The Efficacy of Culturally Adapted Cognitive Behavioral Therapy on the Symptoms of Emotional Disorders

Document Type : Research Paper

Authors

1 MSc in Clinical Psychology, Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran.

2 Assistant Professor, Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran.

3 Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.

Abstract

Culturally Adapted Cognitive Behavioral Therapy (CaCBT) is a newly introduced treatment for emotional disorders applied to enhance Cognitive behavioral therapy Cognitive (CBT) efficiency in non-Western cultures. This study aimed to investigate the efficiency of CaCBT on the symptoms of emotional disorder in Iranian population. The present study was applied in terms of purpose, experimental in terms of data collection and single-case in research design. The statistical population was all students of the University of Tabriz in the year 2018-2019. The depression, anxiety, and stress scale (DASS-42) were implemented on 335 students who enrolled in the study through the multilevel clustering method. Of them, 4 students were selected for the main intervention based on their higher scores in DASS-42. Then, the 8-session CaCBT (Naeem et al., 2015) was administered to both students and their families by two independent therapists. To assess the severity of symptoms, Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were used. The results indicated that CaCBT effectively and significantly changed the symptoms of emotional disorders (e.g. depression and anxiety), and the follow up scores were optimal. The effect sizes for all 4 participants were at least moderate (0.52). It was articulated that appropriate therapeutic protocols for the Iranian population could be developed and applied through changing or adapting traditional psychotherapies based on cultural and contextual components. Clinical and applied considerations of the CaCBT are discussed.

Keywords

References

اصغری مقدم، محمدعلی؛ ساعد، فواد؛ دیباج نیا، پروین؛ زنگنه، جعفر (1387). بررسی مقدماتی اعتبار و پایایی مقیاس‌های افسردگی، اضطراب و استرس (DASS) در نمونه‌های غیر بالینی. ماهنامه علمی- پژوهشی دانشگاه شاهد، 32 (15)، 23-38.
زارعان، مصطفی (1394). ابعاد افسردگی و اضطراب در فرهنگ ایران، رساله دکتری روانشناسی بالینی، دانشگاه شهید بهشتی.
زارعان، مصطفی؛ شهیدی، شهریار؛ وان‌دی‌فایر، فونز؛ دهقانی، محسن (1398). مطالعه کیفی علایم اختلالات هیجانی در برخی از اقوام ایرانی. پژوهش‌های روانشناختی، 44 (22)، 54-76.
علیزاده صحرائی، ام هانی (1395). طراحی راهنمای درمان شناختی – رفتاری مقدماتی برای اختلال وسواس نجس – پاکی با توجه به بافت فرهنگی ایران، پایان نامه کارشناسی ارشد روانشناسی، دانشگاه الزهرا.
فتحی آشتیانی، علی؛ دادستانی، محبوبه (1388). آزمون های رواشناختی: ارزیابی شخصیت و سلامت روان، تهران، بعثت.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. https://doi.org/10.1176/appi.books.9780890425596
Amin, R., Iqbal, A., Naeem, F., & Irfan, M. (2020). Effectiveness of a culturally adapted cognitive behavioural therapy-based guided self-help (CACBT-GSH) intervention to reduce social anxiety and enhance self-esteem in adolescents: a randomized controlled trial from Pakistan. Behavioural and cognitive psychotherapy, 48(5), 503-514. https://doi.org/10.1017/S1352465820000284
Asarnow, L. D., & Manber, R. (2019). Cognitive behavioral therapy for insomnia in depression. Sleep medicine clinics, 14(2), 177-184. https://doi.org/10.1016/j.jsmc.2019.01.009
Beck, A. T. S. R., Steer, R. A. B. G., & Brown, G. (1996). Manual for the Beck depression inventory-II (BDI-II). https://doi.org/10.1037/t00742-000
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of consulting and clinical psychology, 56(6), 893. https://psycnet.apa.org/doi/10.1037/0022-006X.56.6.893
Bennett, S. T., Flett, R. A., & Babbage, D. R. (2014). Culturally adapted cognitive behaviour therapy for Māori with major depression. The Cognitive Behaviour Therapist, 7. https://doi.org/10.1017/S1754470X14000233
Boisseau, C. L., Farchione, T. J., Fairholme, C. P., Ellard, K. K., & Barlow, D. H. (2010). The development of the unified protocol for the transdiagnostic treatment of emotional disorders: A case study. Cognitive and Behavioral Practice, 17(1), 102-113. https://doi.org/10.1016/j.cbpra.2009.09.003
Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment. Psychological assessment, 21(3), 256. https://psycnet.apa.org/doi/10.1037/a0016608
Dejman, M. (2010). Cultural explanatory model of depression among Iranian women in three ethnic groups (Fars, Kurds and Turks). Institutionen för klinisk neurovetenskap/Department of Clinical Neuroscience. http://hdl.handle.net/10616/40153
Dejman, M., Ekblad, S., Forouzan. A. S., Eftekhari, M. b., & Malekafzali, H. (2008). Explanatory Model of Help-Seeking and Coping Mechanisms among Depressed Women in Three Ethnic Groups of Fars, Kurdish, and Turkish in Iran. Arch Iranian Med; 11 (4): 397-406. https://dx.doi.org/08114/AIM.0011
Dobson, D., & Dobson, K. S. (2018). Evidence-based practice of cognitive-behavioral therapy. Guilford publications.
Duarté‐Vélez, Y., Bernal, G., & Bonilla, K. (2010). Culturally adapted cognitive‐behavior therapy: Integrating sexual, spiritual, and family identities in an evidence‐based treatment of a depressed Latino adolescent. Journal of Clinical Psychology, 66(8), 895-906. https://doi.org/10.1002/jclp.20710
Eskici, H. S., Hinton, D. E., Jalal, B., Yurtbakan, T., & Acarturk, C. (2021). Culturally adapted cognitive behavioral therapy for Syrian refugee women in Turkey: A randomized controlled trial. Psychological trauma: theory, research, practice, and policy. https://psycnet.apa.org/doi/10.1037/tra0001138
Eysenck, M. W., & Fajkowska, M. (2018). Anxiety and depression: toward overlapping and distinctive features. Cognition and Emotion, 32(7), 1391-1400. https://doi.org/10.1080/02699931.2017.1330255
Haynes, P. (2015). Application of cognitive behavioral therapies for comorbid insomnia and depression. Sleep Medicine Clinics, 10(1), 77-84. https://doi.org/10.1016/j.jsmc.2014.11.006
Hinton, D. E., Hofmann, S. G., Rivera, E., Otto, M. W., & Pollack, M. H. (2011). Culturally adapted CBT (CA-CBT) for Latino women with treatment-resistant PTSD: A pilot study comparing CA-CBT to applied muscle relaxation. Behaviour research and therapy, 49(4), 275-280. https://doi.org/10.1016/j.brat.2011.01.005
Huguet, A., Miller, A., Kisely, S., Rao, S., Saadat, N., & McGrath, P. J. (2018). A systematic review and meta-analysis on the efficacy of Internet-delivered behavioral activation. Journal of affective disorders, 235, 27-38. https://doi.org/10.1016/j.jad.2018.02.073
Interian, A., Allen, L. A., Gara, M. A., & Escobar, J. I. (2008). A pilot study of culturally adapted cognitive behavior therapy for Hispanics with major depression. Cognitive and Behavioral Practice, 15(1), 67-75. https://doi.org/10.1016/j.cbpra.2006.12.002
Irfan, M. (2016). Developing and testing of culturally adapted CBT (CaCBT) for common mental disorders of Pashto speaking Pakistans and Afghans (Doctoral dissertation, Universidade NOVA de Lisboa (Portugal).
Ishikawa, S. I., Kikuta, K., Sakai, M., Mitamura, T., Motomura, N., & Hudson, J. L. (2019). A randomized controlled trial of a bidirectional cultural adaptation of cognitive behavior therapy for children and adolescents with anxiety disorders. Behaviour research and therapy, 120, 103432. https://doi.org/10.1016/j.brat.2019.103432
Ismail, H., Wright, J., Rhodes, P., & Small, N. (2005). Religious beliefs about causes and treatment of epilepsy. British journal of general practice, 55(510), 26-31.
Jalal, B., Samir, S. W., & Hinton, D. E. (2017). Adaptation of CBT for traumatized Egyptians: Examples from culturally adapted CBT (CA-CBT). Cognitive and Behavioral Practice, 24(1), 58-71. https://doi.org/10.1016/j.cbpra.2016.03.001
Kananian, S., Soltani, Y., Hinton, D., & Stangier, U. (2020). Culturally adapted cognitive behavioral therapy plus problem management (CA‐CBT+) with Afghan refugees: A randomized controlled pilot study. Journal of traumatic stress, 33(6), 928-938. https://doi.org/10.1002/jts.22615
Kasi, P. M., Naqvi, H. A., Afghan, A. K., Khawar, T., Khan, F. H., Khan, U. Z., ... & Khan, H. M. (2012). Coping styles in patients with anxiety and depression. International Scholarly Research Notices, 2012.
Kennard, J. (2016). Benefits and Limitations of Cognitive Behavioral Therapy (CBT) for Treating Anxiety. New York, USA.
Khan, S., Lovell, K., Lunat, F., Masood, Y., Shah, S., Tomenson, B., & Husain, N. (2019). Culturally-adapted cognitive behavioural therapy based intervention for maternal depression: a mixed-methods feasibility study. BMC women's health, 19(1), 1-11. http://dx.doi.org/10.1186/s12905-019-0712-7
Matsumoto, D., & Hwang, H. S. (2012). Culture and emotion: The integration of biological and cultural contributions. Journal of Cross-Cultural Psychology, 43(1), 91-118. https://doi.org/10.1177%2F0022022111420147
Milkie, M. A., & Denny, K. E. (2014). Changes in the cultural model of father involvement: Descriptions of benefits to fathers, children, and mothers in Parents’ Magazine, 1926-2006. Journal of Family Issues, 35(2), 223-253. https://doi.org/10.1177%2F0192513X12462566
Naeem, F., Gul, M., Irfan, M., Munshi, T., Asif, A., Rashid, S., ... & Ayub, M. (2015). Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. Journal of Affective Disorders, 177, 101-107. https://doi.org/10.1016/j.jad.2015.02.012
Naeem, F., Saeed, S., Irfan, M., Kiran, T., Mehmood, N., Gul, M., ... & Farooq, S. (2015). Brief culturally adapted CBT for psychosis (CaCBTp): a randomized controlled trial from a low income country. Schizophrenia Research, 164(1-3), 143-148. https://doi.org/10.1016/j.schres.2015.02.015
Norcross, J. C., & Wampold, B. E. (2018). A new therapy for each patient: Evidence‐based relationships and responsiveness. Journal of clinical psychology, 74(11), 1889-1906. https://doi.org/10.1002/jclp.22678
Schneider, B. (2014). Interpersonal distress and interpersonal problems associated with depression. Columbia University.
Zarean, M., Shahidi, S., Vijver, F. V. D., Dehghani, M., Asadollahpour, A., & Sohrabi, R. (2014). Reflections from indigenous psychology on emotional disorders: A qualitative study in Azeri ethnic group. Practice in Clinical Psychology, 2(4), 285-291. http://jpcp.uswr.ac.ir/article-1-247-en.html

Files

History

  • Receive Date: 08 February 2022
  • Revise Date: 22 February 2022
  • Accept Date: 24 February 2022

Share

How to cite

Statistics