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Culturally adapted cognitive behaviour therapy for Māori with major depression

Published online by Cambridge University Press:  07 January 2015

Simon T. Bennett ,
Ross A. Flett  and
Duncan R. Babbage
Simon T. Bennett*
Affiliation:
School of Psychology, Massey University, Wellington, New Zealand
Ross A. Flett
Affiliation:
School of Psychology, Massey University, Palmerston North, New Zealand
Duncan R. Babbage
Affiliation:
Person Centred Research Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
*
*Author for correspondence: S. T. Bennett, PhD, School of Psychology, Massey University – Wellington Campus, Private Bag 756, Wellington 6140, New Zealand (email: S.T.Bennett@massey.ac.nz).
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Abstract

Māori are the indigenous people of New Zealand and in 2006 comprised approximately 15% of the country's population. Epidemiological data suggests Māori experience rates of depression that are higher than the general population and are less likely to engage in treatment for mental health issues. The main aim of this study was to evaluate the effectiveness of an adapted approach to psychotherapy with Māori. The broad goals of which were to provide empirically grounded guidance for therapists aspiring to provide best practice to their Māori clients. This paper documents the evaluation of a cognitive behavioural therapy (CBT) treatment protocol specifically designed and adapted for delivery to adult Māori clients with a diagnosis of depression. The treatment protocol was administered to 16 Māori clients with a primary diagnosis of depression. The adapted treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. The intervention exhibited considerable promise with large significant reductions in depressive symptomatology in the participant group. Furthermore, significant reductions in negative cognition were observed. This is the first piece of applied clinical research that has examined the effectiveness of an individual psychological therapy exclusively with Māori and the first to examine individual psychotherapy outcomes with an indigenous population using an effectiveness study. The findings have a number of implications for the treatment of Māori clients with depression. This study provides useful guidelines for clinicians providing psychological treatment to Māori and provides strong support for the cultural adaptation of psychological treatment with ethnic minority groups.

Keywords

CBTdepressionFirst NationsindigenousMāori
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 7 , December 2014 , e20
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

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References

Recommended follow-up reading

Durie, M (2004). Understanding health and illness: research at the interface between science and indigenous knowledge. International Journal of Epidemiology 33, 1138–1143.Google Scholar
Interian, A, Allen, LA, Gara, MA, Escobar, JI (2008). A pilot study of culturally adapted cognitive behaviour therapy for Hispanics with major depression. Cognitive and Behavioural Practice 15, 67–75.Google Scholar
Interian, A, Díaz-Martínez, AM (2007). Considerations for culturally competent cognitive-behavioural therapy for depression with Hispanic patients. Cognitive and Behavioural Practice 14, 84–97.CrossRefGoogle Scholar

References

Abbott, MW, Durie, MH (1987). A white shade of pale – taha Māori and professional psychology training. New Zealand Journal of Psychology 16, 58–71.Google Scholar
Allart-van Dam, E, Hosman, CMH, Hoogduin, CAL, Schaap, CPDR (2007). Prevention of depression in sub clinically depressed adults: follow-up effects on the ‘Coping with Depression’ course. Journal of Affective Disorders 97, 219–228.Google Scholar
Asnaani, A, Hofmann, SG (2012). Collaboration in multicultural therapy: establishing a strong therapeutic alliance across cultural lines. Journal of Clinical Psychology 68, 187–197.CrossRefGoogle Scholar
Barrett, MS, Berman, JS (2001). Is psychotherapy more effective when therapists disclose information about themselves? Journal of Consulting and Clinical Psychology 69, 597.Google Scholar
Baxter, J, Kingi, TK, Tapsell, R, Durie, M (2006). Māori. In: Te Rau Hinengaro: The New Zealand Mental Health Survey (ed. Oakley Browne, M. A., Wells, J. E., Scott, K. M.), pp. 139–178. Wellington: Ministry of Health.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Bernal, G, Jiménez-Chafey, MI, Domenech Rodríguez, MM (2009). Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice 40, 361.CrossRefGoogle Scholar
Bennett, ST, Babbage, DR (2014). Cultural adaptation of CBT for aboriginal Australians. Australian Psychologist 49, 19–21.CrossRefGoogle Scholar
Bennett, STM (2009). Te huanga o te ao Maori: cognitive behavioural therapy for Maori clients with depression: development and evaluation of a culturally adapted treatment programme: a dissertation presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Wellington, New Zealand.Google Scholar
Bennett-Levy, J, Wilson, S, Nelson, J, Stirling, J, Ryan, K, Rotumah, D, Budden, W, Beale, D (2014). Can CBT be effective for aboriginal Australians? Perspectives of Aboriginal practitioners trained in CBT. Australian Psychologist 49, 1–7.CrossRefGoogle Scholar
Blackburn, IM, Bishop, S, Glen, AI, Whalley, LJ, Christie, JE (1981). The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination. British Journal of Psychiatry 139, 181–189.Google Scholar
Burt, T, Ishak, WW (2002). Outcome measurement in mood disorders. In: Outcome Measurement in Psychiatry (ed. Ishak, W. W., Burt, T., Sederer, L. I.), pp. 164–165. Washington, DC: American Psychiatric Publishing.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioural Sciences, 2nd edn.Hillsdale, NJ: Erlbaum.Google Scholar
Curry, JF (2001). Specific psychotherapies for childhood and adolescent depression. Biological Psychiatry 49, 1091–1100.Google Scholar
Diamond, P (2005). Whānau healing: how can Māori culture improve mental health. Listener, 24.Google Scholar
Duarté-Vélez, Y, Bernal, G, Bonilla, K (2010). Culturally adapted cognitive-behaviour therapy: integrating sexual, spiritual, and family identities in an evidence-based treatment of a depressed Latino adolescent. Journal of Clinical Psychology 66, 895–906.Google Scholar
Dubicka, B (2008). Adolescents with SSRI-resistant depression: CBT plus antidepressant switch more effective than medication switch alone. Evidence Based Mental Health 11, 110–110.CrossRefGoogle ScholarPubMed
Dugas, MJ, Ladouceur, R (2000). Treatment of GAD targeting intolerance of uncertainty in two types of worry. Behaviour Modification 24, 635–657.CrossRefGoogle ScholarPubMed
Dugas, MJ, Ladouceur, R, Léger, E, Freeston, MH, Langolis, F, Provencher, MD, Boisvert, JM (2003). Group cognitive-behavioural therapy for generalized anxiety disorder: treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology 71, 821.CrossRefGoogle ScholarPubMed
Durie, M (1989). The Treaty of Waitangi – perspectives on social policy. In: Waitangi: Māori & Pākehā Perspectives of the Treaty of Waitangi (ed. Kawharu, I. H.), pp. 280–299. USA: Oxford University Press.Google Scholar
Durie, M (1999). Whānau Development and Māori survival: the challenge of time. In: Proceedings of Te Hua o te Whanau: Whanau Health and Development Conference, 16 April 1999.Google Scholar
Durie, M (2001). Mauri ora: The Dynamics of Māori Health. Auckland: Oxford University Press.Google Scholar
Durie, M (2004). Understanding health and illness: research at the interface between science and indigenous knowledge. International Journal of Epidemiology 33, 1138–1143.Google Scholar
Durie, MH (1986). ‘Te taha hinengaro’: an integrated approach to mental health. Community Mental Health in New Zealand 1, 4–1.Google Scholar
Feeney, GF, Young, RMD, Connor, JP, Tucker, J, McPherson, A (2002). Cognitive behavioural therapy combined with the relapse prevention medication acamprosate: are short term treatment outcomes for alcohol dependence improved? Australian and New Zealand Journal of Psychiatry 36, 622–628.CrossRefGoogle ScholarPubMed
Gelman, CR (2004). Empirically-based principles for culturally competent practice with Latinos. Journal of Ethnic and Cultural Diversity in Social Work 13, 83–108.CrossRefGoogle Scholar
Gelman, CR, López, M, Foster, RP (2006). Evaluating the impact of a cognitive-behavioural intervention with depressed Latinas: a preliminary report. Social Work in Mental Health 4, 1–16.Google Scholar
Gloaguen, V, Cottraux, J, Cucherat, M, Blackburn, IM (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders 49, 59–72.CrossRefGoogle ScholarPubMed
Greenberger, D, Padesky, CA (1995). Mind over Mood: A Cognitive Therapy Treatment Manual for Clients. New York: Guilford Press.Google Scholar
Griffiths, KM, Christensen, H, Jorm, AF, Evans, K, Groves, C (2004). Effect of web-based depression literacy and cognitive–behavioural therapy interventions on stigmatising attitudes to depression randomised controlled trial. British Journal of Psychiatry 185, 342–349.Google Scholar
Herbert, AML (2001). Whanau whakapakari: a Māori-centred approach to child rearing and parent-training programmes. Unpublished doctoral dissertation, University of Waikato, Hamilton, New Zealand.Google Scholar
Hersen, M, Himmelhoch, JM, Thase, ME, Bellack, AS (1984). Effects of social skill training, amitriptyline, and psychotherapy in unipolar depressed women. Behaviour Therapy 15, 21–40.Google Scholar
Hinton, DE, Hofmann, SG, Rivera, E, Otto, MW, Pollack, MH (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, 275–280.CrossRefGoogle ScholarPubMed
Hinton, DE, Pham, T, Tran, M, Safren, SA, Otto, MW, Pollack, MH (2004). CBT for Vietnamese refugees with treatment-resistant PTSD and panic attacks: a pilot study. Journal of Traumatic Stress 17, 429–433.CrossRefGoogle ScholarPubMed
Hinton, DE, Rivera, EI, Hofmann, SG, Barlow, DH, Otto, MW (2012). Adapting CBT for traumatized refugees and ethnic minority patients: examples from culturally adapted CBT (CA-CBT). Transcultural Psychiatry 49, 340–365.Google Scholar
Hirini, P (1997). Counselling Māori clients – He-whakawhiti-nga-whakaaro-i-te-tangata-whaiora-Maori. New Zealand Journal of Psychology 26, 13–18.Google Scholar
Hollon, SD, Kendall, PC (1980). Cognitive self-statements in depression: development of an automatic thoughts questionnaire. Cognitive Therapy and Research 4, 383–395.CrossRefGoogle Scholar
Interian, A, Allen, LA, Gara, MA, Escobar, JI (2008). A pilot study of culturally adapted cognitive behaviour therapy for Hispanics with major depression. Cognitive and Behavioural Practice 15, 67–75.Google Scholar
Interian, A, Díaz-Martínez, AM (2007). Considerations for culturally competent cognitive-behavioural therapy for depression with Hispanic patients. Cognitive and Behavioural Practice 14, 84–97.CrossRefGoogle Scholar
Joe, S, Woolley, ME, Brown, GK, Ghahramanlou-Holloway, M, Beck, AT (2008). Psychometric properties of the Beck Depression Inventory – II in low-income, African American suicide attempters. Journal of Personality Assessment 90, 521–523.Google Scholar
Jones, S (2004). Psychotherapy of bipolar disorder: a review. Journal of Affective Disorders 80, 101–114.Google Scholar
Kaufman, NK, Rohde, P, Seeley, JR, Clarke, GN, Stice, E (2005). Potential mediators of cognitive-behavioural therapy for adolescents with comorbid major depression and conduct disorder. Journal of Consulting and Clinical Psychology 73, 38.CrossRefGoogle ScholarPubMed
Kawharu, IH (1989). Waitangi: Māori and Pākehā perspectives of the Treaty of Waitangi. USA: Oxford University Press.Google Scholar
Keijsers, GPJ, Schaap, CPDR, Hoogduin, CAL (2000). The impact of interpersonal patient and therapist behaviour on outcome in cognitive-behaviour therapy: a review of empirical studies. Behaviour Modification 24, 264–297.Google Scholar
Keller, MB, McCullough, JP, Klein, DN, Arnow, B, Dunner, DL, Gelenberg, AJ, et al. (2000). A comparison of nefazodone, the cognitive behavioural-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine 342, 1462–1470.Google Scholar
King, M (2003). Penguin History of New Zealand. UK: Penguin.Google Scholar
Knox, S, Hill, CE (2003). Therapist self-disclosure: research-based suggestions for practitioners. Journal of Clinical Psychology 59, 529–539.Google Scholar
Koder, DA, Brodaty, H, Anstey, KJ (1996). Cognitive therapy for depression in the elderly. International Journal of Geriatric Psychiatry 11, 97–107.Google Scholar
Koerner, K, Linehan, MM (2000). Research on dialectical behaviour therapy for patients with borderline personality disorder. Psychiatric Clinics of North America 23, 151–167.Google Scholar
Kohn, LP, Oden, T, Muñoz, RF, Robinson, A, Leavitt, D (2002). Brief report: adapted cognitive behavioural group therapy for depressed low-income African American women. Community Mental Health Journal 38, 497–504.Google Scholar
Laliberté, A, Nagel, T, Haswell, M (2010). Low intensity CBT with indigenous consumers: creative solutions for culturally appropriate mental health care. In: Oxford Guide to Low Intensity CBT Interventions (ed. Bennett-Levy, J., Richards, D. A., Farrand, P., Christensen, H., Griffiths, K. M., Kavanagh, D. J., Klein, B., Lau, M. A., Proudfoot, J., Ritterband, L., White, J. and Williams, C.), pp. 577–585. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
Lawson-Te Aho, K (1994). The master's tools. . . Māori development inside Pakeha psychology. Unpublished doctoral dissertation. The University of Waikato, Hamilton, New Zealand.Google Scholar
Levy, MP (2007). Indigenous psychology in Aotearoa: realising Māori aspirations. Unpublished doctoral dissertation, The University of Waikato, Hamilton, New Zealand.Google Scholar
Linehan, MM, Schmidt, H, Dimeff, LA, Craft, JC, Kanter, J, Comtois, KA (1999). Dialectical behaviour therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions 8, 279–292.Google Scholar
Manassis, K, Avery, D, Butalia, S, Mendlowitz, S (2004). Cognitive-behavioural therapy with childhood anxiety disorders: functioning in adolescence. Depression and Anxiety 19, 209–216.CrossRefGoogle ScholarPubMed
Miranda, J, Bernal, G, Lau, A, Kohn, L, Hwang, WC, LaFromboise, T (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology 1, 113–142.Google Scholar
Nathan, S (1999). Tikanga Māori in Aotearoa/New Zealand clinical psychology training programmes: A follow up of Abbott and Durie's (1987) study. Unpublished Master of Arts Thesis, Victoria University of Wellington, Wellington.Google Scholar
Oakley-Browne, MA, Wells, JE, Scott, KM, Kessler, RC, Üstün, TB (2008). Te rau hinengaro: the New Zealand Mental Health Survey, pp. 486–508. World Health Organization.Google Scholar
Okazaki, S, Tanaka-Matsumi, J (2006). Cultural considerations in cognitive-behavioural assessment. In: Culturally Responsive Cognitive-Behavioural Therapy: Assessment, Practice, and Supervision (ed. Hays, P. A. and Iwamasa, G. Y.), pp. 247–266. Washington, DC: American Psychological AssociationGoogle Scholar
Organista, KC (2006). Cognitive-behavioural therapy with Latinos and Latinas. In: Culturally Responsive Cognitive-Behavioural Therapy: Assessment, Practice, and Supervision (ed. Hays, P. A. and Iwamasa, G. Y.), pp. 73–96. Washington, DC: American Psychological Association.Google Scholar
Organista, KC, Muñoz, RF, González, G (1994). Cognitive-behavioral therapy for depression in low-income and minority medical outpatients: Description of a program and exploratory analyses. Cognitive Therapy and Research 18, 241–259.Google Scholar
Orlinsky, DE, Howard, KI (1987). A generic model of psychotherapy. Journal of Integrative & Eclectic Psychotherapy 6, 6–27.Google Scholar
Otto, MW, Hinton, D, Korbly, NB, Chea, A, Ba, P, Gershuny, BS, Pollack, MH (2003). Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behaviour therapy vs sertraline alone. Behaviour Research and Therapy 41, 1271–1276.Google Scholar
Paewai, MK (1997). Cultural safety within clinical psychology: a Māori perspective. Unpublished doctoral dissertation. The University of Waikato, Hamilton, New Zealand.Google Scholar
Patchett-Anderson, LS (1997). Clinical psychologists’ opinions about and uses of tests, assessment, and clinical intervention applications. Unpublished Master of Arts, Massey University, Palmerson North.Google Scholar
Pina, AA, Silverman, WK, Fuentes, RM, Kurtines, WM, Weems, CF (2003). Exposure-based cognitive-behavioural treatment for phobic and anxiety disorders: treatment effects and maintenance for Hispanic/Latino relative to European-American youths. Journal of the American Academy of Child and Adolescent Psychiatry 42, 1179–1187.Google Scholar
Pitama, S, Robertson, P, Cram, F, Gillies, M, Huria, T, Dallas-Katoa, W (2007). Meihana model: a clinical assessment framework. New Zealand Journal of Psychology 36, 118–125.Google Scholar
Pretzer, JL, Beck, AT (1996). A cognitive theory of personality disorders. In: Major Theories of Personality Disorder (ed. Clarkin, J. F. and Lenzenweger, M. F.), pp. 36–105. New York: Guilford Press.Google Scholar
Rosselló, J, Bernal, G, Rivera-Medina, C (2012). Individual and group CBT and IPT for Puerto Rican adolescents with depressive symptoms. Journal of Latina/o Psychology 1 (Suppl.), 36–51.CrossRefGoogle Scholar
Schmitz, JM, Averill, P, Sayre, S, McCleary, P, Moeller, FG, Swann, A (2002). Cognitive-behavioural treatment of bipolar disorder and substance abuse: a preliminary randomized study. Addictive Disorders and their Treatment 1, 17–24.Google Scholar
Soroudi, N, Perez, GK, Gonzalez, JS, Greer, JA, Pollack, MH, Otto, MW, Safren, SA (2008). CBT for medication adherence and depression (CBT-AD) in HIV-infected patients receiving methadone maintenance therapy. Cognitive and Behavioural Practice 15, 93–106.CrossRefGoogle Scholar
Sprinkle, SD, Lurie, D, Insko, SL, Atkinson, G, Jones, GL, Logan, AR, Bissada, NN (2002). Criterion validity, severity cut scores, and test-retest reliability of the Beck Depression Inventory – II in a university counseling center sample. Journal of Counseling Psychology 49, 381.CrossRefGoogle Scholar
Statistics New Zealand (2006). 2006 Census of population and dwellings. Statistics New Zealand.Google Scholar
Stiles, WB, Shapiro, DA, Firth-Cozens, JA (1988). Verbal response mode use in contrasting psychotherapies: a within-subjects comparison. Journal of Consulting and Clinical Psychology 56, 727.CrossRefGoogle ScholarPubMed
Sunseri, PA (2004). Preliminary outcomes on the use of dialectical behavior therapy to reduce hospitalization among adolescents in residential care. Residential Treatment for Children & Youth 21, 59–76.Google Scholar
Toukmanian, SG, Brouwers, MC (1998). Cultural aspects of self-disclosure and psychotherapy. In: Cultural Clinical Psychology: Theory, Research, and Practice (ed. Kazarian, S. S. and Evans, D. R.), pp. 106–124. New York, NY: Oxford University Press.Google Scholar
US Department of Health and Human Services. (2005). Public health service. Food and Drug Administration, 2005.Google Scholar
Waldron, HB, Kaminer, Y (2004). On the learning curve: the emerging evidence supporting cognitive–behavioural therapies for adolescent substance abuse. Addiction 99 (Suppl. 2), 93–105.Google Scholar
Walker, R (1990). Ka whawhai tonu matou: Struggle Without End. Auckland: Penguin.Google Scholar
Westen, D, Bradley, R (2005). Empirically supported complexity rethinking evidence-based practice in psychotherapy. Current Directions in Psychological Science 14, 266–271.Google Scholar
Wattar, U, Sorensen, P, Buemann, I, Birket-Smith, M, Salkovskis, PM, Albertsen, M, Strange, S (2005). Outcome of cognitive-behavioural treatment for health anxiety (hypochondriasis) in a routine clinical setting. Behavioural and Cognitive Psychotherapy 33, 165–175.Google Scholar
Zlotnick, C, Johnson, J, Najavits, LM (2009). Randomized controlled pilot study of cognitive-behavioural therapy in a sample of incarcerated women with substance use disorder and PTSD. Behaviour Therapy 40, 325–336.Google Scholar
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