Post on 08-May-2015
description
Using CBT with South Asian Muslims
Farooq NaeemMBBS, MSc, MRCPsych, PhD
Consultant Psychiatrist & CBT Therapist
Associate Professor, Queens University, Kingston, Canada
Background
Emphasis on culturally adapted psychotherapy for ethnic minorities (USA)
Few guidelines (e.g., Sue, 1990; Bernal, 1995, Hwang, 2006; Tseng 2004; Hays, 2006, Naeem et al, 2009, Rathod et al, 2010)
Few Trials (Hispanics, Latinos, African, Asian)
Status of CBT in Non Western Countries
Cultural competence? Psychotherapy is a cultural phenomenon
Growing diversity of ethnic population
Health disparities between different ethnic groups & Justice or ethical issues (Sue et al, 2009)
Evidence from research (Kohn et al 1999, Sue et al 2005, Naeem et al, 2009)
Developing Culturally adapted CBT, Southampton
Adaptation of CBT in Pakistan
– Depression (2006-9)
– Psychosis
Adaptation of CBT for psychosis in UK (BME population)
Manchester- CA family/ individual therapy for psychosis, substance misuse etc.
Adaptation of CBT for depression in Pakistan
1. Information gathering Interviews with psychologist (Naeem
et al, 2010), Interviews with patients (Naeem et al, in press), Group discussions with students (Naeem et al, 2009) experience of therapy, field observation
1. Southampton adaptation framework (Naeem et al, 2009)
2. Exploratory trial (Naeem et al, 2011)
CBT in non western cultures
English language journals
Few published on depression (Wong et al, 2009, Naeem et al, 2011)
Currently in PakistanRCT of self help,
CBTp- in-patient RCT, brief CBT RCT s (depression and
psychosis), treatment resistant psychosis, CBT for MUS,
One RCT of CBTp in China
Cultural adaptation: Psychosis
Qualitative study to adapt CBTp (Naeem et al, under review)
A total of 92 interviews by 3 psychologists
– Patients (33), Carers (30), Mental health professionals (29) Psychologists (14) Doctors working in psychiatry (15)
exploratory trial of adapted CBT for psychosis (Habib et al, under review)
Bio-Psycho-Social-Spiritual Model Pakistan (Naeem) UK (Shanaya & Peter) UK (Bheeka)
Psycho social stress or worry (25)poverty, (22), loss of balance of mind (2) too much thinking (1) personality (1) Biological hereditary (4), chemicals in brain (6), childbirth (1) phlegm (1) increased heat in liver (1)Spiritual/religious & culturalspirits, magic, taweeds, fear of hawai things (ghosts etc) (8) learning of spiritualism (2) evile eye (1) Gods will (1)Other causes masturbation (1), Don’t know (6)
Previous wrong doingSupernatural beliefs +++++
Social factors ++++
Biological +++
Being arrested Drug induced
Spiritual/religious causes (55%)
Psycho socialStress (18%) Interpersonal causes (20%)
Biological (4.4%).
Dual explanatory models of psychosis (77.7%), combining prescribed medication and seeing a traditional faith healer as a treatment method
Cultural competence in CBT
The Triple A Principle
– Awareness and preparation
– Assessment & engagement
– Adaptation of therapy (minor adjustments)
Awareness and preparation
Southampton Adaptation Framework for SAM (Naeem et al, 2009)
Culture &
related issues
Capacity &
Circumstances
Cognitions &
Beliefs
Cause and effect
Thanks God not Thank you
God’s will not a head injury due to the accident
Language and communication
– Translation of psychological concepts (Name the title technique)
Culture and assertiveness (an example)
North American concept (context)
Based on rights
Asian cultures focus on duties
– Respect (triangulated approach to communication)
– Shame and guilt (Paul Guilberts work)
– Culturally sensitive assertiveness techniques (e.g., apology technique, fogging etc.)
Family related issues
– Both strengths and difficulties
– Help with
Engagement
Follow up
Home work
– Engaging family rather than only patient
Capacity & Circumstances
Individual issues
– Women less likely to seek help
Health system (Resources and organization)
Pathways to care & help seeking behaviour
– Pathways for psychosis different from pathways for depression?
Cognitions & Beliefs
Beliefs about health and illness
– Spiritual/paranormal causes of illness
Beliefs about treatment and treatment provider
– What do you know/think about CBT?
Cognitive errors and dysfunctional beliefs
Assessment
Cultural identity, acculturation & difficulties in cultural adjustments
Understanding of problems/ stigma
Beliefs about illness and its treatment
Expectations from/knowledge of treatment
• Involvement of faith healers, religious healers, alternative healing practices etc.
Engagement-the biggest hurdle
What do patients expect from a (good) healer
Directive style of therapy (Socrates Vs Buddha)
Evidence from research Vs stories of successful cases from other clients
Immediate relief of some symptoms
Therapy- minor adjustments
Psycho education
Family involvement
Culturally accepted treatments
Acceptance/involvement of traditional/faith healers .
Local practices- head massage etc.
Foods/things to avoid- parhaiz
Focus of therapy (e.g., Physical symptoms in thought diaries)
Home work Regular remindersLess of writing workInvolvement of familyUse of beads, audio recorders, mp3 players etc.Time keeping through prayer times Be careful with terminology (e.g., negative
thinking, talking therapy)
Therapy techniques
– Helping clients to identify thoughts & emotions
– Behavioural techniques (Behavioural activation, experiments etc.,) problem solving, etc easy to use.
– Socratic dialogue with care
– Mindfulness/sufisim based techniques with care ? (faith/spiritual authority)
Structural changes in therapy
– Place of therapy, number of sessions, starting therapy while in patient , twice a week sessions initially
Brief vs standard therapy
Use of stories and images
Further readings
CBT in Non Western Cultures
29 CBT therapists from across the world
– Role of culture/religion/system
– CBT techniques minor adjustments
– Therapists awareness of local culture/religion
Thank you
farooqnaeem@yahoo.com