dbt cultural appropriation
However, there is lack of evidence supporting this approach with culturally 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. 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. One paper discusses the application of dialectical behaviour therapy (DBT) with LGBTQ service users (Skerven et al., Reference Skerven, Whicker and LeMaire2019), another describes a case series of vaginismus therapy in Tunisia (Zgueb et al., Reference Zgueb, Ouali, Achour, Jomli and Nacef2019), while the third paper reports use of behaviour therapy when working with gender and sexual minorities in the context of Islamic culture (Langroudi and Skinta, Reference Langroudi and Skinta2019). This can indeed increase the risks mentioned above. Render date: 2023-05-01T13:32:05.576Z 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). CULTURAL APPROPRIATION IS one of the most misunderstood and abused phrases of our tortured age. Currently, the IASP (Improving Access to Structures Psychotherapies) CBT Training Program in Ontario, Canada, is incorporating culturally adapted CBT practices. The authors provide their perspectives on the terms race, culture and ethnicity and share their understanding of these terms for CBT therapists. Family-based cognitive behavioural therapy was offered over 4 months with a successful treatment outcome. Brooks uses a case example to further elaborate the model and emphasize the need for further research in this area. Human societies are evolving at a fast pace. The group intervention reduced depression, anxiety and emotional distress. Kenneth Fung has reported high levels of acceptance of ACT while working with the Cambodian community in Toronto (Fung, Reference Fung2015). When working cross-culturally, many consider a universalist approach to help focus on the similarities across cultures, rather than emphasizing differences (Beck, Reference Beck2016). 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). The protocol was developed in a specialist NHS (National Health Service, England) programme for migrants with PTSD. It tells us that the items and beliefs we hold dear and sacred The author encourages therapists working with BME service users to develop skills to discuss their race, ethnicity, religion and experiences of racism with their service users. Cultural Appreciation is appreciating another culture in an effort to broaden their perspective and connect with others cross-culturally, while cultural appropriation is taking one aspect of a culture that is not their own, such as culturally distinct items, aesthetics, or spiritual practices, and mimics it without consent, permission, or any 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). Scheer, Jillian R. There are (b) seven articles covering different aspects of adaptation of therapies for diverse populations which include: culturally adapted family intervention using case studies (Berry et al., Reference Berry, Day, Mulligan, Seed, Degnan and Edge2018), a discussion of maladaptive schema and schema therapy in the context of Greek culture (Kolonia et al., Reference Kolonia, Tsartsara and Giakoumaki2019), use of a transdiagnostic intervention in low resource countries (Murray et al., Reference Murray, Haroz, Pullmann, Dorsey, Kane, Augustinavicius and Bolton2019), application of acceptance and commitment therapy (ACT) with a Turkish population in London (Perry et al., Reference Perry, Gardener, Oliver, Ta and zen2019), a framework to culturally adapt CBT (Rathod et al., Reference Rathod, Phiri and Naeem2019), a case report of family-based CBT for obsessive compulsive disorder (OCD) from Saudi Arabia (Alatiq and Alrshoud, Reference Alatiq and Alrshoud2018) and a paper discussing CBT in military culture (Zwiebach et al., Reference Zwiebach, Lannert, Sherrill, McSweeney, Sprang, Goodnight and Rauch2019). Feature Flags: { Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. and These values underpin the principle of cultural adaptation of evidence-based psychosocial interventions for people from diverse cultural and sub-cultural backgrounds. for this article. 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 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 delivered by lay counsellors in Iraq and Thailand to treat trauma victims. 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. and 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). However, therapy was not adapted using a systematic approach. hasContentIssue false, British Association for Behavioural and Cognitive Psychotherapies 2019. WebIntroduction. This special edition, therefore, is a welcome addition to a fast-growing area in CBT research and practice: the cultural adaptation of CBT. So far, the uptake of these interventions into health systems has been low (Naeem et al., Reference Naeem, Rathod, Khan and Ayub2016a). Singh, Anneesa D. A simple definition of cultural appropriation is the idea of someone adopting something from a culture that is not their own. Hostname: page-component-75b8448494-jf2r5 Therapist self-disclosure in cognitive-behavior therapy, Gender equality in Muslim-majority countries, The role of global traditional and complementary systems of medicine in treating mental health problems, The importance of understanding military culture, Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, and Supervision, Internalized stigma among sexual minority adults: insights from a social psychological perspective, Cultural aspects in social anxiety and social anxiety disorder, Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care, Culturally adapted cognitive-behavioral therapy for Chinese Americans with depression: a randomized controlled trial. Therapists often do not discuss service users experiences of racism. Li, Shirley Xin Other notable examples of adaptation include: engagement (games, demonstrations, metaphors), use of interpreters to address the language needs of the group, and considering physical health needs at the start of the intervention. WebCultural appropriation takes place when members of a majority group adopt cultural elements of a minority group in an exploitative, disrespectful, or stereotypical way. The success of therapy was attributed to the culturally specific modifications. Most importantly, this definition does not limit culture to race, religion or Cultural appropriation is distinct from cultural exchange, in which two cultures participate in each others rituals and customs on an equal footing. 2022. How is cultural appropriation used in real life? Finally, this special issue publishes seven articles (f) on issues related to service delivery, practice, training and supervision when working with a diverse population. Islam is not an exception, and there are variations in the application of Islamic beliefs in different cultures and traditions (The Economist, 2013). It is heartening to see this field grow over the past decade to the extent that it found its place in a special edition of a highly prestigious journal. One paper describes a practice protocol for dissociative symptoms (Chessell et al., Reference Chessell, Brady, Akbar, Stevens and Young2019), another describes the use of CBT with asylum seekers (King and Said, Reference King and Said2019), and the third paper describes CBT with Mexican homeless girls (Castaos-Cervantes, Reference Castaos-Cervantes2019). 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 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. 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. 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. This approach is supported by the World Health Organization (WHO) as depicted in mhGAP (WHO, 2015), which promotes scaling up of evidence-based interventions and emphasizes the role of lay counsellors in delivering these interventions directly to the community members. I agree with the assertion that these ideas need to be tested through qualitative and quantitative research. Flaskerud and Strehlow (Reference Flaskerud and Strehlow2008) suggest that apparent apathy and neglect of this highly marginalized, traumatized and disadvantaged population might be due to our belief in individual responsibility, free will and self-determination. Cultural appropriation, defined Culture refers to the traditions, customs, beliefs, and practices of any given ethnic, racial, or religious group. Authors suggest that there can be significant benefits for services to provide IAPT training to people already providing culturally specific services. 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 paper highlights the need to improve the BME communitys access to CBT. There is evidence to suggest that CBT needs to be culturally adapted for the Mexicans (Organista and Muoz, Reference Organista and Muoz1996; Shea et al., Reference Shea, Cachelin, Gutierrez, Wang and Phimphasone2016) and we therefore envisage that adaptation took place at three levels: (1) for broader Mexican culture, (2) for the homeless, and (3) for the youth. Therefore, for CBT to stay in the system, it has to evolve, to adapt and even integrate other systems of therapies, in order to address the demands of people with a variety of needs. 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. Estrada, Suzanne 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 authors discourage unnecessary adaptations to standard DBT supported by 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 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. This brief manualized intervention can be delivered in four sessions and might be applicable across cultures. This paper reports the cultural adaptation of ACT for the Turkish-speaking community in England. All these patients had a strict religious upbringing and had dysfunctional beliefs underpinned by their cultural and religious values. 2021. 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). 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). 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 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. The UNESCO (United Nations Educational, Scientific and Cultural Organization) universal declaration on cultural diversity defines culture as the set of distinctive spiritual, material, intellectual and emotional features of society or a social group, and that it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs (UNESCO, 2001). As the author rightly points out, the dearth of CBT studies in this area is troubling. Beck discusses issues related to a topic sensitively and compassionately that many might find challenging. Aminihajibashi, Samira Finally, the authors list available resources in training in military culture for therapists. distress tolerance. The participants reported that low-intensity CBT (LiCBT) was useful, but only when cultural adaptations were made. Structural adaptations included changes in the language. 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. 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). 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). 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). WebThis chapter will discuss culturally specific enhancements of DBT for use with monolingual Spanish-speaking Latinos in community mental health settings. 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). The original Beckian CBT model has been adapted over the years to help service users with anxiety, PTSD, OCD and psychosis. 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. The fourth article emphasizes understanding a clients experience of racism as part of the assessment, formulation and treatment (Beck, Reference Beck2019). They describe some examples from their work to show how the services can better understand the needs of minority populations. This area merits further research. The authors suggest more process research in the use of transdiagnostic therapy manuals in low- and middle-income countries. This interesting article provides food for thought for every therapist. Gender and sexual minorities (GSM) are over-represented in the migrating population. 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). Arun, whites would never claim cultural appropriation. The dissociative responses are explained using the 6 Fs cascade. 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). Shearer, James Clark, Kirsty A. The authors provide case examples. There is no agreed definition. I have tried to divide these articles according to the broader themes, although most articles will fit in more than one thematic area. They suggest that educating service users on CBT plays a vital role in cultures where people, in general, are not aware of CBT. 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). Raphael Kada (Kada, Reference Kada2019) describes his experience of providing CBT for the Jewish community. Gooding, Patricia 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. Therefore, it makes sense to adapt CBT when working with diverse populations. This declaration asserts that cultural pluralism pre-supposes respect for human rights. Globalization also means rapid mobilization of people across national boundaries. 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). Similarly, their suggestion in adapting CBT is also in line with other papers in this issue. They have presented a succinct rationale for the use of ACT and CFT to help Muslim GSM who might migrate to the West to avoid harsh treatment, but might feel trapped due to their experience of racism and anti-Islamic feelings in their host societies. The protocol is discussed from the perspective of working with a refugee and asylum seeker population. Wing, Yun Kwok This article emphasizes the role of mental health services and accreditation bodies. I start with a systematic review of CBT for social anxiety across cultures. Has data issue: false Byford, Sarah They suggest that some BME client groups might test their therapist through initiating TSD. The term cultural appropriation is thought to Historically, deciding exactly what culture is hasnt been easy. Close this message to accept cookies or find out how to manage your cookie settings. and 2023. Day, Crispin Their distress is compounded by views of their family at home and members of their community in their host country. I agree with the authors about the need for more research in this area. They describe the triple-A principle which describes foci of adaptation. Deighton, Jessica and There is a need to improve knowledge of evidence-based therapies through popular electronic and social media, as well as teaching and training health workers. Such a slippery verb, appropriate, from the Latin ad Self-practice, self-reflection (Chigwedere et al., Reference Chigwedere, Thwaites, Fitzmaurice and Donohoe2019) and the critical incident analysis model can be useful tools for these therapists. Tanzania, like many other low- and middle-income countries, has a long tradition of faith healers (Li, Reference Li2011). Chan, Joey Wing Yan 2022. Carter, Ben Additionally, they have to adjust to the differences in the expression of love, lust and romance. 2021. WebThe authors also suggest that culturally attuned enhancements that preserve and complement core principles and functions of DBT may improve treatment outcomes and They suggest that CBT compliments many aspects of military culture, for example agenda setting (emphasis on the daily structure), explicit goals for treatment (focus on mission completion) and focus on skill training (development of strengths). The fifth study reports findings from a qualitative study of therapists experience of CBT training in Tanzania (Stone and Warren, Reference Stone and Warren2011). 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). A collaborative approach might not be acceptable across cultures. Based on this initial research and their clinical experience, and in order to further improve strategies to improve therapeutic alliance and engagement, they discuss TSD in this article. Brooks identifies some of the challenges that refugees, asylum seekers and survivors of torture may present with. 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. Pachankis, John E. Nevertheless, third wave therapies should be culturally adapted and tested. Some of this information might even be useful when working with service users from other Abrahamic religions. substance use disorders. Fonagy, Peter The review focuses on seven case studies of cultural adaptations of CBT for social anxiety disorder (SAD) for a culturally diverse population published separately. Sufism, an equivalent of mindfulness in Islam, might be more acceptable for Muslim clients and is worth exploring in this context. DBT combined techniques from behaviour therapy and Zen Buddhism (Reddy and Vijay, Reference Reddy and Vijay2017) and was developed to help suicidal behaviours among borderline personality disorder service users (Linehan et al., Reference Linehan, Armstrong, Suarez, Allmon and Heard1991). At its core, DBT helps people build four major skills: mindfulness. Read 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. Ho, Pin-Cheng The attitudes towards LGBTQ+ in Muslim countries have been influenced by religion and Islamic jurisprudence, as well their social, political and cultural history. This special issue addresses a variety of problems, populations and psychotherapies. 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. and and This population is at an increased risk of emotional and mental health problems. 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). This information can then be used to enhance therapeutic alliance and inform formulation and treatment. The principles of CBT underpinned the intervention, with elements of DBT, CFT and ACT. 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). In terms of the mode of delivery, a group approach was considered more suitable to provide peer support and normalization for the UASC. The authors concluded that if applied thoughtfully, CBT can be used for patients in Saudi Arabia. As the review included only a small number of case studies, it will be too early to draw any conclusions. Bains, Anmol Stallard, Paul Rebessi, Isabela Pizzarro 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). Followed by their pioneering work, more studies have been published from Tanzania (ODonnell et al., Reference ODonnell, Dorsey, Gong, Ostermann, Whetten, Cohen and Whetten2014; Woods-Jaeger et al., Reference Woods-Jaeger, Kava, Akiba, Lucid and Dorsey2017). Cultural appropriation is the adoption of certain elements from another culture without the consent of people who belong to that culture. 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. 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). In this article, Michelle Brooks emphasizes the need for the reflective practice, self-practice and critical incident analysis model when working with service users with complex needs, such as refugees, asylum seekers and survivors of torture attending the IAPT (Improving Access to Psychological Therapies) programme. The over-arching theme of the paper is the engagement of the BME community in a collaborative manner while addressing stigma and with an emphasis on services being flexible in order to engage BME communities. Nitty gritty. Does clienttherapist gender matching influence therapy course or outcome in psychotherapy? 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.