ineffective because the patient & therapist perceive the treatment process in different ways

• Kinzie et al (1987) - cultural & educational factors can influence compliancy with the treatment

cultural negotiation

Kirmayer (2001) - concludes that, since the cultural background of a person can lead them to interpret their symptoms in different ways, there has to be a form of clinical negotiation between clinician & patient

• this negotiation helps to frame the treatment & symptoms in culturally acceptable way

internal model of illness needs to be considered

• a patient’s beliefs about treatment are heavily influence by their beliefs about the disorder & by the way they internally represent their illness

  • known as the patient’s internal model of illness

  • is a culturally determined representation of a mental disorder

• Naem et al (2012) - aimed to develop a culturally sensitive CBT

  • after the data was collected, there were 4 large themes that emerged

    • patient’s perceptions of depression

    • patient’s model causes of depression

    • modes of referral for help

    • patient’s knowledge & experience concerning the treatment for depression

culturally sensitive treatment

in order to develop a culturally sensitive approach to treatment, you have to begin with evidence-based treatment (treatment that’s been proven to be effective in clinical trials)

• for depression, this can be CBT

• in order to adapt the evidence-based approach to a specific cultural context, changes can be made from the relatively superficial to relatively deep

• top-down adaptations = making relatively superficial changes to the treatment

• bottom-up adaptations = making relatively deep changes

  • researchers typically use qualitative methods

Ecological Validity Framework - a framework that’s been used to design culturally sensitive treatments. below are 8 areas that it outlines that may need to be adapted

• language

• persons (ethnic similarities between client & therapist)

• metaphors (expressing oneself in a culturally relevant form)

• content (cultural knowledge, client’s values & traditions)

• concepts (beliefs about treatment in line with the patient’s culture)

• goals (using the beliefs about treatment goals from the patient’s country)

• method (adaptation of culturally appropriate methods of treatment)

effectiveness of culturally sensitive treatments

Griner and Smith (2006) - found a moderately strong benefit of culturally adapted interventions

• but treatments for groups of same-race participants were 4 times more effective than treatments for mixed-race groups

• so, cultural adaptations carried out for specific sub-populations may be more effective than simply making treatments for culturally flexible

• acculturation also proved to be an important factor in determining the effectiveness of culturally adapted treatment

  • older participants responded better to culturally adapted therapy than younger people, likely cuz older ppl were less acculturated