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Cbt culture 200613


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Development of Culturally adapted Cognitive Behavior Therapy (CaCBT)

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Cbt culture 200613

  1. 1. Using CBT with South Asian Muslims Farooq Naeem MBBS, MSc, MRCPsych, PhD Consultant Psychiatrist & CBT Therapist Associate Professor, Queens University, Kingston, Canada
  2. 2. Background  Emphasis on culturally adapted psychotherapy for ethnic minorities (USA)  Few guidelines (e.g., Sue, 1990; Bernal, 1995, Hwang, 2006; Tseng 2004; Hays, 2006, Naeem et al, 2009, Rathod et al, 2010)  Few Trials (Hispanics, Latinos, African, Asian)  Status of CBT in Non Western Countries
  3. 3. Cultural competence?  Psychotherapy is a cultural phenomenon  Growing diversity of ethnic population  Health disparities between different ethnic groups & Justice or ethical issues (Sue et al, 2009)  Evidence from research (Kohn et al 1999, Sue et al 2005, Naeem et al, 2009)
  4. 4. Developing Culturally adapted CBT, Southampton  Adaptation of CBT in Pakistan – Depression (2006-9) – Psychosis  Adaptation of CBT for psychosis in UK (BME population)  Manchester- CA family/ individual therapy for psychosis, substance misuse etc.
  5. 5. Adaptation of CBT for depression in Pakistan Information gathering Interviews with psychologist (Naeem et al, 2010), Interviews with patients (Naeem et al, in press), Group discussions with students (Naeem et al, 2009) experience of therapy, field observation 1. Southampton adaptation framework (Naeem et al, 2009) 2. Exploratory trial (Naeem et al, 2011) 1.
  6. 6. CBT in non western cultures English language journals Few published on depression (Wong et al, 2009, Naeem et al, 2011) Currently in Pakistan  RCT of self help,  CBTp- in-patient RCT, brief CBT RCT s (depression and psychosis), treatment resistant psychosis, MUS, One RCT of CBTp in China CBT for
  7. 7. Cultural adaptation: Psychosis  Qualitative study to adapt CBTp (Naeem et al, under review)  A total of 92 interviews by 3 psychologists – Patients (33), Carers (30), Mental health professionals (29) Psychologists (14) Doctors working in psychiatry (15)  exploratory trial of adapted CBT for psychosis (Habib et al, under review)
  8. 8. Bio-Psycho-Social-Spiritual Model Pakistan (Naeem) UK (Shanaya & Peter) UK (Bheeka) Psycho social stress or worry (25) poverty, (22), loss of balance of mind (2) too much thinking (1) personality (1) Biological hereditary (4), chemicals in brain (6), childbirth (1) phlegm (1) increased heat in liver (1) Spiritual/religious & cultural spirits, magic, taweeds, fear of hawai things (ghosts etc) (8) learning of spiritualism (2) evile eye (1) Gods will (1) Other causes masturbation (1), Don’t know (6) Previous wrong doing Supernatural beliefs +++++ Spiritual/religious causes (55%) Social factors ++++ Psycho social Stress (18%) Interpersonal causes (20%) Biological +++ Biological (4.4%). Being arrested Drug induced Dual explanatory models of psychosis (77.7%), combining prescribed medication and seeing a traditional faith healer as a treatment method
  9. 9. Cultural competence in CBT  The Triple A Principle – Awareness and preparation – Assessment & engagement – Adaptation of therapy (minor adjustments)
  10. 10. Awareness and preparation Culture & related issues Capacity & Circumstances Cognitions & Beliefs
  11. 11. Cause and effect
  12. 12. God’s will not a head injury due to the accident Thanks God not Thank you
  13. 13.  Language and communication – Translation of psychological concepts (Name the title technique) Culture and assertiveness (an example) North American concept (context) Based on rights Asian cultures focus on duties
  14. 14. – Respect (triangulated approach to communication) – Shame and guilt (Paul Guilberts work) – Culturally sensitive assertiveness techniques (e.g., apology technique, fogging etc.)
  15. 15.  Family related issues – Both strengths and difficulties – Help with Engagement Follow up Home work – Engaging family rather than only patient
  16. 16. Capacity & Circumstances  Individual issues – Women less likely to seek help  Health system (Resources and organization)  Pathways to care & help seeking behaviour – Pathways for psychosis different from pathways for depression?
  17. 17. Cognitions & Beliefs  Beliefs about health and illness – Spiritual/paranormal causes of illness  Beliefs about treatment and treatment provider – What do you know/think about CBT?  Cognitive errors and dysfunctional beliefs
  18. 18. Assessment  Cultural identity, acculturation & difficulties in cultural adjustments  Understanding of problems/ stigma  Beliefs about illness and its treatment  Expectations from/knowledge of treatment • Involvement of faith healers, religious healers, alternative healing practices etc.
  19. 19. Engagement-the biggest hurdle  What do patients expect from a (good) healer  Directive style of therapy (Socrates Vs Buddha)  Evidence from research Vs stories of successful cases from other clients  Immediate relief of some symptoms
  20. 20. Therapy- minor adjustments Psycho education Family involvement Culturally accepted treatments Acceptance/involvement of traditional/faith healers . Local practices- head massage etc. Foods/things to avoid- parhaiz
  21. 21. Focus of therapy (e.g., Physical symptoms in thought diaries) Home work Regular reminders Less of writing work Involvement of family Use of beads, audio recorders, mp3 players etc. Time keeping through prayer times Be careful with terminology (e.g., negative thinking, talking therapy)
  22. 22.  Therapy techniques – Helping clients to identify thoughts & emotions – Behavioural techniques (Behavioural activation, experiments etc.,) problem solving, etc easy to use. – Socratic dialogue with care – Mindfulness/sufisim based techniques with care ? (faith/spiritual authority)
  23. 23.  Structural changes in therapy – Place of therapy, number of sessions, starting therapy while in patient , twice a week sessions initially  Brief vs standard therapy
  24. 24. Use of stories and images
  25. 25. Further readings
  26. 26. CBT in Non Western Cultures  29 CBT therapists from across the world – Role of culture/religion/system – CBT techniques minor adjustments – Therapists awareness of local culture/religion
  27. 27. Thank you