Structural adaptations included changes in the language. Beck discusses issues related to a topic sensitively and compassionately that many might find challenging. Kada suggests adaptations both at the individual therapist level (to make therapy acceptable) and at the service level (to improve access and engagement). Skar, Ane-Marthe Solheim 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). Cultural appropriation | Definition, History, Types, & Examples Several attempts have been made at adapting third wave therapies (Cheng and Merrick, Reference Cheng and Merrick2017; Fuchs et al., Reference Fuchs, Lee, Roemer and Orsillo2013; Mercado and Hinojosa, Reference Mercado and Hinojosa2017; Ramaiya et al., Reference Ramaiya, Fiorillo, Regmi, Robins and Kohrt2017). How to Talk About Race They suggest that some BME client groups might test their therapist through initiating TSD. The idea of therapist matching has been a topic of debate; however, research in this area has reported mixed results (Flaskerud, Reference Flaskerud1990; Lambert, Reference Lambert2016). 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. However, they claim that in this case, the cultural context and the broader family system were not the primary factors in the development and maintenance of the problem. 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). Even when the participants background is reported, a broader term such as White, Asian or Black is used, ignoring variations among these groups. 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. Therapy was adapted using qualitative methods while maintaining the theoretical underpinning of BA and was found to be feasible and acceptable (Mir et al., Reference Mir, Meer, Cottrell, McMillan, House and Kanter2015). Case studies in this review were reported from the USA and Japan. This brief manualized intervention can be delivered in four sessions and might be applicable across cultures. The adaptations were made at structural and didactic levels. Cultural Appropriation 12. Family interventions might be more appealing to people from collectivistic cultural backgrounds, and therefore the adaptation of family intervention for this group might improve access, engagement and thus outcomes. Barletta, Janana Bianca As far as I know, this is the first paper to address TSD in a cultural context. 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 Acceptance and commitment therapy: Western adoption of Buddhist tenets? These authors start by highlighting the need to recognize a military culture in therapeutic encounters. 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. These authors describe an evidence-based framework that has evolved over a decade. In addition to adapting BA, they have developed a self-help booklet. 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. Most importantly, this definition does not limit culture to race, religion or nationality, thus recognizing cultural aspects of groups based on gender, gender preferences, age and disabilities. We are already discovering that behavioural approaches might need few changes in their application across cultures (Alatiq and Alrshoud, Reference Alatiq and Alrshoud2018). These findings confirm some of the findings from cultural adaptation of individual CBT for psychosis (Li et al., Reference Li, Zhang, Luo, Liu, Liu, Lin and Naeem2017; Naeem et al., Reference Naeem, Habib, Gul, Khalid, Saeed, Farooq and Kingdon2014; Naeem et al., Reference Naeem, Saeed, Irfan, Kiran, Mehmood, Gul and Kingdon2015b; Rathod et al., Reference Rathod, Kingdon, Phiri and Gobbi2010; Rathod et al., Reference Rathod, Phiri, Harris, Underwood, Thagadur, Padmanabi and Kingdon2013), in particular the role played by trauma, coercive treatment and racism (Rathod et al., Reference Rathod, Kingdon, Phiri and Gobbi2010). Therapists working with traumatized individuals are at increased risk of burnout, compassion fatigue and vicarious trauma (Iqbal, Reference Iqbal2015). The t-v (tu-vos) distinctions are common around the globe and expressed in a variety of forms. Despite very high rates of mental health problems and suicidal behaviours, the LGBTQ+ community faces numerous barriers in accessing mental healthcare (Veltman and Chaimowitz, Reference Veltman and Chaimowitz2014). Their original study consisted of individual in-depth face-to-face interviews with patients with psychosis (n = 15) and focused groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25). These values underpin the principle of cultural adaptation of evidence-based psychosocial interventions for people from diverse cultural and sub-cultural backgrounds. distress tolerance. Ghazala Mir and colleagues have very thoughtfully incorporated religious concepts in this intervention, such as self-compassion, hope and taking responsibility for ones actions, and have addressed misconceptions around religious teachings. Such a slippery verb, appropriate, from the Latin ad Harmful Effects of Cultural Appropriation - Health Finally, I agree with the authors that this intervention should be used across the board. Therefore, practical measures to improve access and providing training in culturally adapted therapy might be the most practical way forward. Singh, Anneesa D. Aminihajibashi, Samira This intervention was planned around three key themes: physical health needs, emotional wellbeing, and resilience-building. Engaging local mental health professionals can play a vital role in this regard to understand the ground realities, rather than taking a public health approach. Authors are encouraged to further this work by developing a manualized intervention that can be tested through experimental research. 2022. Susana Castaos-Cervantes (Castaos-Cervantes, Reference Castaos-Cervantes2019) describes the preliminary efficacy of a brief cognitive behavioural group therapy group intervention tailored to Mexican homeless girls. Kenneth Fung has reported high levels of acceptance of ACT while working with the Cambodian community in Toronto (Fung, Reference Fung2015). Cultural and sub-cultural background also influence beliefs about wellbeing, causes of illness and its cure, help-seeking behaviours, healing systems and even the healers (Altweck et al., Reference Altweck, Marshall, Ferenczi and Lefringhausen2015; Bhugra, Reference Bhugra2006; Bhugra and Bhui, Reference Bhugra and Bhui1998; Hagmayer and Engelmann, Reference Hagmayer and Engelmann2014). Not only was vippasana diluted and stripped into mindfulness (heavily used in CBR and other forms of therapy), now DBT, an up and coming form of therapy, heavily relies on eastern meditation techniques without proper attribution. Sufism, an equivalent of mindfulness in Islam, might be more acceptable for Muslim clients and is worth exploring in this context. 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. The authors discourage unnecessary adaptations to standard DBT supported by They provide best practice guidelines for BME and White therapists, as well as service managers to enable them to work more effectively with service users from different ethnic and cultural backgrounds, for example to consider the current socio-political context. Cognitive behavioural therapy (CBT), like most modern psychotherapies, is underpinned by the European-American values (Hays and Iwamasa, Reference Hays and Iwamasa2006; Naeem et al., Reference Naeem, Phiri, Rathod and Ayub2019; Stone et al., Reference Stone, Beck, Hashempour and Thwaites2018). Currently, a quantitative evaluation is underway. This Ca-CBTp was found to be feasible and acceptable as well as effective in a pilot RCT (Rathod et al., Reference Rathod, Phiri, Harris, Underwood, Thagadur, Padmanabi and Kingdon2013). The fourth article emphasizes understanding a clients experience of racism as part of the assessment, formulation and treatment (Beck, Reference Beck2019). The protocol was developed in a specialist NHS (National Health Service, England) programme for migrants with PTSD. CULTURAL APPROPRIATION IS one of the most misunderstood and abused phrases of our tortured age. The ethical considerations of counselling psychologists working with trauma: is there a risk of vicarious traumatisation? There is also evidence to suggest that using online platforms for delivering CBT might address cultural barriers (Alavi et al., Reference Alavi, Hirji, Sutton and Naeem2016). Understanding ACT, DBT, and FAP: Similarities and Differences discuss the pros and cons of TSD. The authors provide case examples. It is, however, envisaged that therapists shared the same cultural values as the client, might be mindful of these norms, and possibly delivered therapy in Arabic some vital aspects of cultural adaptation. Cultural appropriation is the adoption of certain elements from another culture without the consent of people who belong to that culture. The treatment outcomes were generally promising in all cases, reporting a significant decrease of SAD symptoms, which were maintained over time. In addition to providing some guidance for therapists, Phiri et al. It is defined as situations where a person associated with one group uses cultural elements from Future research in this area should explore stakeholders views on improving access to IAPT services for BME communities. At first glance, it appears that this Cognitive-behavioral treatment of chronically parasuicidal borderline patients, Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness, Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England, Culturally adapted dialectical behavior therapy in an underserved community mental health setting: a latina adult case study, Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence, Psychotherapy with military personnel: lessons learned, challenges ahead, International Journal of Emergency Mental Health, Adapted behavioural activation for the treatment of depression in Muslims, First episode psychosis and ethnicity: initial findings from the AESOP study, Using cognitive behaviour therapy with South Asian Muslims: findings from the culturally sensitive CBT project, An evidence-based framework for cultural adaptation of cognitive behaviour therapy: process, methodology and foci of adaptation, World Cultural Psychiatry Research Review, Treating unresolved grief and posttraumatic stress symptoms in orphaned children in Tanzania: group-based trauma-focused cognitive behavioral therapy, Cognitive behavioral therapy with Latinos, Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT), The effectiveness of a lay health worker led intervention for depressive and anxiety disorders in primary care: the MANAS cluster randomized trial in Goa, India, Effect of a multicomponent behavioral intervention in adults impaired by psychological distress in a conflict-affected area of Pakistan: a randomized clinical trial, A cultural adaptation of dialectical behavior therapy in Nepal, Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users and health professionals views and opinions, Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial, Belief in supernatural causes of mental illness among Malay patients: impact on treatment, Empirical reality of dialectical behavioral therapy in borderline personality, Civilian psychologists in an army culture: the ethical challenge of cultural competence, Culturally competent adaptation of cognitive-behavioural therapy for psychosis: cases of Orthodox Jewish patients with messianic delusions. Yarrum, Jynna 2022. Climbing the totem pole. Finally, the authors list available resources in training in military culture for therapists. Jensen, Tine K. 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. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. While the authors mention elements of cultural adaptation of the manual, no systematic attempts were made to adapt the manual culturally. The results of the qualitative analysis found five superordinate themes: the medical model, novelty, practicalities, process and therapist effects. The authors discuss the impact of minority stress, shame and migration stress in this group. Homelessness is often triggered by violence, trauma and adversity in childhood that makes the homeless culture attractive in giving status and acceptance to these individuals (Ravenhill, Reference Ravenhill2008). This study reports the results of post-intervention effects of a culturally adapted ACT group. It is heartening to see the breadth and width of topics covered in this special issue. Phiri and colleagues used a systematic approach to culturally adapt CBTp (Rathod et al., Reference Rathod, Kingdon, Phiri and Gobbi2010) in England. When working with refugees, these therapists have to face multiple barriers, such as language, religion and culture. The authors describe culturally adapted techniques they used to make therapy compatible with the local cultural context. The third article discusses issues of race, cthnicity and culture in CBT to support therapists and service managers to deliver culturally competent therapy (Naz et al., Reference Naz, Gregory and Bahu2019). The first article discusses the need for service change to improve access to culturally adapted therapy (Beck and Naz, Reference Beck and Naz2019). Note These authors have touched on a highly sensitive issue in a very skilful, diligent and empathic manner. and DBT is especially suited for cultural adaptations in several ways. To the extent that the cultural-appropriation police are urging their targets to respect others who are different, they are saying something that everyone needs to hear. for this article. Most importantly, a focus on the implementation of adapted CBT, service development and improving access to adapted CBT is required, which can only happen with building the evidence base and advocacy for the right to evidence-based care. I agree with the assertion that these ideas need to be tested through qualitative and quantitative research. Two papers (e) focus on CBT for two religious groups, i.e. The authors suggest that ACT and CFT may provide a practical framework for a culturally adapted therapy that targets the needs of those experiencing intersectional LGBTQ+ and Muslim identities. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. However, the authors point out that there was little discussion or consideration given to other, non-culture-related factors that could potentially contribute to the success of therapy. There is no agreed definition. We hope for further research to test this adapted therapy against standard ACT, using improved design and adequately powered RCTs that focus on specific problems. 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. Human societies are evolving at a fast pace. Cultural appropriation is the practice of using or taking something from another culture without giving proper recognition or respect to that culture, Mia Moody What Does Cultural Appropriation Really Mean? - New York Times Ethical travel tips: How to avoid cultural appropriation when However, mindfulness might not be acceptable to everyone from outside the West due to religious or cultural reasons. Culturally adapted dialectical behavior therapy in an Orthodox Jews and Muslims (Kada, Reference Kada2019; Mir et al., Reference Mir, Ghani, Meer and Hussain2019). client initiated therapist self-disclosure (TSD). 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. The authors provide their perspectives on the terms race, culture and ethnicity and share their understanding of these terms for CBT therapists. 2023. A qualitative study from Montreal to explore the reasons for the under-use of conventional mental health services by people of Caribbean origin reported that tendency of physicians to prescribe pills is a significant barrier. No Comments have been published for this article. It can be described as the act by a member of a relatively dominant culture of taking a traditional cultural expression and repurposing it in a different context, without authorization, acknowledgement and/or compensation, in a way that causes harm to the traditional cultural expression holder (s). 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. This review did not require ethics committee approval. 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. Brooks uses a case example to further elaborate the model and emphasize the need for further research in this area. They identified six significant themes: training experience in two different roles, the broader context of both services and their accessibility to the BME service users, differences encountered, adapting therapy for BME service users and therapists language and cultural expertise not being valued. These ideas have significant implications for equity in terms of service provision. I agree that community centres might be a suitable alternative to deal with stigma. Hudson, Jennifer L. Family intervention reduces hospital admission, encourage compliance with medication, improves general social impairment and the levels of expressed emotion within the family (Pharoah et al., Reference Pharoah, Mari, Rathbone and Wong2010), and therefore is recommended by NICE (NICE, 2014). Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Cultural adaptations of CBT: a summary and discussion University of Toronto and Centre for Addiction and Mental Health, Toronto, Canada, Volume 12: Special Issue: Cultural Adaptations of CBT, https://doi.org/10.1017/S1754470X19000278, Reference Stone, Beck, Hashempour and Thwaites, Reference Tam, Wong, Chow, Ng, Ng, Cheung and Mak, Reference Altweck, Marshall, Ferenczi and Lefringhausen, Reference Berry, Day, Mulligan, Seed, Degnan and Edge, Reference Kolonia, Tsartsara and Giakoumaki, Reference Murray, Haroz, Pullmann, Dorsey, Kane, Augustinavicius and Bolton, Reference Perry, Gardener, Oliver, Ta and zen, Reference Zwiebach, Lannert, Sherrill, McSweeney, Sprang, Goodnight and Rauch, Reference Zgueb, Ouali, Achour, Jomli and Nacef, Reference Chessell, Brady, Akbar, Stevens and Young, Reference Hakim, Thompson and Coleman-Oluwabusola, Reference Phiri, Rathod, Gobbi, Carr and Kingdon, Reference Gureje, Nortje, Makanjuola, Oladeji, Seedat and Jenkins, Reference Hwang, Myers, Chiu, Mak, Butner, Fujimoto and Miranda, Reference Edge, Degnan, Cotterill, Berry, Baker, Drake and Abel, Reference Fearon, Kirkbride, Morgan, Dazzan, Morgan, Lloyd and Murray, Reference Morgan, Dazzan, Morgan, Jones, Harrison, Leff and Fearon, Reference Pharoah, Mari, Rathbone and Wong, Reference Li, Zhang, Luo, Liu, Liu, Lin and Naeem, Reference Naeem, Habib, Gul, Khalid, Saeed, Farooq and Kingdon, Reference Naeem, Saeed, Irfan, Kiran, Mehmood, Gul and Kingdon, Reference Rathod, Kingdon, Phiri and Gobbi, Reference Rathod, Phiri, Harris, Underwood, Thagadur, Padmanabi and Kingdon, Reference Bolton, Lee, Haroz, Murray, Dorsey, Robinson and Bass, Reference Weiss, Murray, Zangana, Mahmooth, Kaysen, Dorsey and Bolton, Reference Bonilla-Escobar, Fandio-Losada, Martnez-Buitrago, Santaella-Tenorio, Tobn-Garca, Muoz-Morales and Bolton, Reference Patel, Weiss, Chowdhary, Naik, Pednekar, Chatterjee and Kirkwood, Reference Rahman, Hamdani, Awan, Bryant, Dawson, Khan and Ommeren, Reference Rathod, Pinninti, Irfan, Gorczynski, Rathod, Gega and Naeem, Reference Ramaiya, Fiorillo, Regmi, Robins and Kohrt, Reference Sue, Zane, Nagayama Hall and Berger, Reference Naeem, Phiri, Munshi, Rathod, Ayub, Gobbi and Kingdon, Reference Kayrouz, Dear, Kayrouz, Karin, Gandy and Titov, Reference Reger, Etherage, Reger and Gregory, Reference Soeters, Winslow, Weibull and Caforio, Reference Hoge, Castro, Messer, McGurk, Cotting and Koffman, Reference Stevelink, Malcolm, Mason, Jenkins, Sundin and Fear, Reference Spoont, Sayer, Thuras, Erbes and Winston, Reference Linehan, Armstrong, Suarez, Allmon and Heard, Reference Mndez-Bustos, Calati, Rubio-Ramrez, Oli, Courtet and Lopez-Castroman, Reference Panos, Jackson, Hasan and Panos, Reference Hawton, Witt, Taylor Salisbury, Arensman, Gunnell, Hazell and van Heeringen, Reference Ismail, Wright, Rhodes and Small, Reference Shea, Cachelin, Gutierrez, Wang and Phimphasone, Reference Shabtai, Pirutinsky, Rosmarin, Ben-Avie, Ives and Loewenthal, Reference McEvoy, Williamson, Kada, Frazer, Dhliwayo and Gask, Reference Mir, Meer, Cottrell, McMillan, House and Kanter, Reference Walpole, McMillan, House, Cottrell and Mir, Reference Memon, Taylor, Mohebati, Sundin, Cooper, Scanlon and Visser, Reference Baillie, Harrop, Hopewell-Kelly, Stephens, Byrne and Nelson, Reference ODonnell, Dorsey, Gong, Ostermann, Whetten, Cohen and Whetten, Reference Woods-Jaeger, Kava, Akiba, Lucid and Dorsey, Reference Chigwedere, Thwaites, Fitzmaurice and Donohoe, Reference Sodeke-Gregson, Holttum and Billings, Reference Goldfried, Burckell and Eubanks-Carter, Online CBT is effective in overcoming cultural and language barriers in patients with depression, Engaging minority ethnic communities to improve access to palliative care: barriers and strategies, Transcultural Cognitive Behaviour Therapy for Anxiety and Depression: A Practical Guide, Psychotherapy for ethnic minorities: issues, context and practice. This area merits further research. The term cultural appropriation, is by far a familiar one. Farrelly, Maria They argue that family systems, religion and local cultural beliefs should all be taken into consideration when providing culturally adapted CBT. Homoerotic themes were prevalent in poetry and other literary genres written in major languages of the Muslim world from the eighth century into the modern era (El-Rouayheb, Reference El-Rouayheb2005). Sclare, Irene These results indicated that the level of distinctiveness threat experienced increases the perception of cultural appropriation. Figure: Detailed depiction of the study designs and categories of cultural appropriation. Brooks identifies some of the challenges that refugees, asylum seekers and survivors of torture may present with. Similarly, their suggestion in adapting CBT is also in line with other papers in this issue. 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. 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). 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). This special issue addresses a variety of problems, populations and psychotherapies. In the end, political will, lobbying, public awareness and public demand play an important role in changes in service delivery and improving access to care. 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). Has data issue: false They also highlight the culturally sensitive practice of involving faith or religious healers in therapy (Kada, Reference Kada2019; Mir et al., Reference Mir, Ghani, Meer and Hussain2019; Naeem et al., Reference Naeem, Phiri, Munshi, Rathod, Ayub, Gobbi and Kingdon2015a). There is also a need to test the culture-free aspects of CBT. Dialectical Behavioral Therapy (DBT) - Healthline Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers. This declaration asserts that cultural pluralism pre-supposes respect for human rights.
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