Skip to main content Accessibility help

Cultural adaptation of cognitive–behavioural therapy

  • Farooq Naeem (a1), Peter Phiri (a2), Shanaya Rathod (a3) and Muhammad Ayub (a4)


The study of cultural factors in the application of psychotherapy across cultures – ethnopsychotherapy – is an emerging field. It has been argued that Western cultural values underpin cognitive–behavioural therapy (CBT) as they do other modern psychosocial interventions developed in the West. Therefore, attempts have been made to culturally adapt CBT for ethnic minority patients in the West and local populations outside the West. Some frameworks have been proposed based on therapists’ individual experiences, but this article describes a framework that evolved from a series of qualitative studies to culturally adapt CBT and that was field tested in randomised controlled trials. We describe the process of adaptation, details of methods used and the areas that need to be focused on to adapt CBT to a given culture. Further research is required to move the field forward, but cultural adaptation alone cannot improve outcomes. Access to evidence-based psychosocial interventions, including CBT, needs to be improved for culturally adapted interventions to achieve their full potential.


After reading this article you will be able to:

  • recognise the link between cultural factors and the need to adapt psychosocial interventions
  • identify the necessary steps to culturally adapt CBT
  • understand the modifications required to deliver therapy to individuals from diverse cultural backgrounds.


Corresponding author

Correspondence Dr Farooq Naeem, 33 Russell St, Toronto, ON M5S 2S1, Canada. Email:


Hide All




Hide All
Barrera, M, Castro, FG, Strycker, LA, et al. (2013) Cultural adaptations of behavioral health interventions: a progress report. Journal of Consulting and Clinical Psychology, 81: 196205.
Bernal, G, Bonilla, J, Bellido, C (1995) Ecological validity and cultural sensitivity for outcome research: issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology, 23: 6782.
Bhikha, A, Farooq, S, Chaudhry, N, et al. (2015) Explanatory models of psychosis amongst British South Asians. Asian Journal of Psychiatry, 16: 4854.
Bhugra, D, Bhui, K (1998) Psychotherapy for ethnic minorities: issues, context and practice. British Journal of Psychotherapy, 14: 310–26.
Bhugra, D, Bhui, K, Rosemarie, M (1999) Cultural identity and its measurement: a questionnaire for Asians. International Review of Psychiatry, 11: 244–9.
Bhui, K (2010) Culture and complex interventions: lessons for evidence, policy and practice. British Journal of Psychiatry, 197: 172–3.
Bridges, K, Goldberg, D (1987) Somatic presentation of depressive illness in primary care. Journal of the Royal College of General Practitioners, Occasional Paper, (36): 911.
Brown, C, Conner, KO, McMurray, M (2012) Toward cultural adaptation of interpersonal psychotherapy for depressed African American primary care patients. In Cultural Adaptations: Tools for Evidence-Based Practice with Diverse Populations (eds Bernal, G, Domenech Rodriguez, MM): 223–38. American Psychological Association.
Chen, SW-H, Davenport, DS (2005) Cognitive-behavioral therapy with Chinese American clients: cautions and modifications. Psychotherapy: Theory, Research, Practice, Training, 42: 101–10.
Cinnirella, M, Loewenthal, KM (1999) Religious and ethnic group influences on beliefs about mental illness: a qualitative interview study. British Journal of Medical Psychology, 72: 505–24.
Culyer, AJ, Wagstaff, A (1993) Equity and equality in health and health care. Journal of Health Economics, 12: 431–57.
Davey, MP, Kissil, K, Lynch, L, et al. (2013) A culturally adapted family intervention for African American families coping with parental cancer: outcomes of a pilot study. Psycho-Oncology, 22: 1572–80.
Edge, D, Degnan, A, Cotterill, S, et al. (2018) Culturally Adapted Family Intervention (CaFI) for African-Caribbean People Diagnosed with Schizophrenia and Their Families: A Mixed-Methods Feasibility Study of Development, Implementation and Acceptability. Health Services and Delivery Research, 6(32).
Fierros, M, Smith, C (2006) The relevance of Hispanic culture to the treatment of a patient with posttraumatic stress disorder (PTSD). Psychiatry (Edgmont), 3: 4956.
Fernando, S (1991) Mental Health, Race and Culture. Macmillan.
Frey, LL, Roysircar, G (2004) Effects of acculturation and worldview for white American, South American, South Asian, and Southeast Asian students. International Journal for the Advancement of Counselling, 26: 229–48.
Hays, PA, Iwamasa, GY (2006) Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, and Supervision. American Psychological Association.
Hendry, J, Underdown, S (2012) Anthropology: A Beginner's Guide. Oneworld Publications.
Hwang, W-C (2006) The psychotherapy adaptation and modification framework: application to Asian Americans. American Psychologist, 61: 702–15.
Hwang, W-C, Myers, HF, Chiu, E, et al. (2015) Culturally adapted cognitive-behavioral therapy for Chinese Americans with depression: a randomized controlled trial. Psychiatric Services, 66: 1035–42.
Karenga, M, Karenga, T (2007) The Nguzo Saba and the black family: principles and practices of well-being and flourishing. In Black Families (4th edn) (ed McAdoo, HP): 728. SAGE Publications.
Kinderman, P (2014) Get the message right: a psychosocial model of mental health and well-being. In A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing (ed Kinderman, P): 3047. Palgrave Macmillan.
Kirmayer, LJ (2012) Rethinking cultural competence. Transcultural Psychiatry, 49: 149–64.
Kohn, LP, Oden, T, Muñoz, RF, et al. (2002) Brief report: adapted cognitive behavioral group therapy for depressed low-income African American women. Community Mental Health Journal, 38: 497504.
Laungani, P (2004) Asian Perspectives in Counselling and Psychotherapy. Psychology Press.
Li, W, Zhang, L, Luo, X, et al. (2017) A qualitative study to explore views of patients’, carers’ and mental health professionals’ to inform cultural adaptation of CBT for psychosis (CBTp) in China. BMC Psychiatry, 17: 131.
Lloyd, KR, Jacob, KS, Patel, V, et al. (1998) The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders. Psychological Medicine, 28: 1231–7.
Naeem, F, Gobbi, M, Ayub, M, et al. (2009a) University students’ views about compatibility of cognitive behaviour therapy (CBT) with their personal, social and religious values (a study from Pakistan). Mental Health, Religion & Culture, 12: 847–55.
Naeem, F, Ayub, M, Gobbi, M, et al. (2009b) Development of Southampton Adaptation Framework for CBT (SAF-CBT): a Framework for Adaptation of CBT in Non-Western Culture. Journal of Pakistan Psychiatric Society, 6: 7984.
Naeem, F, Gobbi, M, Ayub, M, et al. (2010) Psychologists experience of cognitive behaviour therapy in a developing country: a qualitative study from Pakistan. International Journal of Mental Health Systems, 4: 2.
Naeem, F (2012a) Adaptation of Cognitive Behaviour Therapy for Depression in Pakistan: Adaptation of Cognitive Behaviour Therapy for Depression in Pakistan. Lambert Academic Publishing.
Naeem, F, Ayub, M, Kingdon, D, et al. (2012b) Views of depressed patients in Pakistan concerning their illness, its causes, and treatments. Qualitative Health Research, 22: 1083–93.
Naeem, F, Ayub, M, McGuire, N, et al. (2013) Culturally Adapted CBT (CaCBT) for Depression: Therapy Manual for Use with South Asian Muslims [Kindle edition]. Pakistan Association of Cognitive Therapists (PACT).
Naeem, F, Sarhandi, I, Gul, M, et al. (2014a) A multicentre randomised controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan. Journal of Affective Disorders, 156: 224–7.
Naeem, F, Habib, N, Gul, M, et al. (2014b) A qualitative study to explore patients’, carers’ and health professionals’ views to culturally adapt CBT for psychosis (CBTp) in Pakistan. Behavioural and Cognitive Psychotherapy, 44: 4355.
Naeem, F, Phiri, P, Munshi, T, et al. (2015a) Using cognitive behaviour therapy with South Asian Muslims: findings from the culturally sensitive CBT project. International Review of Psychiatry, 27: 233–46.
Naeem, F, Gul, M, Irfan, M, et al. (2015b) Brief Culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. Journal of Affective Disorders, 177: 101–7.
Naeem, F, Saeed, S, Irfan, M, et al. (2015c) Brief culturally adapted CBT for psychosis (CaCBTp): a randomized controlled trial from a low income country. Schizophrenia Research, 164: 143–8.
Naeem, F, Phiri, P, Nasar, A, et al. (2016) An evidence-based framework for cultural adaptation of Cognitive Behaviour Therapy: process, methodology and foci of adaptation. World Cultural Psychiatry Research Review, 11: 6770.
Naeem, F (2017) A qualitative study to explore views of patients’, carers’ and mental health professionals’ to inform cultural adaptation of CBT for psychosis (CBTp) in China. BMC Psychiatry, 17: 131.
Parveen, T (2001) Cognitive Therapy in Cross-cultural Contexts: Making Clinical Sense of Occult Beliefs. University of Oxford.
Ramaiya, MK, Fiorillo, D, Regmi, U, et al. (2017) A cultural adaptation of dialectical behavior therapy in Nepal. Cognitive and Behavioral Practice, 24: 428–44.
Rathod, S, Kingdon, D, Phiri, P, et al. (2010) 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. Behavioural and Cognitive Psychotherapy, 38: 511–33.
Rathod, S, Phiri, P, Harris, S, et al. (2013) Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophrenia Research, 143: 319–26.
Rathod, S, Kingdon, D (2014) Case for cultural adaptation of psychological interventions for mental healthcare in low and middle income countries. BMJ, 349: g7636.
Rathod, S, Gega, L, Degnan, A, et al. (2018) The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses. Neuropsychiatric Disease and Treatment, 14: 165–78.
Razali, SM, Khan, UA, Hasanah, CI (1996) Belief in supernatural causes of mental illness among Malay patients: impact on treatment. Acta Psychiatrica Scandinavica, 94: 229–33.
Reber, A (1985) Dictionary of Psychology. Penguin.
Sahin, NH, Sahin, N (1992) How dysfunctional are the dysfunctional attitudes in another culture? British Journal of Medical Psychology, 65: 1726.
Scorzelli, JF, Reinke-Scorzelli, M (1994) Cultural sensitivity and cognitive therapy in India. The Counseling Psychologist, 22: 603610.
Shaikh, BT, Hatcher, J (2005) Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. Journal of Public Health, 27: 4954.
Sipe, WEB, Eisendrath, SJ (2012) Mindfulness-based cognitive therapy: theory and practice. Canadian Journal of Psychiatry, 57: 63–9.
Substance Abuse and Mental Health Services Administration (2014) Improving Cultural Competence (Treatment Improvement Protocol (TIP) Series No. 59). SAMHSA .
Sue, S, Zane, N, Nagayama Hall, GC, et al. (2009) The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60: 525–48.
Tam, PWC, Wong, DFK, Chow, KKW, et al. (2007) Qualitative analysis of dysfunctional attitudes in Chinese persons suffering from depression. Hong Kong Journal of Psychiatry, 17(4): 109.
Tseng, W-S (2004) Culture and psychotherapy: Asian perspectives. Journal of Mental Health, 13: 151–61.
Triandis, H, Lambert, W (1980) Handbook of Cross-cultural Psychology. Allyn and Bacon.
UN Economic Analysis & Policy Division (2018) World Economic Situation and Prospects: Monthly Briefing, January 2018 (no. 110). Global Economic Monitoring Unit .
UNESCO (2002) Records of the General Conference, 31st Session, Paris, 15 October to 3 November 2001. Vol 1: Resolutions. United Nations Educational, Scientific and Cultural Organization.
Verghese, A (2008) Spirituality and mental health. Indian Journal of Psychiatry, 50: 233–7.
Wallace, PM, Pomery, EA, Latimer, AE, et al. (2010) A review of acculturation measures and their utility in studies promoting Latino health. Hispanic Journal of Behavioral Sciences, 32: 3754.
Whitley, R, Kirmayer, LJ, Groleau, D (2006) Understanding immigrants’ reluctance to use mental health services: a qualitative study from Montreal. Canadian Journal of Psychiatry, 51: 205–9.


Related content

Powered by UNSILO

Cultural adaptation of cognitive–behavioural therapy

  • Farooq Naeem (a1), Peter Phiri (a2), Shanaya Rathod (a3) and Muhammad Ayub (a4)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Cultural adaptation of cognitive–behavioural therapy

  • Farooq Naeem (a1), Peter Phiri (a2), Shanaya Rathod (a3) and Muhammad Ayub (a4)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *