There is a need for further research on a model developed by these authors, which has been tried elsewhere (Baillie et al., Reference Baillie, Harrop, Hopewell-Kelly, Stephens, Byrne and Nelson2014; CFHI, 2018). This case report describes the application of CBT in dealing with family accommodation (defined as how relatives, in particular parents, may assist in compulsive rituals, provide reassurance or modify their routines to alleviate or avoid the distress experienced by the obsessive-compulsive child). Therapists working with traumatized individuals are at increased risk of burnout, compassion fatigue and vicarious trauma (Iqbal, Reference Iqbal2015). 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). for this article. distress tolerance. The prevalence rates of mental health difficulties among UASC are understandably higher than among children seeking asylum with their families, or children who are not from refugee or asylum-seeking backgrounds. I also suggest that authors should consider replication of this model in other countries, especially non-Western countries. Culture can influence religions, such as a blue-eyed Jesus in Europe and an Indian-looking Jesus in South Asia (Trendpost, 2015). use of popular teachings and poems of Rumi, culturally familiar, non-technical language and video material from popular Turkish media and culturally syntonic translation of the therapy material. Rebessi, Isabela Pizzarro Third wave therapies are good examples of integration of CBT with another model of therapy. 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). Chan, Joey Wing Yan } The number of Muslims migrating to Europe and North America has increased over the last decade. CBT involves exploration and attempts to modify core beliefs. The Atlantic Haddock, Gillian Both verbal and non-verbal language plays a vital role in psychotherapeutic encounters. Nevertheless, third wave therapies should be culturally adapted and tested. Barletta, Janana Bianca The authors suggest more process research in the use of transdiagnostic therapy manuals in low- and middle-income countries. 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). In the 21st century, cultural appropriationlike globalizationisnt just inevitable; its potentially positive. 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. While some therapists might be less interested in these topics, others might not explore these areas due to their anxieties around race relations. Authors are encouraged to further this work by developing a manualized intervention that can be tested through experimental research. WebCultural appropriation takes place when members of a majority group adopt cultural elements of a minority group in an exploitative, disrespectful, or stereotypical way. All these patients had a strict religious upbringing and had dysfunctional beliefs underpinned by their cultural and religious values. 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. CULTURAL APPROPRIATION IS one of the most misunderstood and abused phrases of our tortured age. DBTACES in a multicultural community mental health Core beliefs, underlying assumptions and even the content of automatic thoughts vary across cultures (Sahin and Sahin, Reference Sahin and Sahin1992; Tam et al., Reference Tam, Wong, Chow, Ng, Ng, Cheung and Mak2007). The authors have used a variety of approaches to describe their experiences of working with people from diverse backgrounds. 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). (Reference Memon, Taylor, Mohebati, Sundin, Cooper, Scanlon and Visser2016) describe factors affecting the relationship between service users and healthcare providers, e.g. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. This article emphasizes the role of mental health services and accreditation bodies. Scheer, Jillian R. Developed by Linehan Here, I briefly summarize and discuss the papers in this special issue. In addition to adapting BA, they have developed a self-help booklet. Reviewers report that therapists claimed that they practised cultural awareness and were open to discuss culture and were attentive to cultural norms as well as culture-specific expressions of SAD and the level of acculturation. WebIntroduction. Culturally adapting CBT is the only way access to this evidence-based therapy can be improved for marginalized communities in Europe and North America and for the local population outside of these regions where more than 80% of the world population lives. Render date: 2023-05-01T13:32:05.576Z This paper describes the authors experience of delivering training in culturally sensitive CBT, thoughtful commentary on race relations in England, and improving access to CBT for BME clients. 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). (PDF) Culturally Adapted Dialectical Behavior Therapy in These include awareness of the service users culture, consideration of cultural issues during the assessment and engagement phase and areas in therapy that need adjustment for therapy to be effective. 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. Understanding military culture becomes even more critical for civilian mental health professionals who are providing help to military personnel or veterans. Sufism, an equivalent of mindfulness in Islam, might be more acceptable for Muslim clients and is worth exploring in this context. There was no association between time devoted to coping strategies and traumatic stress scores (Bober and Regehr, Reference Bober and Regehr2006). However, we should also keep in mind that service users from different cultural backgrounds vary in their tendency to self-disclosure (Chen, Reference Chen1995; Yoo, Reference Yoo2012). However, it is yet to be determined how sustainable these therapies are in the long term. Acceptance and commitment therapy (ACT) is a trans-diagnostic intervention that has been tried both in the West and outside the West. As the UASCs have typically experienced multiple losses, traumatic experiences, significant disruption and psychosocial stressors, a trauma focus approach was used. This paper reports the cultural adaptation of ACT for the Turkish-speaking community in England. Cognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. These authors start by highlighting the need to recognize a military culture in therapeutic encounters. This study reports the results of post-intervention effects of a culturally adapted ACT group. There is a need to adapt CBT for this group using a systematic approach. 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). This can indeed increase the risks mentioned above. Cultural appropriation, defined Culture refers to the traditions, customs, beliefs, and practices of any given ethnic, racial, or religious group. Estrada, Suzanne The lay counsellors, under supervision, demonstrated high levels of fidelity to the intervention. The authors provide case examples. 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. The finding that behavioural techniques need few adjustments and are almost culture free has been previously reported (Naeem et al., Reference Naeem, Gobbi, Ayub and Kingdon2010). They emphasize the need to provide training and supervision to deliver culturally competent care to BME service users and encourage self-reflection among therapists. The attitudes towards LGBTQ+ in Muslim countries have been influenced by religion and Islamic jurisprudence, as well their social, political and cultural history. In terms of the mode of delivery, a group approach was considered more suitable to provide peer support and normalization for the UASC. Neufeld, Carmem Beatriz Globalization is bringing people together, and increasing their knowledge and awareness of the latest technologies in healthcare. Therefore, practical measures to improve access and providing training in culturally adapted therapy might be the most practical way forward. Werntz, Alexandra Same-sex relationships were generally tolerated in pre-modern Islamic societies. 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). The authors describe culturally adapted techniques they used to make therapy compatible with the local cultural context. James, Kirsty Brown, June Cultural appropriation: Using elements of a marginalized culture, including clothing, images, or ideas, in ways that disrespect the culture. They rightly point out that adaptation work does not suggest changes in mental health care systems. 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. Beck discusses issues related to a topic sensitively and compassionately that many might find challenging. emotional regulation. As the review included only a small number of case studies, it will be too early to draw any conclusions. Islam is not an exception, and there are variations in the application of Islamic beliefs in different cultures and traditions (The Economist, 2013). Other authors have suggested the idea that neutral places in the community might improve access to services and engagement with the BME communities (Beck and Naz, Reference Beck and Naz2019; Kada, Reference Kada2019). The protocol was developed in a specialist NHS (National Health Service, England) programme for migrants with PTSD. 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. Andrade, Brendan F. Gender and sexual minorities (GSM) are over-represented in the migrating population. They highlight the need for commitment and investment, by all stakeholders, such as therapists, supervisors, clinical leads, service managers, Clinical Commissioning Groups (CCGs) and NHS England. The earliest known use of the term cultural appropriation is credited to Arthur E. Christy (1899 1946), a professor of literature at the University of Illinois (Martin, 2018). The assertion that the expression of social anxiety is influenced by social and cultural factors (Hofmann et al., Reference Hofmann, Asnaani and Hinton2010) has common sense appeal. This information can then be used to enhance therapeutic alliance and inform formulation and treatment. Finally, the authors list available resources in training in military culture for therapists. How is cultural appropriation used in real life? 12. This declaration asserts that cultural pluralism pre-supposes respect for human rights. There is a need to consider ways to deliver these interventions without putting extra demands on health systems while taking into consideration the available resource. Nitty gritty. This review did not require ethics committee approval. DBT is an evidence-based practice (Linehan, 2014), and research reflects mindfulness and acceptance-based therapies to indicate some clinical promise with The authors concluded that the lay counsellors delivered the intervention flexibly and were able to learn the decision-making processes of the therapy manual. Chan, Ngan Yin 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. 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. Rhodes, Jean E. The authors used thematic analysis to further elaborate on critical elements of this theme and how this could impact on (a) therapists reaction towards TSD, (b) the therapeutic alliance, and ultimately (c) the outcomes of therapy. Currently, the IASP (Improving Access to Structures Psychotherapies) CBT Training Program in Ontario, Canada, is incorporating culturally adapted CBT practices. and 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. This issue can be addressed in future research. There is (a) one systematic review of CBT for social anxiety among the culturally diverse population (Jankowska, Reference Jankowska2019). Most importantly, they address the cultural issues too. They describe their experience of successfully training therapists in delivering culturally adapted BA, which supports Muslim service users who choose to use positive religious coping as a resource for health. This intervention was planned around three key themes: physical health needs, emotional wellbeing, and resilience-building. These authors suggest that young children cannot be treated without considering attachment patterns, the broader family system and cultural variables. This brief manualized intervention can be delivered in four sessions and might be applicable across cultures. As the author rightly points out, the dearth of CBT studies in this area is troubling. Fonagy, Peter There is also a need to test the culture-free aspects of CBT. The results of the qualitative analysis found five superordinate themes: the medical model, novelty, practicalities, process and therapist effects. First, DBT emphasizes client expectations, attributions, values, roles, beliefs, coping styles, and Authors suggest that there can be significant benefits for services to provide IAPT training to people already providing culturally specific services. A collaborative approach might not be acceptable across cultures. Future research must focus on systematically adapting CBT that can be tested through fully powered trials and evaluated for cost-effectiveness. The term cultural appropriation, is by far a familiar one. 2021. I have tried to divide these articles according to the broader themes, although most articles will fit in more than one thematic area. The Different Perceptions of Cultural Appropriation Columbia 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. Bertie, Lizl-Antoinette A systematic review of interventions for treating depression in Muslim patients reported that many studies do not distinguish between beliefs and values that are religious and those that are cultural, and that most of the evidence was methodologically weak or included assertions made without qualification (Walpole et al., Reference Walpole, McMillan, House, Cottrell and Mir2013). However, therapy was not adapted using a systematic approach. Stone and Arroll report a qualitative study to explore the experiences of therapists trained in CBT in Tanzania. Therapists focused on cultural factors during assessment and engagement, shared learning, communication, coping skills and endings. It is not the content of the TSD they are testing per se, but how the therapist responds. Raphael Kada (Kada, Reference Kada2019) describes his experience of providing CBT for the Jewish community. 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). They describe some examples from their work to show how the services can better understand the needs of minority populations. Mindfulness-based approaches as practised in the West have also been criticized as either lacking the philosophical, theoretical or theological underpinning (Kirmayer, Reference Kirmayer2015) or even being a tool misused by the capitalist West (Illing, Reference Illing2019). The Debate About Cultural Appropriation - O'Neill The original Beckian CBT model has been adapted over the years to help service users with anxiety, PTSD, OCD and psychosis. Skerven et al. Qualitative responses indicated that the culturally adapted ACT was feasible and acceptable. There are wider cultural variations in self-disclosure. They offer practical advice on discussing these issues. The term cultural appropriation is thought to 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. Future research in this area should explore stakeholders views on improving access to IAPT services for BME communities. The authors suggest that any attempt at holding on to the Politeness Plural cultural, linguistic schema in the Greek-speaking culture employed by either the therapist or the client reinforces emotional distancing and prevents the therapy from working through those maladaptive coping and internalized dysfunctional mechanisms of self that perpetuate schemas on both. 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. CBT research until recently has primarily focused on white, middle-class, well-educated service users, who are of European-American identities (Suinn, Reference Suinn2003). Case studies in this review were reported from the USA and Japan. They suggest that some BME client groups might test their therapist through initiating TSD. 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. They suggest that educating service users on CBT plays a vital role in cultures where people, in general, are not aware of CBT. There are multiple arguments in favour of adapting CBT for people from a diverse background (Sue et al., Reference Sue, Zane, Nagayama Hall and Berger2009). Contributors to this special issue of the Cognitive Behaviour Therapist have tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. and and For sexual minorities, minority stress has been implicated as an increased risk of emotional and mental health disorders. 02 September 2019. The authors report three cases to describe the therapy process, insights learned by therapists and compared those with the original model they developed. Most importantly, he provides practical guidance on how to do this: the appropriate time to make such enquiries, co-developing a genogram, carefully phrasing questions and use of information gathered to guide treatment. Similarly, racism as a barrier to access to help and as a cause for the emotional and mental health problem has been previously reported (Rathod et al., Reference Rathod, Kingdon, Phiri and Gobbi2010; Ward and Brown, Reference Ward and Brown2015). Clark, Kirsty A. This implies that interventions adapted for religious groups should take into consideration the cultural factors as well. and 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). Kada suggests adaptations both at the individual therapist level (to make therapy acceptable) and at the service level (to improve access and engagement). Pachankis, John E. Family-based cognitive behavioural therapy was offered over 4 months with a successful treatment outcome. This special issue publishes papers on both adaptation and integration of therapies to fulfil the needs of groups with complex needs and from different cultures and sub-cultures. Military personnel share a common bond, feeling of unity and a sense of purpose and direction. The dissociative responses are explained using the 6 Fs cascade. 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). 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. Cultural appropriation is the practice of using or taking something from another culture without giving proper recognition or respect to that culture, Mia Moody Seven participants from Tanzanias only psychiatric hospital who had completed CBT training were interviewed. It's a controversial topic, one that activists and celebrities like Adrienne Keene and Jesse Williams have helped bring into the national spotlight. In addition to providing some guidance for therapists, Phiri et al. This will require establishing trust and partnership with the community. I encourage the author to develop this work in the form of a training workshop. However, much of the public remains confused about what the The authors considered adaptations at numerous levels. Finally, cultural considerations should be an essential part of the CBT courses and training of new CBT therapists. WebCultural appropriation has been identified across a range of fields, including religion, music, sports, fashion, visual art, and film. The intervention is also available online (https://medicinehealth.leeds.ac.uk/downloads/download/131/results_and_resources_for_addressing_depression_in_muslim_communities). Byford, Sarah The authors also report feasibility, acceptability and preliminary effectiveness of the intervention. The fourth article emphasizes understanding a clients experience of racism as part of the assessment, formulation and treatment (Beck, Reference Beck2019). discuss the pros and cons of TSD. The authors have expanded on their work over a decade in developing a framework for cultural adaptation of CBT that can be replicated (Naeem et al., Reference Naeem, Phiri, Munshi, Rathod, Ayub, Gobbi and Kingdon2015a; Naeem et al., Reference Naeem, Rathod, Khan and Ayub2016a,b; Naeem et al., Reference Naeem, Phiri, Rathod and Ayub2019; Rathod et al., Reference Rathod, Kingdon, Phiri and Gobbi2010). This one and half-hour part two online training was designed to provide an overview of the culturally adapted Dialectical Behavior Therapy (DBT) for Hispanic WebDBT is an intervention that has demonstrated efficacy for reducing suicidality (Swales et al., 2000), which may be effective among Native American clients. 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 suggestion that individual variations and environmental factors shape stress response might apply to groups of individuals (Ellis et al., Reference Ellis, Jackson and Boyce2006). Human societies are evolving at a fast pace. One example often used to illustrate cultural appropriation is history, experience and traditions. Cultural Therefore, it makes sense to adapt CBT when working with diverse populations. I agree that community centres might be a suitable alternative to deal with stigma. Such a slippery verb, appropriate, from the Latin ad Climbing the totem pole. The authors concluded that if applied thoughtfully, CBT can be used for patients in Saudi Arabia. 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. So far, the uptake of these interventions into health systems has been low (Naeem et al., Reference Naeem, Rathod, Khan and Ayub2016a). The White Science of Meditation Day, Crispin 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. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand, A randomized controlled trial of a transdiagnostic cognitive-behavioral intervention for Afro-descendants survivors of systemic violence in Colombia, The lack of cancer surveillance data on sexual minorities and strategies for change, Differences in self-disclosure patterns among Americans versus Chinese: a comparative study, Cultural adaptation of dialectical behavior therapy for a Chinese international student with eating disorder and depression, Self-practice/self-reflection as an alternative to personal training-therapy in cognitive behavioural therapy training: a qualitative analysis, Religious and ethnic group influences on beliefs about mental illness: a qualitative interview study, The stress response systems: universality and adaptive individual differences, Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study, Matching client and therapist ethnicity, language, and gender: a review of research, Using mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds: clinical considerations, meta-analysis findings, and introduction to the special series.
