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and The authors discourage unnecessary adaptations to standard DBT supported by They describe the critical elements of the adapted intervention using case summaries. I agree with the assertion that these ideas need to be tested through qualitative and quantitative research. Huggett, Charlotte Dialectical Behavioral Therapy (DBT) - Healthline This will require establishing trust and partnership with the community. I agree that community centres might be a suitable alternative to deal with stigma. 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). 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. Cognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. 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. and 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. Jensen, Tine K. 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. hasContentIssue false, British Association for Behavioural and Cognitive Psychotherapies 2019. This declaration asserts that cultural pluralism pre-supposes respect for human rights. and Weaver, Timothy Farrelly, Maria Scheer, Jillian R. The success of therapy was attributed to the culturally specific modifications. Culturally Adapted Dialectical Behavior Therapy for Hispanic Evidence from fully powered trials will help towards implementation not just in England but in Muslim countries too. Clark, Kirsty A. Feature Flags: { 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. 2022. The notion that mindfulness-based therapies might be readily acceptable to people from a non-Western background has a common sense appeal. emotional regulation. WebCultural appropriation takes place when members of a majority group adopt cultural elements of a minority group in an exploitative, disrespectful, or stereotypical way. Deighton, Jessica 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. 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). However, it is yet to be determined how sustainable these therapies are in the long term. 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). Has data issue: false It is heartening to see the breadth and width of topics covered in this special issue. 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). 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). 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. They suggest more empirical research in this field. Strategies for reducing secondary or vicarious trauma: do they work? Therapists working with traumatized individuals are at increased risk of burnout, compassion fatigue and vicarious trauma (Iqbal, Reference Iqbal2015). Ghazala Mir and co-workers have culturally adapted behavioural activation (BA) for Muslim service users in England. 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. interpersonal effectiveness. Anti-Racism | isitdbt.net 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. Fonagy, Peter This study reports the results of post-intervention effects of a culturally adapted ACT group. Cultural considerations in dialectical behavior therapy Future research must focus on systematically adapting CBT that can be tested through fully powered trials and evaluated for cost-effectiveness. 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). Ethical travel tips: How to avoid cultural appropriation when Hakim et al. substance use disorders. Third wave therapies are good examples of integration of CBT with another model of therapy. 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. Finally, the authors list available resources in training in military culture for therapists. Authors believe combining these two paradigms can help LGBTQ+ service users in effectively interacting with this population. Close this message to accept cookies or find out how to manage your cookie settings. Memon et al. As far as I know, this is the first paper to address TSD in a cultural context. Hostname: page-component-75b8448494-jf2r5 However, much of the public remains confused about what the Rodak, Terri 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). This issue can be addressed in future research. This article emphasizes the role of mental health services and accreditation bodies. 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 British Journal of Medical Psychology, Mexican American womens perspectives on a culturally adapted cognitive-behavioral therapy guided self-help program for binge eating, Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients, Practical psychotherapy: adaptation of dialectical behavior therapy by a VA Medical Center, The prevalence of mental health disorders in (ex-)military personnel with a physical impairment: a systematic review, Cognitive behaviour therapy training in a developing country: a pilot study in Tanzania, The case for cultural competency in psychotherapeutic interventions, Answering questions regarding the future directions of behavior therapy, Qualitative analysis of dysfunctional attitudes in Chinese persons suffering from depression, Mental health care for people who identify as lesbian, gay, bisexual, transgender, and (or) queer, Canadian Journal of Psychiatry. Seven participants from Tanzanias only psychiatric hospital who had completed CBT training were interviewed. 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). These authors have touched on a highly sensitive issue in a very skilful, diligent and empathic manner. 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. 2021. WebCultural appropriation is a murky concept. A simple definition of cultural appropriation is the idea of someone adopting something from a culture that is not their own. 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. They argue that family systems, religion and local cultural beliefs should all be taken into consideration when providing culturally adapted 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. This can indeed increase the risks mentioned above. Finally, I agree with the authors that this intervention should be used across the board. How to Talk About Race 2022. It was the very definition of cultural appropriation: when a dominant group of people adopt the customs, practices and ideas of another group of people, often 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). Orthodox Jews and Muslims (Kada, Reference Kada2019; Mir et al., Reference Mir, Ghani, Meer and Hussain2019). 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. Read 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. It's a controversial topic, one that activists and celebrities like Adrienne Keene and Jesse Williams have helped bring into the national spotlight. James, Kirsty The fourth article emphasizes understanding a clients experience of racism as part of the assessment, formulation and treatment (Beck, Reference Beck2019). Cultural appropriation | Definition, History, Types, & Examples discuss the pros and cons of TSD. Culturally adapted dialectical behavior therapy in an The authors concluded that CBT can be an acceptable and effective treatment for culturally diverse SAD sufferers with modest modifications, and that applying them increases the treatment compliance and its outcomes, although they issue caution based on the quality of reporting and multiple methodological issues. 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. 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 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). In addition to adapting BA, they have developed a self-help booklet. "useRatesEcommerce": false 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). When respect for diversity is taken to crazy 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. Hagler, Matthew A. (Reference Hakim, Thompson and Coleman-Oluwabusola2019) explored the experience of four IAPT low-intensity Psychological Wellbeing Practitioners (PWP) who had previously worked as BME Community Mental Health Workers (CMHW). } 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). The authors discuss the impact of minority stress, shame and migration stress in this group. Developed by Linehan Therapy was delivered by lay counsellors in Iraq and Thailand to treat trauma victims. This paper, therefore, is a welcome addition to the existing literature in the area. Finally, cultural considerations should be an essential part of the CBT courses and training of new CBT therapists. 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). Islam is not an exception, and there are variations in the application of Islamic beliefs in different cultures and traditions (The Economist, 2013). Furthermore, individuals might vary in their level of acculturation and religiosity, and this should be taken into consideration (Joseph and DiDuca, Reference Joseph and DiDuca2007). It has been proposed that our knowledge of language use can be used as a source of technologies for investigating the process of psychotherapy (Russell, Reference Russell1989). This population is at an increased risk of emotional and mental health problems. Tanzania, like many other low- and middle-income countries, has a long tradition of faith healers (Li, Reference Li2011). They discuss two themes (therapist effects and process) in detail, as they believe these to be particularly relevant to the clinical application of the therapy in this context. 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). 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. Many authors have pointed to the uniqueness of military culture as being different from civilian culture, based on routines, structures, hierarchies and the dress codes, among many other attributes (Hall, Reference Hall2011; Reger et al., Reference Reger, Etherage, Reger and Gregory2008; Soeters et al., Reference Soeters, Winslow, Weibull and Caforio2006). The authors argue that holding on to the Politeness Plural linguistic schema may reinforce emotional distancing and might compromise schema healing. This special issue addresses a variety of problems, populations and psychotherapies. The dissociative responses are explained using the 6 Fs cascade. How dysfunctional are the dysfunctional attitudes in another culture? This implies that interventions adapted for religious groups should take into consideration the cultural factors as well. The ethical considerations of counselling psychologists working with trauma: is there a risk of vicarious traumatisation? Culture, religion and spirituality influence the belief systems of people, including beliefs about illness, its causes and treatment (Cinnirella and Loewenthal, Reference Cinnirella and Loewenthal1999; Ismail et al., Reference Ismail, Wright, Rhodes and Small2005; Razali et al., Reference Razali, Khan and Hasanah1996). 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. WebDBT is an intervention that has demonstrated efficacy for reducing suicidality (Swales et al., 2000), which may be effective among Native American clients. This declaration asserts that cultural pluralism pre-supposes respect for human rights. How is cultural appropriation used in real life? Cultural considerations in dialectical behavior therapy. - APA 2023. Skerven et al. 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). The authors concluded that if applied thoughtfully, CBT can be used for patients in Saudi Arabia. Therefore, it makes sense to adapt CBT when working with diverse populations. Therapists focused on cultural factors during assessment and engagement, shared learning, communication, coping skills and endings. Similarly, their suggestion in adapting CBT is also in line with other papers in this issue. Globalization is bringing people together, and increasing their knowledge and awareness of the latest technologies in healthcare. 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 This paper examines the Greek cultural, linguistic schema of Politeness Plural in the application of a Schema Therapy mode model. We are becoming more mindful of the need to equal rights of all members of society, and to all societies and cultures and sub-cultures. In terms of the mode of delivery, a group approach was considered more suitable to provide peer support and normalization for the UASC. The review focuses on seven case studies of cultural adaptations of CBT for social anxiety disorder (SAD) for a culturally diverse population published separately. I agree with the authors about the need for more research in this area. (PDF) Culturally Adapted Dialectical Behavior Therapy in Stone and Warren previously reported the development and implementation of a CBT training course for clinicians working in Tanzania (Stone and Warren, Reference Stone and Warren2011). This review did not require ethics committee approval. 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). Cultural Such a slippery verb, appropriate, from the Latin ad Some examples of cultural sensitivity included: need to be aware of service users culture, language barriers and translations, level of acculturation, socio-cultural constructs, therapeutic relationship and style of therapy, which are in line with the existing literature (Hays and Iwamasa, Reference Hays and Iwamasa2006; Hwang et al., Reference Hwang, Myers, Chiu, Mak, Butner, Fujimoto and Miranda2015; Naeem et al., Reference Naeem, Phiri, Rathod and Ayub2019; Organista and Muoz, Reference Organista and Muoz1996; Ward and Brown, Reference Ward and Brown2015). CULTURAL APPROPRIATION IS one of the most misunderstood and abused phrases of our tortured age. The subculture of homelessness has been described as the culture of individuals who are homeless and share similar beliefs, values, norms, behaviours, social structures, and a common economic situation, all in response to a comparable living environment (Flaskerud and Strehlow, Reference Flaskerud and Strehlow2008). They also discuss the integration of ACT and compassion-focused therapy (CFT) in helping this population. The critical incident analysis model consists of a five-stage process: (1) account of the incident, (2) initial responses to the incident, (3) issues and dilemmas highlighted by this incident, (4) learning and (5) outcomes. 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. There are wider cultural variations in self-disclosure. These findings are consistent with North American literature on culturally adapting CBT (Rosen et al., Reference Rosen, Rebeta and Rothschild2014; Shabtai et al., Reference Shabtai, Pirutinsky, Rosmarin, Ben-Avie, Ives and Loewenthal2016) and to improve access to mental health services for Jews (McEvoy et al., Reference McEvoy, Williamson, Kada, Frazer, Dhliwayo and Gask2017). 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 Different Perceptions of Cultural Appropriation Columbia and The fifth study reports findings from a qualitative study of therapists experience of CBT training in Tanzania (Stone and Warren, Reference Stone and Warren2011). Family-based cognitive behavioural therapy was offered over 4 months with a successful treatment outcome. 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). These effects persisted on follow-up. It is therefore surprising that only limited literature is available on the adaptation of psychotherapy with military personnel (Miller, Reference Miller2010; Spoont et al., Reference Spoont, Sayer, Thuras, Erbes and Winston2003). Acceptance and commitment therapy: Western adoption of Buddhist tenets? 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). Currently, the IASP (Improving Access to Structures Psychotherapies) CBT Training Program in Ontario, Canada, is incorporating culturally adapted CBT practices. As homosexuality is considered a sin in Islam, it might be worth exploring the link between the concept of sin and associated shame in this context. 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). poor communication, inadequate recognition or response to mental health needs, cultural naivety, insensitivity and discrimination as well as lack of awareness of different services among service users and providers. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers. distress tolerance. This paper highlights a gap and provides the way forward in working with a highly stigmatized group. and 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. CBT research until recently has primarily focused on white, middle-class, well-educated service users, who are of European-American identities (Suinn, Reference Suinn2003). The authors point out that the NICE guidelines do not look at the suitability of cultural adaptations of CBT or how services could be best organized to meet the needs of BME populations. 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. Note Cultural appropriation is the practice of using or taking something from another culture without giving proper recognition or respect to that culture, Mia Moody Brown, June 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).