Cultural Adaptation of CBT for Serious Mental Illness: A Guide for Training and Practice

This book pulls together all the current data on the effectiveness of culturally sensitive CBT in this area, as well as providing clinicians with a manual to learn and practice culturally informed CBT. I can confidently recommend it as helpful for anyone working with severely mentally ill clients.

Aaron T. Beck, MD, University Professor Emeritus of Psychiatry, University of Pennsylvania

In a globalized world we need methods to adapt interventions so they are equally effective for different groups. Many have undertaken cultural adaptations but to have some of the major voices in CBT produce guidance on cultural adaptation produces a priceless treasure.

Kwame McKenzie, MD, FRCPsych (UK), Medical Director CAMH, Professor of Psychiatry, University of Toronto

This volume offers a practical guide to culturally adapting CBT for severe mental health conditions. The authors are gifted clinicians and investigators that present a sophisticated overview of key conceptual and pragmatic issues in working with diverse communities.

Guillermo Bernal, PhD, Director, Institute for Psychological Research, University of Puerto Rico, Rio Piedras, Puerto Rico

There was a time when psychological therapies were not thought to be appropriate for all patients. Clinicians did not have the tools to adapt their skills. No more!

Kamaldeep Bhui, Professor of Cultural Psychiatry & Epidemiology, Queen Mary University of London

Although proven as one of the most effective evidence–based therapies, a key criticism of the theoretical framework of cognitive behavioural therapy (CBT) is that it is Eurocentric and therefore an ineffective tool for treating people from diverse cultural backgrounds. As a result, people from ethnic minority groups are often reluctant to work with therapists, who in turn do not feel confident in their ability to work effectively with them.

This book is designed to enable CBT clinicians to engage people from diverse cultural backgrounds by adapting their therapeutic techniques, resulting in increased therapist confidence and much improved patient outcomes. It explores the cultural norms and expectations of groups including African Caribbean, African American, Chinese, Latino, Indian, and South Asian Muslim, considering attitudes to mental illness, the role of family and wider community, and cultural barriers to engaging with therapy. Featuring an array of clinical case studies along with coverage of the most up–to–date data from CBT research in ethnic minority groups, this is an essential new resource for anyone studying or practicing CBT.

Foreword ix

Preface xi

Acknowledgements xiii

1 Introduction 1

2 Cultural Adaptation of Cognitive Behavioural Therapy: Principles and Challenges 14

3 Philosophical Orientation and Ethical and Service Considerations 46

4 The Therapeutic Relationship and Technical Adjustments 86

5 General Theoretical Modifications in Orienting Clients to Therapy 121

6 Individualized Case Formulation 135

7 Individualized Treatment Planning 165

8 Psychosis: Cultural Aspects of Presentation and Adaptations to Treatment 192

9 Depression: Cultural Aspects of Presentation and Adaptations to Treatment 227

10 Bipolar Affective Disorder: Cultural Aspects of Presentation and Adaptations to Treatment 248

11 Recovery, Relapse Prevention, and Finishing Therapy 273

12 Policy and Training Implications 293

Appendix

1 Social Factors: My Immigration Journey 306

2 Aida Longitudinal Formulation 308

3 Setting Goals to Improve Quality of Life 310

4 Voices Diary 312

5 What Do Voices Say? 314

6 Working on Coping Strategies: Pleasant Events Schedule 315

7 Preventing a Relapse or Breakdown 317

8 Circle of Support 320

9 Relapse Prevention Plans 322

Index 326

Dr Shanaya Rathod is Consultant Psychiatrist, Clinical Services Director, and Director of Research at Southern Health NHS Foundation Trust, UK. Dr Rathod has been Fellow of the National Institute for Health and Care Excellence. She has published a number of papers in peer reviewed journals, book chapters, and books, including Back to Life, Back to Normality: Cognitive Therapy, Recovery and Psychosis (2009).

David Kingdon is Professor of Mental Health Care Delivery at the University of Southampton, UK, and Honorary Consultant Adult Psychiatrist for Southern Health NHS Foundation Trust. He has previously worked as Medical Director for Nottingham Health Care Trust and Senior Medical Officer (Severe Mental Illness) in the UK Department of Health, UK. He now does policy and implementation work for NHS England and is editor of their mental health web sites.

Dr Narsimha R Pinninti is Professor of Psychiatry at the Rowan University School of Osteopathic Medicine and Chief Medical Officer for Twin Oaks Community Services in New Jersey, USA. A certified cognitive therapist and psychiatrist for the Assertive Community Treatment Team, Dr Pinninti has published over 40 articles in peer–reviewed journals and authored two manuals on how to teach CBT interventions for case managers and clients.

Douglas Turkington is Professor of Psychosocial Psychiatry at Newcastle University, UK. Professor Turkington is an expert on the efficacy and effectiveness of CBT in the treatment of schizophrenia. A fellow of the Royal College of Psychiatrists and founding fellow of the Faculty of Cognitive Therapy in Philadelphia, he has written more than 100 articles on the subject of CBT in schizophrenia.

Dr Peter Phiri, PhD, is CBT Specialist and Research & Development Manager (Interim) at Southern Health NHS Foundation Trust and Honorary Lecturer at the University of Southampton, UK. He is an accredited member of the British Association of Behavioural and Cognitive Psychotherapy.