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Cultural adaptation of cognitive behaviour therapy for depression: a qualitative study exploring views of patients and practitioners from India

Published online by Cambridge University Press:  31 March 2022

Sayma Jameel
Affiliation:
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, India
Manjula Munivenkatappa*
Affiliation:
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, India
Shyam Sundar Arumugham
Affiliation:
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, India
K Thennarasu
Affiliation:
Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore-560029, India
*
*Corresponding author. Email: [email protected]

Abstract

Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, culture can influence engagement and treatment efficacy of CBT. Several attempts have been made in Asian countries to develop a culturally adapted CBT for depression. However, research in the Indian context documenting the views on cultural influence of CBT is limited. The present study is an attempt to explore the views of patients and therapists in India by following an evidence-based approach that focuses on three areas for adaptation: (1) awareness of relevant cultural issues and preparation for therapy; (2) assessment and engagement; and (3) adjustments in therapy techniques. Semi-structured interviews with three consultant clinical psychologists/therapists, a focused group discussion with six clinical psychologists, and two patients undergoing CBT for depression were conducted. The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The results highlight therapists’ experiences, problems faced, and recommendations in all three areas of adaptation. The findings highlight the need for adaptation with understanding and acknowledging the culture differences and clinical presentation. Culturally sensitive assessment and formulation with minor adaptation in clinical practice was recommended. Therapists emphasised the use of proverbs, local stories and simplified terminologies in therapy. The findings will aid in providing culturally sensitive treatment to patients with depression in India.

Key learning aims

  1. (1) To understand the views of Indian patients and therapists based on their experience of CBT.

  2. (2) To understand the need for cultural adaptation of CBT in India.

  3. (3) To understand the adaptations by therapists while using CBT in clinical practice.

  4. (4) To gain perspective on how CBT can be culturally adapted to meet the needs of the Indian population.

Type
Original Research
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Naeem, F., Phiri, P., Nasar, A., Munshi, T., Ayub, M., & Rathod, S. (2016). An evidence-based framework for cultural adaptation of cognitive behaviour therapy: process, methodology and foci of adaptation. World Cultural Psychiatry Research Review, 11, 6770 Google Scholar
Rathod, S., Kingdon, D., Pinninti, N., Turkington, D., & Phiri, P. (2015). Cultural Adaptation of CBT for Serious Mental Illness: A Guide for Training and Practice. Wiley Blackwell. https://doi.org/10.1002/9781118976159 CrossRefGoogle Scholar

References

Algahtani, H. M. S., Almulhim, A., Alnajjar, F. A., Ali, M. K., Irfan, M., Ayub, M., & Naeem, F. (2019). Cultural adaptation of cognitive behavioural therapy (CBT) for patients with depression and anxiety in Saudi Arabia and Bahrain: a qualitative study exploring views of patients, carers, and mental health professionals. the Cognitive Behaviour Therapist, 12. https://doi.org/10.1017/S1754470X1900028X CrossRefGoogle Scholar
Alladin, W. (2009). An ethno biopsychosocial human rights model for educating community counsellors globally. Counselling Psychology Quarterly, 22, 1724. https://doi.org/10.1080/09515070903003640 CrossRefGoogle Scholar
American Psychological Association (2017). Multicultural guidelines: an ecological approach to Context, Identity, and Intersectionality. Retrieved from: http://www.apa.org/about/policy/multicultural-guidelines.pdf Google Scholar
An, Q., Wang, K., Sun, F., & Zhang, A. (2020). The effectiveness of modified, group-based CBT for dementia worry among Chinese elders. Journal of Affective Disorders, 274, 7684. https://doi.org/10.1016/j.jad.2020.05.054 CrossRefGoogle ScholarPubMed
Barrera, M., Castro, F. G., Strycker, L. A., & Toobert, D. J. (2013). Cultural adaptations of behavioral health interventions: a progress report. Journal of Consulting and Clinical Psychology, 81, 196205. https://doi.org/10.1037/a0027085 CrossRefGoogle ScholarPubMed
Bhugra, D. (1989). Attitudes towards mental illness: a review of the literature. Acta Psychiatrica Scandinavica, 80, 112. https://doi.org/10.1111/j.1600-0447.1989.tb01293.x CrossRefGoogle ScholarPubMed
Bobak, M., Pikhart, H., Pajak, A., Kubinova, R., Malyutina, S., Sebakova, H., Topor-Madry, R., Nikitin, Y., & Marmot, M. (2006). Depressive symptoms in urban population samples in Russia, Poland and the Czech Republic. British Journal of Psychiatry, 188, 359365. https://doi.org/10.1192/bjp.188.4.359 CrossRefGoogle ScholarPubMed
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101. https://doi.org/10.1191/1478088706qp063oa CrossRefGoogle Scholar
Brockington, I. F., Hall, P., Levings, J., & Murphy, C. (1993). The community’s tolerance of the mentally ill. British Journal of Psychiatry, 162, 9399. https://doi.org/10.1192/bjp.162.1.93 CrossRefGoogle ScholarPubMed
Bromberger, J. T., Harlow, S., Avis, N., Kravitz, H. M., & Cordal, A. (2004). Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women: the Study of Women’s Health Across the Nation (SWAN). American Journal of Public Health, 94, 13781385. https://doi.org/10.2105/ajph.94.8.1378 CrossRefGoogle Scholar
Bryant, M. J., Simons, A. D., & Thase, M. E. (1999). Therapist skill and patient variables in homework compliance: controlling an uncontrolled variable in cognitive therapy outcome research. Cognitive Therapy and Research, 23, 381399. https://doi.org/10.1023/A:1018703901116 CrossRefGoogle Scholar
Chaplin, T. M., & Cole, P. M. (2005). The role of emotion regulation in the development of psychopathology. In Hankin, B. L. & Abela., J. R. Z. (eds), Development of Psychopathology: A Vulnerability-Stress Perspective (pp. 4974). Sage Publications, Inc. https://doi.org/10.4135/9781452231655.n3 CrossRefGoogle Scholar
Chaplin, T. M., Hong, K., Bergquist, K., & Sinha, R. (2008). Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving. Alcoholism, Clinical and Experimental Research, 32, 12421250. https://doi.org/10.1111/j.1530-0277.2008.00679.x CrossRefGoogle ScholarPubMed
Corrigan, P. W., & Penn, D. L. (1998). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54, 765776.CrossRefGoogle Scholar
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58, 376385. https://doi.org/10.1177/070674371305800702 CrossRefGoogle ScholarPubMed
Detweiler-Bedell, J. B., & Whisman, M. A. (2005). A lesson in assigning homework: therapist, client, and task characteristics in cognitive therapy for depression. Professional Psychology: Research and Practice, 36, 219223. https://doi.org/10.1037/0735-7028.36.2.219 CrossRefGoogle Scholar
Edge, D., Degnan, A., Cotterill, S., Berry, K., Baker, J., Drake, R., & Abel, K. (2018). Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability. Health Services and Delivery Research, 6, 1316. https://doi.org/10.3310/hsdr06320 CrossRefGoogle Scholar
El Rhermoul, F. Z., Naeem, F., Kingdon, D., Hansen, L., & Toufiq, J. (2018). A qualitative study to explore views of patients, carers and mental health professionals’ views on depression in Moroccan women. International Journal of Culture and Mental Health, 11, 178193. https://doi.org/10.1080/17542863.2017.1355397 CrossRefGoogle Scholar
Gloaguen, V., Cottraux, J., Cucherat, M., & Blackburn, I. M. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49, 5972. https://doi.org/10.1016/s0165-0327(97)00199-7 CrossRefGoogle ScholarPubMed
Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: a meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43, 531548. https://doi.org/10.1037/0033-3204.43.4.531 CrossRefGoogle ScholarPubMed
Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy, 47, 9931014. https://doi.org/10.1016/j.beth.2016.09.005 CrossRefGoogle ScholarPubMed
Hays, P. A. (1995). Multicultural applications of cognitive-behavior therapy. Professional Psychology: Research and Practice, 26, 309315. https://doi.org/10.1037/0735-7028.26.3.309 CrossRefGoogle Scholar
Husain, N., Zulqernain, F., Carter, L.-A., Chaudhry, I. B., Fatima, B., Kiran, T., Chaudhry, N., Naeem, S., Jafri, F., Lunat, F., Haq, S. U., Husain, M., Roberts, C., Naeem, F., & Rahman, A. (2017). Treatment of maternal depression in urban slums of Karachi, Pakistan: a randomized controlled trial (RCT) of an integrated maternal psychological and early child development intervention. Asian Journal of Psychiatry, 29, 6370. https://doi.org/10.1016/j.ajp.2017.03.010 CrossRefGoogle ScholarPubMed
Hwang, W.-C., Wood, J. J., Lin, K.-M., & Cheung, F. (2006). Cognitive-behavioral therapy with Chinese Americans: research, theory, and clinical practice. Cognitive and Behavioral Practice, 13, 293303. https://doi.org/10.1016/j.cbpra.2006.04.010 CrossRefGoogle Scholar
Hwang, W. C., Myers, H. F., Chiu, E., Mak, E., Butner, J. E., Fujimoto, K., Wood, J. J., & Miranda, J. (2015). Culturally adapted cognitive-behavioral therapy for Chinese Americans with depression: a randomized controlled trial. Psychiatric Services, 66, 10351042. https://doi.org/10.1176/appi.ps.201400358 CrossRefGoogle ScholarPubMed
Iwata, N., & Buka, S. (2002). Race/ethnicity and depressive symptoms: A cross-cultural/ethnic comparison among university students in East Asia, North and South America. Social Science and Medicine, 55, 22432252. https://doi.org/10.1016/S0277-9536(02)00003-5 CrossRefGoogle Scholar
Joel, D., Sathyaseelan, M., Jayakaran, R., Vijayakumar, C., Muthurathnam, S., & Jacob, K. S. (2003). Explanatory models of psychosis among community health workers in South India. Acta Psychiatrica Scandinavica, 108, 6669. https://doi.org/10.1034/j.1600-0447.2003.01327.x CrossRefGoogle ScholarPubMed
Kanazawa, A., White, P. M., & Hampson, S. E. (2007). Ethnic variation in depressive symptoms in a community sample in Hawaii. Cultural Diversity and Ethnic Minority Psychology, 13, 3544. https://doi.org/10.1037/1099-9809.13.1.35 CrossRefGoogle Scholar
Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: a replication and extension. Clinical Psychology: Science and Practice, 17, 144156. https://doi.org/10.1111/j.1468-2850.2010.01204.x Google Scholar
Kohn, L. P., Oden, T., Muñoz, R. F., Robinson, A., & Leavitt, D. (2002). Adapted cognitive behavioral group therapy for depressed low-income African American women. Community Mental Health Journal, 38, 497504. https://doi.org/10.1023/A:1020884202677 CrossRefGoogle ScholarPubMed
Kumar, N., & Gupta, P. (2012). Cognitive behavioural therapy in India: adaptations, beliefs and challenges. In Naeem, F., & Kingdon, D. (eds), Cognitive Behaviour Therapy in Non-Western Cultures (pp. 6177). New York, USA: Nova Science Publishers Inc.Google Scholar
Kuruvilla, K. (2000). Cognitive behaviour therapy yesterday, today and tomorrow. Indian Journal of Psychiatry, 42, 114124. https://www.indianjpsychiatry.org/temp/IndianJPsychiatry422114-2886849_080108.pdf Google Scholar
Kuruvilla, K. (2010). Indian contribution to behavior therapy. Indian Journal of Psychiatry, 52, 371377. https://doi.org/https://doi.org/10.4103/019-5545.69271 CrossRefGoogle ScholarPubMed
Laungani, P. (1997). Replacing client-centred counselling with culture-centred counselling. Counselling Psychology Quarterly, 10, 343351. https://doi.org/10.1080/09515079708254184 CrossRefGoogle Scholar
Laungani, P. (2004). Asian perspectives in counselling and psychotherapy. Asian Perspectives in Counselling and Psychotherapy, pp. 1261. Routledge. https://doi.org/10.4324/9780203697085 CrossRefGoogle Scholar
Li, W., Zhang, L., Luo, X., Liu, B., Liu, Z., Lin, F., Liu, Z., Xie, Y., Hudson, M., Rathod, S., Kingdon, D., Husain, N., Liu, X., Ayub, M., & Naeem, F. (2017). A qualitative study to explore views of patients’, carers’ and mental health professionals’ to inform cultural adaptation of CBT for psychosis (CBTp) in China. BMC Psychiatry, 17. https://doi.org/10.1186/s12888-017-1290-6 CrossRefGoogle Scholar
Li, Z.-J., Guo, Z.-H., Wang, N., Xu, Z.-Y., Qu, Y., Wang, X.-Q., Sun, J., Yan, L.-Q., Ng, R. M. K., Turkington, D., & Kingdon, D. (2015). Cognitive-behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China. Psychological Medicine, 45, 18931905. https://doi.org/10.1017/S0033291714002992 CrossRefGoogle ScholarPubMed
Lin, K.-M., & Cheung, F. (1999). Mental health issues for Asian Americans. Psychiatric Services, 50, 774780. https://doi.org/10.1176/ps.50.6.774 CrossRefGoogle ScholarPubMed
Moodley, R., Rai, A., & Alladin, W. (2010). Bridging East-West Psychology and Counselling: Exploring the Work of Pittu Laungani. Sage Publications. https://doi.org/10.4135/9788132105534 CrossRefGoogle Scholar
Morrow, S. L. (2005). Quality and trustworthiness in qualitative research in counseling psychology. Journal of Counseling Psychology, 52, 250260. https://doi.org/10.1037/0022-0167.52.2.250 CrossRefGoogle Scholar
Muñoz, R.F., & Miranda, J. (1996). Individual therapy manual for cognitive-behavioral treatment of depression. https://www.rand.org/content/dam/rand/pubs/monograph_reports/2005/MR1198.6.pdf Google Scholar
Naeem, F. (2012). Adaptation of Cognitive Behaviour Therapy for Depression in Pakistan. Lambert Academic Publishing.Google Scholar
Naeem, F., Gul, M., Irfan, M., Munshi, T., Asif, A., Rashid, S., Khan, M. N. S., Ghani, S., Malik, A., Aslam, M., Farooq, S., Husain, N., & Ayub, M. (2015). Brief Culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. Journal of Affective Disorders, 177, 101107. https://doi.org/10.1016/j.jad.2015.02.012 CrossRefGoogle ScholarPubMed
Naeem, F., Latif, M., Mukhtar, F., Kim, Y. R., Li, W., Butt, M. G., Kumar, N., & Ng, R. (2021). Transcultural adaptation of cognitive behavioral therapy (CBT) in Asia. Asia-Pacific Psychiatry, 13. https://doi.org/10.1111/appy.12442 CrossRefGoogle Scholar
Naeem, F., Phiri, P., Nasar, A., Gerada, A., Munshi, T., Ayub, M., & Rathod, S. (2016). An evidence-based framework for cultural adaptation of cognitive behaviour therapy: process, methodology and foci of adaptation. World Cultural Psychiatry Research Review, 112, 6170.Google Scholar
Naeem, F., Phiri, P., Rathod, S., & Ayub, M. (2019). Cultural adaptation of cognitive–behavioural therapy. BJPsych Advances, 25, 387395. https://doi.org/10.1192/bja.2019.15 CrossRefGoogle Scholar
Naeem, F., Sarhandi, I., Gul, M., Khalid, M., Aslam, M., Anbrin, A., Saeed, S., Noor, M., Fatima, G., Minhas, F., Husain, N., & Ayub, M. (2014). A multicentre randomised controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan. Journal of Affective Disorders, 156, 224227. https://doi.org/10.1016/j.jad.2013.10.051 CrossRefGoogle ScholarPubMed
Ng, C. H. (1997). The stigma of mental illness in Asian cultures. Australian and New Zealand Journal of Psychiatry, 31, 382390. https://doi.org/10.3109/00048679709073848 CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S., & Hilt, L. (2006). Possible contributors to the gender differences in alcohol use and problems. Journal of General Psychology, 133, 357374. https://doi.org/10.3200/GENP.133.4.357-374 CrossRefGoogle Scholar
Otto, W. (1999). Mental health consumers’ experience of Stigma. Schizophrenia Bulletin, 25, 467478. http://psycnet.apa.org/buy/1999-03984-006 Google Scholar
Rathod, S., & Kingdon, D. (2014). Case for cultural adaptation of psychological interventions for mental healthcare in low and middle income countries. BMJ, 349, g7636. https://doi.org/10.1136/bmj.g7636 CrossRefGoogle ScholarPubMed
Rathod, S., Kingdon, D., Pinninti, N., Turkington, D., & Phiri, P. (2015). Cultural Adaptation of CBT for Serious Mental Illness. John Wiley & Sons, Ltd. https://doi.org/10.1002/9781118976159 CrossRefGoogle Scholar
Rathod, S., Kingdon, D., Smith, P., & Turkington, D. (2005). Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics – data on a previously published randomised controlled trial. Schizophrenia Research, 74, 211219. https://doi.org/10.1016/j.schres.2004.07.003 CrossRefGoogle ScholarPubMed
Ryum, T., Stiles, T. C., Svartberg, M., & McCullough, L. (2010). The effects of therapist competence in assigning homework in cognitive therapy with cluster C personality disorders: results from a randomized controlled trial. Cognitive and Behavioral Practice, 17, 283289. https://doi.org/10.1016/j.cbpra.2009.10.005 CrossRefGoogle Scholar
Selvapandiyan, J. (2020). The negative side of culture-based CBTs: an example from India. Asian Journal of Psychiatry, 52. https://doi.org/10.1016/j.ajp.2020.102036 CrossRefGoogle Scholar
Summerfield, D., & Veale, D. (2008). Proposals for massive expansion of psychological therapies would be counterproductive across society. British Journal of Psychiatry, 192, 326330. https://doi.org/10.1192/bjp.bp.107.046961 CrossRefGoogle ScholarPubMed
Sussman, L. K., Robins, L. N., & Earls, F. (1987). Treatment-seeking for depression by black and white Americans. Social Science and Medicine, 24, 187196. https://doi.org/10.1016/0277-9536(87)90046-3 CrossRefGoogle ScholarPubMed
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