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. Wang, Katie Skerven et al. Future research in this area should explore stakeholders views on improving access to IAPT services for BME communities. McQuillin, Samuel D. Shearer, James Both the cultural adaptation of CBT that focuses on differences across cultures and a universalist approach focusing on similarities across cultures merit further investigation. and While the authors mention elements of cultural adaptation of the manual, no systematic attempts were made to adapt the manual culturally. Ghazala Mir and co-workers have culturally adapted behavioural activation (BA) for Muslim service users in England. 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. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. client initiated therapist self-disclosure (TSD). 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. The participants reported that low-intensity CBT (LiCBT) was useful, but only when cultural adaptations were made. There is evidence to suggest that DBT is an effective treatment (Mndez-Bustos et al., Reference Mndez-Bustos, Calati, Rubio-Ramrez, Oli, Courtet and Lopez-Castroman2019; Panos et al., Reference Panos, Jackson, Hasan and Panos2014). This article describes a clinical protocol for supporting those presenting with PTSD and severe dissociative symptoms, particularly dissociative flashbacks, based on a cross-culturally applicable model. Where does cultural appropriation come from? Seven participants from Tanzanias only psychiatric hospital who had completed CBT training were interviewed. The number of Muslims migrating to Europe and North America has increased over the last decade. I start with a systematic review of CBT for social anxiety across cultures. 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). This paper addresses issues above and beyond cultural adaptation of interventions and provides insights into the racial, political and health systems related issues, and most importantly the conflicts these issues can cause among therapists. Rhodes, Jean E. They suggest that educating service users on CBT plays a vital role in cultures where people, in general, are not aware of CBT. Cultural appropriation is the practice of using or taking something from another culture without giving proper recognition or respect to that culture, Mia Moody 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. 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. Additionally, they have to adjust to the differences in the expression of love, lust and romance. These authors start by highlighting the need to recognize a military culture in therapeutic encounters. I encourage the author to develop this work in the form of a training workshop. Pratt, Daniel 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. Barletta, Janana Bianca The authors provide their perspectives on the terms race, culture and ethnicity and share their understanding of these terms for CBT therapists. 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. and Lets explore a few different ways cultural appropriation can be perpetuated, taken from a largely American context: A member of a majority group profiting financially or socially from the culture of a minority group is cultural appropriation. and 02 September 2019. 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. 2022. WebThe authors also suggest that culturally attuned enhancements that preserve and complement core principles and functions of DBT may improve treatment outcomes and Currently, the IASP (Improving Access to Structures Psychotherapies) CBT Training Program in Ontario, Canada, is incorporating culturally adapted CBT practices. 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). This population is at an increased risk of emotional and mental health problems. This issue can be addressed in future research. How is cultural appropriation used in real life? Military personnel share a common bond, feeling of unity and a sense of purpose and direction. The authors concluded that if applied thoughtfully, CBT can be used for patients in Saudi Arabia. Such a slippery verb, appropriate, from the Latin ad 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. Evidence from fully powered trials will help towards implementation not just in England but in Muslim countries too. Sclare, Irene These authors have touched on a highly sensitive issue in a very skilful, diligent and empathic manner. Most importantly, they address the cultural issues too. 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). The group intervention reduced depression, anxiety and emotional distress. The authors emphasize some of the salient features of military culture: the organizational structure of the military and its branches, a timeline of major wars and operations, the ranking hierarchy, and its language that should be considered in adapting therapy for this group. 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. Cultural appropriation is defined as the use of objects or elements of a non-dominant culture in a way that doesnt respect their original meaning, give credit to their source, or reinforces stereotypes or contributes to oppression (Verywell Mind).Appropriation is often confused with appreciation, but the two are very different. 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). Nitty gritty. One example often used to illustrate cultural appropriation is history, experience and traditions. 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. Similarly, researchers do not record information concerning participants sexual orientation (Bowen and Boehmer, Reference Bowen and Boehmer2007). 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. They propose further investigation in this area. They offer practical advice on discussing these issues. Cultural appropriation, defined Culture refers to the traditions, customs, beliefs, and practices of any given ethnic, racial, or religious group. The findings of Stone and Warren, in particular people in low- and middle-income countries not being aware of the existence of modern psychotherapies and professionals reliance on a medical model, are in line with published literature (Naeem et al., Reference Naeem, Gobbi, Ayub and Kingdon2010). Day, Crispin 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). DBT is an evidence-based practice (Linehan, 2014), and research reflects mindfulness and acceptance-based therapies to indicate some clinical promise with 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). 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. 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). Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Memon et al. Currently, a quantitative evaluation is underway. 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). Globalization also means rapid mobilization of people across national boundaries. The authors report three cases to describe the therapy process, insights learned by therapists and compared those with the original model they developed. There is, however, a need to confirm the effectiveness of culturally adapted family interventions through fully powered RCTs. The next step should be a large scale evaluation of the manualized form of this intervention. The authors describe dealing with religious and cultural beliefs, and the role played by the family, engaging family members in therapy, dealing with shame and guilt, and local practices, such as magic rituals. Yarrum, Jynna When working with refugees, these therapists have to face multiple barriers, such as language, religion and culture. Therapists often do not discuss service users experiences of racism. Another survey from Canada reported time spent with trauma victims to be the strongest predictor of the traumatic stress. Finally, I agree with the authors that this intervention should be used across the board. 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. Understanding military culture becomes even more critical for civilian mental health professionals who are providing help to military personnel or veterans. The treatment outcomes were generally promising in all cases, reporting a significant decrease of SAD symptoms, which were maintained over time. 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). 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 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). A Cochrane Review reported that DBT reduces the frequency of repetition of self-harm, although no differences were observed in the proportion of patients repeating self-harm or other outcomes such as suicidal ideation and depression (Hawton et al., Reference Hawton, Witt, Taylor Salisbury, Arensman, Gunnell, Hazell and van Heeringen2016). Haddock, Gillian Even when the participants background is reported, a broader term such as White, Asian or Black is used, ignoring variations among these groups. They rightly point out that adaptation work does not suggest changes in mental health care systems. We know that racism creates an inherently invalidating environment. CBT involves exploration and attempts to modify core beliefs. 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). So far, the uptake of these interventions into health systems has been low (Naeem et al., Reference Naeem, Rathod, Khan and Ayub2016a). This review did not require ethics committee approval. These authors describe an evidence-based framework that has evolved over a decade. 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. Aminihajibashi, Samira Kenneth Fung has reported high levels of acceptance of ACT while working with the Cambodian community in Toronto (Fung, Reference Fung2015). 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). 2022. Finally, the authors argue that more resources are required to understand and address the barriers to accessing mental health services for BME service users. 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. The fifth study reports findings from a qualitative study of therapists experience of CBT training in Tanzania (Stone and Warren, Reference Stone and Warren2011). Clark, Kirsty A. 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). This paper highlights a gap and provides the way forward in working with a highly stigmatized group. This intervention was planned around three key themes: physical health needs, emotional wellbeing, and resilience-building. Andrade, Brendan F. While lower prevalence rates of SAD are reported from some non-Western cultures (Hofmann et al., Reference Hofmann, Asnaani and Hinton2010), these might be due to individuals seeking help from practitioners of traditional, complementary and alternative medicine (Gureje et al., Reference Gureje, Nortje, Makanjuola, Oladeji, Seedat and Jenkins2015). These adaptations are in line with our current knowledge of cultural adaptations described by other authors in this special issue. The authors advise that a schema therapist needs to remain inquisitive of potential maladaptive or/and internalized dysfunctional coping mechanisms of inter-relating that are masked by the use of the Politeness Plural linguistic schema. 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They also discuss the sub-cultures within the army, based on religion, race or gender, etc. These ideas have significant implications for equity in terms of service provision. To fully understand its consequences, though, we need to make sure we have a working definition of culture itself. The notion that mindfulness-based therapies might be readily acceptable to people from a non-Western background has a common sense appeal. Jensen, Tine K. 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. Web1.12K subscribers. There was no association between time devoted to coping strategies and traumatic stress scores (Bober and Regehr, Reference Bober and Regehr2006). and Andrew Beck starts by presenting evidence that experience of racism can be a cumulative risk factor for developing mental health problems. I agree with the assertion that these ideas need to be tested through qualitative and quantitative research. Hakim et al. 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.
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