It is possible that people presenting with biological symptoms of depression and anxiety attend the modern health facilities, while those with predominantly psychological symptoms or those with a spiritual model of illness, attend faith or religious healers (Naeem, Reference Naeem2013; Naeem et al., Reference Naeem, Phiri, Munshi, Rathod, Ayub, Gobbi and Kingdon2015a). Understanding ACT, DBT, and FAP: Similarities and Differences When working cross-culturally, many consider a universalist approach to help focus on the similarities across cultures, rather than emphasizing differences (Beck, Reference Beck2016). As language can be a barrier, authors provide some guidance on training interpreters. Cultural appropriation There is evidence to suggest that DBT is an effective treatment (Mndez-Bustos et al., Reference Mndez-Bustos, Calati, Rubio-Ramrez, Oli, Courtet and Lopez-Castroman2019; Panos et al., Reference Panos, Jackson, Hasan and Panos2014). A survey of compassion satisfaction, burnout and secondary traumatic stress of British therapists working with traumatized individuals reported that a higher risk of secondary traumatic stress was predicted in therapists engaging in more individual supervision and self-care activities and those with a personal trauma history (Sodeke-Gregson et al., Reference Sodeke-Gregson, Holttum and Billings2013). Li, Shirley Xin The term cultural appropriation is thought to They describe some examples from their work to show how the services can better understand the needs of minority populations. 2022. 2021. Third wave therapies are good examples of integration of CBT with another model of therapy. Therapists focused on cultural factors during assessment and engagement, shared learning, communication, coping skills and endings. Self-practice, self-reflection (Chigwedere et al., Reference Chigwedere, Thwaites, Fitzmaurice and Donohoe2019) and the critical incident analysis model can be useful tools for these therapists. There is a need to adapt CBT for this group using a systematic approach. There is evidence to suggest that CBT needs to be culturally adapted for the Mexicans (Organista and Muoz, Reference Organista and Muoz1996; Shea et al., Reference Shea, Cachelin, Gutierrez, Wang and Phimphasone2016) and we therefore envisage that adaptation took place at three levels: (1) for broader Mexican culture, (2) for the homeless, and (3) for the youth. Therefore, practical measures to improve access and providing training in culturally adapted therapy might be the most practical way forward. and This paper reports on the process of culturally adapted family intervention from a therapists perspective. The authors describe dealing with religious and cultural beliefs, and the role played by the family, engaging family members in therapy, dealing with shame and guilt, and local practices, such as magic rituals. Murray and colleagues (Reference Murray, Haroz, Pullmann, Dorsey, Kane, Augustinavicius and Bolton2019) present data from two previously conducted RCTs (Bolton et al., Reference Bolton, Lee, Haroz, Murray, Dorsey, Robinson and Bass2014; Weiss et al., Reference Weiss, Murray, Zangana, Mahmooth, Kaysen, Dorsey and Bolton2015) in which they tested a modular, multi-problem, transdiagnostic manual using the common elements treatment approach (CETA). Cultural appropriation is the practice of using or taking something from another culture without giving proper recognition or respect to that culture, Mia Moody It makes common sense that experienced health professionals regardless of their background can offer extra advantages to their service users if they transition to the IAPT. Their experience of racism, perceived biases and discrimination mean that TSD can play a vital role in building trust and improving engagement (Beck and Naz, Reference Beck and Naz2019). Both verbal and non-verbal language plays a vital role in psychotherapeutic encounters. This paper describes one of the themes from that study in greater detail, i.e. Historically, deciding exactly what culture is hasnt been easy. Very high rates of post-traumatic stress disorder (PTSD), depression, anxiety and psychological distress have been reported among army personnel and veterans (Hoge et al., Reference Hoge, Castro, Messer, McGurk, Cotting and Koffman2004; Statistics Canada, 2014; Stevelink et al., Reference Stevelink, Malcolm, Mason, Jenkins, Sundin and Fear2015). The term sub-culture is used to refer to minority cultures within a broader dominant culture. Future research must focus on systematically adapting CBT that can be tested through fully powered trials and evaluated for cost-effectiveness. A collaborative approach might not be acceptable across cultures. I agree with the assertion that these ideas need to be tested through qualitative and quantitative research. The authors report three cases to describe the therapy process, insights learned by therapists and compared those with the original model they developed. For sexual minorities, minority stress has been implicated as an increased risk of emotional and mental health disorders. Finally, Kada endorses community-based services (Beck and Naz, Reference Beck and Naz2019), the use of neutral places for therapy, and the importance of social media and online platforms in this context. In this thought-provoking article, the authors argue that attempts to culturally adapt interventions for Black and Minority ethnic (BME) service users will not have the desired impact if sufficient measures are not in place to improve access to psychological services. Brooks uses a case example to further elaborate the model and emphasize the need for further research in this area. However, there is lack of evidence supporting this approach with culturally They rightly point out that adaptation work does not suggest changes in mental health care systems. This information can then be used to enhance therapeutic alliance and inform formulation and treatment. The Different Perceptions of Cultural Appropriation Columbia hasContentIssue false, British Association for Behavioural and Cognitive Psychotherapies 2019. The fourth article emphasizes understanding a clients experience of racism as part of the assessment, formulation and treatment (Beck, Reference Beck2019). These are commendable efforts. One example often used to illustrate cultural appropriation is history, experience and traditions. This paper examines the Greek cultural, linguistic schema of Politeness Plural in the application of a Schema Therapy mode model. The authors describe culturally adapted techniques they used to make therapy compatible with the local cultural context. As the author rightly points out, the dearth of CBT studies in this area is troubling. The authors describe the mother of a 14-year-old female patient who carried out almost all the compulsive behaviours and rituals for her child. Same-sex relationships were generally tolerated in pre-modern Islamic societies. WebCultural appropriation takes place when members of a majority group adopt cultural elements of a minority group in an exploitative, disrespectful, or stereotypical way. Weaver, Timothy Bains, Anmol WebCultural appropriation is the act of adopting elements of an outside, often minority culture, including knowledge, practices, and symbols, without understanding or respecting the original culture and context. Phiri and colleagues used a systematic approach to culturally adapt CBTp (Rathod et al., Reference Rathod, Kingdon, Phiri and Gobbi2010) in England. This paper describes combining DBT with a sexual stigma model (Herek et al., Reference Herek, Gillis and Cogan2009) for LGBTQ+ service users receiving therapy for borderline personality disorders. 2023. Clark, Kirsty A. They suggest that educating service users on CBT plays a vital role in cultures where people, in general, are not aware of CBT. and Gender and sexual minorities (GSM) are over-represented in the migrating population. Ghazala Mir and co-workers have culturally adapted behavioural activation (BA) for Muslim service users in England. Stigma and discrimination based on sexual orientation or gender identity have a severe impact on the mental health of LGBTQ+ people (Meyer, Reference Meyer2003). Chan, Ngan Yin 2021. The intervention reduced anxiety, depression and emotional dysregulation, and improved assertiveness. Followed by their pioneering work, more studies have been published from Tanzania (ODonnell et al., Reference ODonnell, Dorsey, Gong, Ostermann, Whetten, Cohen and Whetten2014; Woods-Jaeger et al., Reference Woods-Jaeger, Kava, Akiba, Lucid and Dorsey2017). They argue that family systems, religion and local cultural beliefs should all be taken into consideration when providing culturally adapted CBT. As the review included only a small number of case studies, it will be too early to draw any conclusions. emotional regulation. This brief manualized intervention can be delivered in four sessions and might be applicable across cultures. Therapy was delivered by lay counsellors in Iraq and Thailand to treat trauma victims. There is (a) one systematic review of CBT for social anxiety among the culturally diverse population (Jankowska, Reference Jankowska2019). The findings of Stone and Warren, in particular people in low- and middle-income countries not being aware of the existence of modern psychotherapies and professionals reliance on a medical model, are in line with published literature (Naeem et al., Reference Naeem, Gobbi, Ayub and Kingdon2010). This work encourages us to discuss the clients religious and cultural beliefs and to engage the client as experts not only in their problems but also in their culture and religion. WebMaybe the differences would be that FAP makes a greater emphasis in the disclosing of therapists reactions as a way to evoke and reinforce clients desirable actions, while DBT Exposure and response prevention was used to help the client. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers. These authors start by highlighting the need to recognize a military culture in therapeutic encounters. 02 September 2019. I will now briefly consider each of the papers in this special issue of the Cognitive Behaviour Therapist, providing a short summary of each paper, followed by a discussion, including suggestions on further enhancing our understanding of cultural issue related to CBT and on further promoting CBT across cultures and the subcultures. This approach is supported by the World Health Organization (WHO) as depicted in mhGAP (WHO, 2015), which promotes scaling up of evidence-based interventions and emphasizes the role of lay counsellors in delivering these interventions directly to the community members. While literature reports perceived barriers to accessing mental health services among BME communities (Memon et al., Reference Memon, Taylor, Mohebati, Sundin, Cooper, Scanlon and Visser2016), not many models of improving access to psychological services for the BME group exist. DBT is especially suited for cultural adaptations in several ways. The success of therapy was attributed to the culturally specific modifications. Shearer, James Nevertheless, third wave therapies should be culturally adapted and tested. It is heartening to see the breadth and width of topics covered in this special issue. discuss the pros and cons of TSD. The belief that not being a pious person is associated with depression or anxiety is also common among other religious groups (Mir et al., Reference Mir, Ghani, Meer and Hussain2019; Naeem et al., Reference Naeem, Phiri, Munshi, Rathod, Ayub, Gobbi and Kingdon2015a). While frameworks in the past were based on therapists personal experience, these authors have described a systematic approach to culturally adapt CBT that is based on evidence and has been tested through RCTs. Haddock, Gillian Transdiagnostic mental health interventions have been tested in Uganda, Iraq, Thailand, Pakistan and India (Bolton et al., Reference Bolton, Lee, Haroz, Murray, Dorsey, Robinson and Bass2014; Bonilla-Escobar et al., Reference Bonilla-Escobar, Fandio-Losada, Martnez-Buitrago, Santaella-Tenorio, Tobn-Garca, Muoz-Morales and Bolton2018; Patel et al., Reference Patel, Weiss, Chowdhary, Naik, Pednekar, Chatterjee and Kirkwood2010; Rahman et al., Reference Rahman, Hamdani, Awan, Bryant, Dawson, Khan and Ommeren2016; Weiss et al., Reference Weiss, Murray, Zangana, Mahmooth, Kaysen, Dorsey and Bolton2015). It tells us that the items and beliefs we hold dear and sacred The second article describes an evaluation of the transition from the Black, Asian and minority ethnic (BME) community mental health worker to the IAPT low-intensity psychological wellbeing practitioner (Hakim et al., Reference Hakim, Thompson and Coleman-Oluwabusola2019). The authors considered adaptations at numerous levels. Therapists working with traumatized individuals are at increased risk of burnout, compassion fatigue and vicarious trauma (Iqbal, Reference Iqbal2015). Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. distress tolerance. Scheer, Jillian R. The protocol was developed in a specialist NHS (National Health Service, England) programme for migrants with PTSD. This paper highlights the need to improve the BME communitys access to CBT. Revue Canadienne de Psychiatrie, Interventions for treating depression in Muslim patients: a systematic review, A culturally adapted depression intervention for African American adults experiencing depression: Oh Happy Day, Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial, The art and skill of delivering culturally responsive trauma-focused cognitive behavioral therapy in Tanzania and Kenya, Psychological Trauma: Theory, Research, Practice and Policy. Evidence from fully powered trials will help towards implementation not just in England but in Muslim countries too. The first article discusses the need for service change to improve access to culturally adapted therapy (Beck and Naz, Reference Beck and Naz2019). Huggett, Charlotte Skerven et al. Read However, prejudice towards this community worsened in the Islamic world, possibly due to the European laws during the colonial period and the rise of Islamist fundamentalism in the 1980s (The Economist, 2018). All these patients had a strict religious upbringing and had dysfunctional beliefs underpinned by their cultural and religious values. This article describes a clinical protocol for supporting those presenting with PTSD and severe dissociative symptoms, particularly dissociative flashbacks, based on a cross-culturally applicable model. The intervention is also available online (https://medicinehealth.leeds.ac.uk/downloads/download/131/results_and_resources_for_addressing_depression_in_muslim_communities). While egalitarian societies are subtle in acceptance of authority figures, in other societies showing respect for authority is a cultural norm and therefore hard to negotiate. However, this will require a two-pronged approach: improving race relations at a national level and working closely with the accreditation bodies and service providers through canvassing, and emphasizing the role social factors play in the management of emotional and mental health problems. Authors suggest that there can be significant benefits for services to provide IAPT training to people already providing culturally specific services. In particular, it was possible to engage service users in family intervention for psychosis with and without biological family members. The major limitation of this framework is that it focuses on CBT and might not be generalizable to other therapies. Most adaptations involved modifications to language, metaphors, methods, and context. Conclusions: Culturally adapted DBT has been implemented and accepted among several racial, ethnic, and cultural groups, although there is insufficient evidence to determine whether culturally adapted DBT is more efficacious than nonadapted DBT. Some of this information might even be useful when working with service users from other Abrahamic religions. Estrada, Suzanne Understanding military culture becomes even more critical for civilian mental health professionals who are providing help to military personnel or veterans. Byford, Sarah Stallard, Paul In addition to describing the culturally adapted CBT techniques, the authors highlight the issues of gender discrimination and female sexuality in Muslim countries (Gouda and Potrafke, Reference Gouda and Potrafke2016). Finally, two papers describe the importance of self-reflection, self-practice and supervision (Brooks, Reference Brooks2019) and therapist self-disclosure (Phiri et al., Reference Phiri, Rathod, Gobbi, Carr and Kingdon2019). They discuss the barriers in access to CBT, such as stigma and racism (mistrust of services and service providers), therapists level of awareness (gender, religion and rituals), the religious beliefs (depression occurring only in those who are not genuinely religious) as well as the level of religiosity (Orthodox, Liberal, Conservative and Reform, non-affiliated or secular Jews). Farrelly, Maria Therefore, sensitive use of TSD considered to be a useful tool (Goldfried et al., Reference Goldfried, Burckell and Eubanks-Carter2003) becomes even more critical when working with BME communities. Religious beliefs about causes and treatment of epilepsy, The Dimensions of Religiosity Scale: 20-item self-report measure of religious preoccupation, guidance, conviction, and emotional involvement, Formulation and treatment: integrating religion and spirituality in clinical practice, Child and Adolescent Psychiatric Clinics of North America, Meta-analysis of the efficacy and acceptability of cognitive-behavioural therapy for Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder. What Is Cultural Appropriation The term cultural appropriation, is by far a familiar one. What Is Cultural Appropriation? | Britannica Only limited literature is available on CBT with Arab clients (Kayrouz et al., Reference Kayrouz, Dear, Kayrouz, Karin, Gandy and Titov2018). This systematic review reports case studies, as there were no randomized controlled trials (RCTs) in this area. The authors argue that holding on to the Politeness Plural linguistic schema may reinforce emotional distancing and might compromise schema healing. Cultural appropriation is defined as the use of objects or elements of a non-dominant culture in a way that doesnt respect their original meaning, give credit to their source, or reinforces stereotypes or contributes to oppression (Verywell Mind).Appropriation is often confused with appreciation, but the two are very different. The creation of a new workforce requiring additional funding might pose a barrier in uptake into the systems with low resources, or might not be necessary. and This paper reports the cultural adaptation of ACT for the Turkish-speaking community in England. 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.
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