Hostname: page-component-7c8c6479df-xxrs7 Total loading time: 0 Render date: 2024-03-29T08:00:30.480Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  15 July 2010

Shanaya Rathod*
Affiliation:
Hampshire Partnership NHS Foundation Trust, Winchester, UK
David Kingdon
Affiliation:
University of Southampton, Royal South Hampshire Hospital, UK
Peter Phiri
Affiliation:
University of Southampton, Royal South Hampshire Hospital, UK
Mary Gobbi
Affiliation:
University of Southampton, Royal South Hampshire Hospital, UK
*
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

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.

Type
Accelerated Publication
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bhugra, D. (1997). Setting up psychiatric services: cross-cultural issues in planning and delivery. International Journal of Social Psychiatry, 43, 1628.Google Scholar
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.Google Scholar
Bhui, K. (2002). Racism and Mental Health: London: Jessica Kingsley.Google Scholar
Bhui, K. and Bhugra, D. (2004). Communication with patients from other cultures: the place of explanatory models. Advances in Psychiatric Treatment, 10, 474478.Google Scholar
Cantor-Graae, E. and Selten, P. (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry, 162, 1224.Google Scholar
Casas, M. (1988). Cognitive behavioural approaches: a minority perspective. The Counselling Psychologist, 16, 106110.Google Scholar
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.Google Scholar
Chung, K. (1996). Adaptation of Cognitive Therapy to Korean Culture. 132, CME Syllabus and Proceedings Summary, 149th Annual Meeting of APA.Google Scholar
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.Google Scholar
Creswell, J. W. (2009). Research Design, Qualitative, Quantitative, and Mixed Method Approaches (3rd ed.). Los Angeles: Sage.Google Scholar
Deffenbacher, L. (1988). Agreement and response to neglected variables in cognitive-behavioral treatments. The Counselling Psychologist, 16, 314317.Google Scholar
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.Google Scholar
Fearon, P. and Morgan, C. (2006). Environmental factors in schizophrenia: the role of migrant studies. Schizophrenia Bulletin, 32, 405408.Google Scholar
Fernando, S. (1988). Race and Culture in Psychiatry. London: Billing and Sons Ltd.Google Scholar
Garcia, G. and Zea, C. (Eds.) (1997). Psychological Interventions and Research with Latino Populations. Boston: Allyn and Bacon.Google Scholar
Giorgi, A. (1995). Phenomenological psychology. In Smith, J. A., Hare, R. and Van Langenhove, L. (Eds.), Rethinking Psychology. London: Sage.Google Scholar
Hsieh, H. and Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 12771288.Google Scholar
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.Google Scholar
Kingdon, D. and Turkington, D. (2005). Cognitive Therapy of Schizophrenia. New York: The Guildford Press.Google Scholar
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.Google Scholar
Kitzinger, J. (1995). Qualitative research: introducing focus groups. British Medical Journal, 311, 299302.Google Scholar
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.Google Scholar
Krueger, R. A. (1994). Focus Groups: a practical guide for applied research (2nd edn.). Thousand Oaks, CA: Sage.Google Scholar
Kvale, S. (1996). Interviews: an introduction to qualitative research interviewing. London: Sage.Google Scholar
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.Google Scholar
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)Google Scholar
McCabe, R. and Priebe, S. (2004). Explanatory models of illness in schizophrenia: comparison of four ethnic groups. British Journal of Psychiatry, 185, 2530.Google Scholar
Merton, R. K., Fiske, M. and Kendall, P. L. (1990). The Focused Interview: a manual of problems and procedures (2nd edn.). London: Collier MacMillan.Google Scholar
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.Google Scholar
Morse, J. and Field, P. (1996). Nursing Research: the application of qualitative approaches. London: Chapman & Hall.Google Scholar
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.Google Scholar
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.Google Scholar
Nazroo, Y. (1997). Ethnicity and Mental Health. London: Policy Studies Institute.Google Scholar
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.Google Scholar
Office for National Statistics (2001). Census of Population. Available at: http://www.neighbourhood.statistics.gov.ukGoogle Scholar
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.Google Scholar
Patel, V. and Andrade, C. (2003). Pharmacological treatment of severe psychiatric disorders in the developing world: lessons from India. CNS Drugs, 17, 10711080.Google Scholar
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.Google Scholar
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.Google Scholar
Polit, F. and Hungler, P. (1999). Nursing Research: principles and methods (6th edn.). Philadelphia: Lippincott.Google Scholar
Rack, P. (1992). Race, Culture, and Mental Disorder. London: Tavistock Publications.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
Rathod, S., Naeem, F., Phiri, P. and Kingdon, D. (2008). Expansion of psychological therapies. The British Journal of Psychiatry, 193, 256.Google Scholar
Richie, J. and Lewis, J. (2003). Qualitative Research Practice: a guide for social science students and researchers. Thousand Oaks, CA: Sage.Google Scholar
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.Google Scholar
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.Google Scholar
Sainsbury Centre for Mental Health (2002). Breaking the Circles of Fear. London: Sainsbury Centre for Mental Health.Google Scholar
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.Google Scholar
Simons, L., Lathlean, J. and Squire, C. (2008). Shifting the focus: sequential methods of analysis with qualitative data. Qualitative Health Research, 18, 120132.Google Scholar
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=290Google Scholar
Spradley, P. (1980). Participant Observation. New York: Holt, Rinehorn and Winston.Google Scholar
Stewart, D. W. and Shamdasani, P. N. (1990). Focus Groups: theory and practice. London: Sage.Google Scholar
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.Google Scholar
Triandis, H. C. (1995). Individualism and Collectivism. Boulder, CO: Westview Press.Google Scholar
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.Google Scholar
Tseng, Wen-Shing, Chang, S. C. and Nishjzono, M. (2005). Asian Culture and Psychotherapy: implications for East and West. Honolulu: University of Hawaii Press.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
Zubin, J. and Spring, B. (1977). Vulnerability: a new view on schizophrenia. Journal of Abnormal Psychology, 86, 103126.Google Scholar
Submit a response

Comments

No Comments have been published for this article.