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Developing Culturally Sensitive Cognitive Behaviour Therapy for Psychosis for Ethnic Minority Patients by Exploration and Incorporation of Service Users' and Health Professionals' Views and Opinions

  • Shanaya Rathod (a1), David Kingdon (a2), Peter Phiri (a2) and Mary Gobbi (a2)

Abstract

Background: Studies of cognitive behaviour therapy (CBT) for schizophrenia demonstrate that African-Caribbean and Black African patients have higher dropout rates and poor outcomes from treatment. Aim: The main aim of the study was to produce a culturally sensitive adaption of an existing CBT manual for therapists working with patients with psychosis from specified ethinic minority communities (African-Caribbean, Black-African/Black British, and South Asian Muslims). This will be based on gaining meaningful understanding of the way members (lay and service users) of these minority communities typically view psychosis, its origin and management including their cultural influences, values and attitudes. Method: This two-centre (Hampshire and West London) qualitative study consisted of individual semi-structured interviews with patients with schizophrenia (n = 15); focus groups with lay members from selected ethnic communities (n = 52); focus groups or semi-structured interviews with CBT therapists (n = 22); and mental health practitioners who work with patients from the ethnic communities (n = 25). Data were analyzed thematically using evolving themes and content analysis. NVivo 8 was used to manage and explore data. Results: There was consensus from the respondent groups that CBT would be an acceptable treatment if culturally adapted. This would incorporate culturally-based patient health beliefs, attributions concerning psychosis, attention to help seeking pathways, and technical adjustments. Conclusion: While individualization of therapy is generally accepted as a principle, in practice therapists require an understanding of patient-related factors that are culturally bound and influence the way the patient perceives or responds to therapy. The findings of this study have practical implications for therapists and mental health practitioners using CBT with people with psychosis from BME communities.

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Corresponding author

Reprint requests to Shanaya Rathod, Consultant Psychiatrist and Associate Medical Director, Hampshire Partnership NHS Foundation Trust, Melbury Lodge, Winchester, Hampshire SO22 5DG, UK. E-mail: shanayarathod@nhs.net

References

Hide All
Bhugra, D. (1997). Setting up psychiatric services: cross-cultural issues in planning and delivery. International Journal of Social Psychiatry, 43, 1628.
Bhui, K. (1998). London's ethnic minorities and the provision of mental health services. In Johnson, et al. (Eds.) London's Mental Health. South London: Kings Fund.
Bhui, K. (2002). Racism and Mental Health: London: Jessica Kingsley.
Bhui, K. and Bhugra, D. (2004). Communication with patients from other cultures: the place of explanatory models. Advances in Psychiatric Treatment, 10, 474478.
Cantor-Graae, E. and Selten, P. (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry, 162, 1224.
Casas, M. (1988). Cognitive behavioural approaches: a minority perspective. The Counselling Psychologist, 16, 106110.
Chen, J., Nakano, Y., Letzugu, T., Ogawa, S., Funayama, T., Watanabe, N., Noda, Y. and Furukawa, T. (2007). Group cognitive behaviour therapy for Japanese patients with social anxiety disorder: preliminary outcomes and their predictors. BMC Psychiatry, 7, 69.
Chung, K. (1996). Adaptation of Cognitive Therapy to Korean Culture. 132, CME Syllabus and Proceedings Summary, 149th Annual Meeting of APA.
Cowdrill, V. and Keeling, C. (2007). Race and Culture Issues in Cognitive Behaviour Therapy. Lecture to Diploma in CBT for Severe Mental Health Problems. University of Southampton, UK.
Creswell, J. W. (2009). Research Design, Qualitative, Quantitative, and Mixed Method Approaches (3rd ed.). Los Angeles: Sage.
Deffenbacher, L. (1988). Agreement and response to neglected variables in cognitive-behavioral treatments. The Counselling Psychologist, 16, 314317.
Elliot, R., Fischer, C. T. and Rennie, D. L. (1999). Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology, 38, 215229.
Fearon, P. and Morgan, C. (2006). Environmental factors in schizophrenia: the role of migrant studies. Schizophrenia Bulletin, 32, 405408.
Fernando, S. (1988). Race and Culture in Psychiatry. London: Billing and Sons Ltd.
Garcia, G. and Zea, C. (Eds.) (1997). Psychological Interventions and Research with Latino Populations. Boston: Allyn and Bacon.
Giorgi, A. (1995). Phenomenological psychology. In Smith, J. A., Hare, R. and Van Langenhove, L. (Eds.), Rethinking Psychology. London: Sage.
Hsieh, H. and Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 12771288.
King, M., Nazroo, J., Weich, S., McKenzie, K., Bhui, K., Karlsen, S., Stansfeld, S., Tyrer, P., Blanchard, M., Lloyd, K., McManus, S., Sproston, K. and Erens, B. (2005). Psychotic symptoms in the general population of England: a comparison of ethnic groups (The EMPIRIC study). Social Psychiatry and Psychiatric Epidemiology, 40, 375381.
Kingdon, D. and Turkington, D. (2005). Cognitive Therapy of Schizophrenia. New York: The Guildford Press.
Kirkbride, J. B., Fearon, P., Morgan, C., Dazzan, P., Morgan, K., Tarrant, J., Lloyd, T., Holloway, J., Hutchinson, G., Leff, J., Mallet, R. M., Harrison, G., Murray, R. M. and Jones, P. B. (2006). On behalf of the AESOP Study Group. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AESOP study. Archives of General Psychiatry, 63, 250258.
Kitzinger, J. (1995). Qualitative research: introducing focus groups. British Medical Journal, 311, 299302.
Kohn, L. P., Oden, T., Munoz, R. F., Robinson, A. and Leavitt, D. (2002). Adapted cognitive behavioural group therapy for depressed low-income African American women. Community Mental Health Journal, 38, 497504.
Krueger, R. A. (1994). Focus Groups: a practical guide for applied research (2nd edn.). Thousand Oaks, CA: Sage.
Kvale, S. (1996). Interviews: an introduction to qualitative research interviewing. London: Sage.
Lewis, S., Tarrier, N., Haddock, G., Bentall, R., Kinderman, P., Kingdon, D., Siddle, R., Drake, R., Everitt, J., Leadley, K., Benn, A., Grazebrook, K., Haley, C., Akhtar, S., Davies, L., Palmer, S., Faragher, B. and Dunn, G. (2002). Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes. British Journal of Psychiatry, 181, 9197.
Lombard, D. (2008). Healthcare Commission survey reveals increase in proportion of BME patients. Available at: http://www.communitycare.co.uk/articles/2008/11/28/110123 (Accessed: February 2009)
McCabe, R. and Priebe, S. (2004). Explanatory models of illness in schizophrenia: comparison of four ethnic groups. British Journal of Psychiatry, 185, 2530.
Merton, R. K., Fiske, M. and Kendall, P. L. (1990). The Focused Interview: a manual of problems and procedures (2nd edn.). London: Collier MacMillan.
Morrison, A. P., French, P., Walford, L., Lewis, S. W., Kilcommons, J. G., Parker, S. and Bentall, R. (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. British Journal of Psychiatry, 185, 291297.
Morse, J. and Field, P. (1996). Nursing Research: the application of qualitative approaches. London: Chapman & Hall.
Naeem, F., Ayub, M., Gobbi, M. and Kingdon, D. (in press). Development of Southampton Adaptation Framework for CBT (SAF-CBT): a framework for adaptation of CBT in non-Western cultures. Journal of the Pakistan Psychiatric Society.
Naeem, F., Phiri, P., Rathod, S. and Kingdon, D. (2010). Using CBT with diverse patients: working with South Asian Muslims. In Mueller, M., Kennerley, H., McManus, F. and Westbrook, D. (Eds.) Oxford Guide to Surviving as a CBT Therapist. Oxford: Oxford University Press.
Nazroo, Y. (1997). Ethnicity and Mental Health. London: Policy Studies Institute.
Nuechterlein, K. H., Dawson, M. E., Ventura, J., Gitlin, M., Subotnik, K. L., Snyder, K. S., Mintz, J. and Bartzokis, G. (1994). The vulnerability-stress model of schizophrenic relapse: a longitudinal study. Acta Psychiatrica Scandinavica, Supplementum, 382, 5864.
Office for National Statistics (2001). Census of Population. Available at: http://www.neighbourhood.statistics.gov.uk
Owusu-Bempah, K. (2002). Culture, self and cross-ethnic therapy. In Mason, B. and Sawyer, A. (Eds.), Exploring the Unsaid: creativity, risks and dilemmas in working cross-culturally. London: Karnac.
Patel, V. and Andrade, C. (2003). Pharmacological treatment of severe psychiatric disorders in the developing world: lessons from India. CNS Drugs, 17, 10711080.
Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., Hosman, C., McGuire, H., Rojas, G. and van Ommeren, M. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet, 370, 9911005.
Pinto, R., Ashworth, M. and Jones, R. (2008). Schizophrenia in Black Caribbeans in the UK: an exploration of underlying causes of the high incidence rate. British Journal of General Practice, 58, 429434.
Polit, F. and Hungler, P. (1999). Nursing Research: principles and methods (6th edn.). Philadelphia: Lippincott.
Rack, P. (1992). Race, Culture, and Mental Disorder. London: Tavistock Publications.
Rahman, A., Malik, A., Sikander, S., Roberts, C. and Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet, 372, 902909.
Rathod, S., Kingdon, D., Phiri, P. and Gobbi, M. (2009). Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority groups by exploration and incorporation of Service User's and Health Professionals views and opinions. Report to the Department of Health, Delivering Race Equality, Clinical Trailblazers programme.
Rathod, S., Kingdon, D., Smith, P. and Turkington, D. (2005). Insight into schizophrenia: the effects of cognitive behavioral therapy on the components of insight and association with sociodemographics – data on a previously published randomised controlled trial. Schizophrenia Research, 74, 211219.
Rathod, S., Naeem, F., Phiri, P. and Kingdon, D. (2008). Expansion of psychological therapies. The British Journal of Psychiatry, 193, 256.
Richie, J. and Lewis, J. (2003). Qualitative Research Practice: a guide for social science students and researchers. Thousand Oaks, CA: Sage.
Rojas, G., Fritsch, R., Solis, J., Jadresic, E., Castillo, C., González, M., Guajardo, V., Lewis, G., Peters, T. J. and Araya, R. (2007). Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial. Lancet, 370, 16291637.
Ruiz, R. A. and Casas, J. M. (1981). Culturally relevant and behavioristic counselling for Chicano college students. In Pedersen, P., Draguns, J., Longer, W. J. and Trimble, J. (Eds.), Counselling Across Cultures. (rev. ed., pp. 181202). Honolulu: East West Center.
Sainsbury Centre for Mental Health (2002). Breaking the Circles of Fear. London: Sainsbury Centre for Mental Health.
Sharpley, M., Hutchinson, G., Murray, R. M. and McKenzie, K. (2001). Understanding the excess of psychosis among African-Caribbean population in England: review of current hypothesis. British Journal of Psychiatry, 178, 6068.
Simons, L., Lathlean, J. and Squire, C. (2008). Shifting the focus: sequential methods of analysis with qualitative data. Qualitative Health Research, 18, 120132.
Specialist Library for Ethnicity and Health (2009). Schizophrenia and ethnic minorities in Britain: an urgent need to improve the evidence base. Published by SLEH. Accessed on 17/06/09 Available at: http://www.library.nhs.uk/Ethnicity/ViewResource.aspx?resID=282996andtabID=290
Spradley, P. (1980). Participant Observation. New York: Holt, Rinehorn and Winston.
Stewart, D. W. and Shamdasani, P. N. (1990). Focus Groups: theory and practice. London: Sage.
Thornicroft, G., Parkman, S. and Ruggeri, M. (1999). Satisfaction with mental health services: issues for ethnic minorities. In Bhugra, D. and Bahl, V., Ethnicity: an agenda for Mental Health. London: The Royal College of Psychiatrists.
Triandis, H. C. (1995). Individualism and Collectivism. Boulder, CO: Westview Press.
Trower, P., Birchwood, M., Meaden, A., Byrne, S., Nelson, A. and Ross, K. (2004). Cognitive therapy for command hallucinations: randomised controlled trial. British Journal of Psychiatry, 184, 312320.
Tseng, Wen-Shing, Chang, S. C. and Nishjzono, M. (2005). Asian Culture and Psychotherapy: implications for East and West. Honolulu: University of Hawaii Press.
Turkington, D., Kingdon, D., Rathod, S., Hammond, K., Pelton, J. and Mehta, R. (2006). Outcomes of an effectiveness trial of cognitive-behavioural intervention by mental health nurses in schizophrenia. British Journal of Psychiatry, 189, 3640.
Turkington, D., Kingdon, D. and Turner, T. (2002). Effectiveness of a brief cognitive behavioural therapy intervention in the treatment of schizophrenia. British Journal of Psychiatry, 180, 523527.
Williams, M. W., Koong, H. F. and Haarhoff, B. (2006). Cultural considerations in using cognitive behaviour therapy with Chinese people: a case study of an elderly Chinese woman with generalized anxiety disorder. New Zealand Journal of Psychology. November.
Wykes, T., Steel, C., Everitt, B. and Tarrier, N. (2008). Cognitive behaviour therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34, 523537.
Zimmermann, G., Favrod, J., Trieu, V. H. and Pomini, V. (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research, 77, 19.
Zubin, J. and Spring, B. (1977). Vulnerability: a new view on schizophrenia. Journal of Abnormal Psychology, 86, 103126.
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Behavioural and Cognitive Psychotherapy
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Developing Culturally Sensitive Cognitive Behaviour Therapy for Psychosis for Ethnic Minority Patients by Exploration and Incorporation of Service Users' and Health Professionals' Views and Opinions

  • Shanaya Rathod (a1), David Kingdon (a2), Peter Phiri (a2) and Mary Gobbi (a2)
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