Client-led culturally responsive CBT – integrating familism in the treatment of chronic depression: a case study

2020 ◽  
Vol 13 ◽  
Author(s):  
Lilian Skilbeck ◽  
Christopher Spanton ◽  
Ian Roylance
Keyword(s):  
Cultural Adaptation ◽  
Treatment Plan ◽  
Behavioural Therapy ◽  
Cultural Responsiveness ◽  
Chronic Depression ◽  
List Type ◽  
Her Family ◽  
Psychological Therapies ◽  
Cognitive Behavioural

Abstract Britain has increasingly become a multi-cultural society. In order to improve access to primary care psychological therapy including cognitive behavioural therapy (CBT), there has been an increase in focus on cultural adaptation and cultural responsiveness. To date, these adaptations have focused on domains such as language, beliefs and values. In this case, familism was the focus for adaptation. The client was a 22-year-old female from a black African-British background. She presented with severe symptoms of chronic depression as measured on routine standard questionnaires and the interview. She had minimal success from previous interventions and was struggling to make progress. Therapy was guided by the client’s views on what issues had a bearing on her difficulties. The client hypothesised that familism factors with themes around ‘my parents’ culture’ and ‘family comes first’ were interacting with her cognitive behavioural factors to maintain her problem. She requested the involvement of her family in her treatment plan. In line with the Improving Access to Psychological Therapies–Black, Asian and Minority Ethnic service user Positive Practice Guide, this was integrated as part of her formulation. Upon involvement of her father in a single session, the client attained reliable improvement. She attributed her improvement to this involvement. By the end of therapy, she reached recovery, which was maintained at 3-month follow-up. This study was responsive to the client’s own perceived cultural needs through the integration of familism into her CBT formulation. It illustrates a client-led cultural adaptation of CBT to treat chronic depression. Key learning aims It is hoped that the reader will increase their understanding of the following from reading this case study: (1) Creating an environment where clients can freely discuss their perceived cultural factors from the outset. (2) Client-led cultural responsiveness to their expressed cultural needs. (3) Familism as a domain for adapting CBT.

scholarly journals ‘Felt security’ as a means of facilitating imagery rescripting in psychosis: a clinical protocol and illustrative case study

2020 ◽  
Vol 13 ◽  
Author(s):  
Katherine Newman-Taylor
Keyword(s):  
Behavioural Therapy ◽  
Illustrative Case ◽  
Imagery Task ◽  
List Type ◽  
Short Term ◽  
Cognitive Behavioural ◽  
Imagery Rescripting ◽  
Illustrative Case Study ◽  
The Impact

Abstract People with psychosis do not have routine access to trauma-focused cognitive behavioural therapy (CBT) interventions such as imagery rescripting (IR), partly due to clinical caution. This case study describes the use of a simple imagery task designed to engender ‘felt security’, as a means of facilitating IR with a woman struggling with distressing memory intrusions, linked to her voices and paranoia. We assessed the impact of the felt security task, which was used before IR to enable Kip to engage in reprocessing of her trauma memories, and again after IR so that she would leave sessions feeling safe. The brief imagery task was effective in improving felt security before IR sessions. Felt security then reduced during IR, when distressing material was recalled and reprocessed, and increased again when the task was repeated. It is not yet clear whether trauma-focused interventions such as IR need to be routinely adapted for people with psychosis. In the event that individuals express concerns about IR, if the person’s formulation indicates that high levels of arousal may trigger an exacerbation of voices, paranoia or risk, or where clinicians are otherwise concerned about interventions likely to increase emotional arousal in the short term, the felt security task may facilitate safe and effective reprocessing of trauma memories. This in turn may increase access to trauma-focused CBT for people with psychosis. Key learning aims (1) To understand that people with psychosis need access to trauma-focused CBT. (2) To be familiar with a simple attachment-based imagery task designed to foster ‘felt security’. (3) To learn that this task may facilitate imagery rescripting in people with psychosis.

Helping clients ‘restart their engine’ – use of in-session cognitive behavioural therapy behavioural experiments for engagement and treatment in persistent depression: a case study

2020 ◽  
Vol 13 ◽  
Author(s):  
Lilian Skilbeck ◽  
Christopher Spanton ◽  
Ian Roylance
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
List Type ◽  
Perceptual Field ◽  
Major Depressive ◽  
Cognitive Behavioural ◽  
Persistent Depression ◽  
Recommendations For Practice ◽  
Behavioural Experiments

Abstract Behavioural experiments (BEs) are a major cognitive ingredient in the cognitive behavioural therapy (CBT) model which can be applied in-session or between-sessions. In-session BEs are particularly effective and widely demonstrated in anxiety disorders, yet they remain under-utilised in depression. Clients presenting with persistent depression are often difficult to engage due to the chronicity of their symptoms and their learnt self-perpetuating demoralised states. Research to date demonstrates the effectiveness of in-session BEs in engagement and treatment in depression. This case study details the treatment of a client presenting with persistent major depressive disorder (MDD) with hopelessness and how in-session BEs effected engagement and treatment. This case study is discussed with reference to strengths, limitations, clinical implications and recommendations for practice and development. Key learning aims It is hoped that the reader of this case study will increase their understanding of the following: (1) Using BEs to help engagement and treatment in persistent MDD. (2) Instilling hope by starting in-session BEs during the assessment stage. (3) When to plan or seize opportunities for off-the-cuffin-session BEs. (4) Setting no-lose BEs to enable clients to widen their perceptual field. (5) The importance of repeated BEs to consolidate experiential learning.

scholarly journals Transdiagnostic CBT for adult emotional disorders: A feasibility open trial from Saudi Arabia

2019 ◽  
Vol 12 ◽  
Author(s):  
Yousra Alatiq ◽  
Omar Al Modayfer
Keyword(s):  
Saudi Arabia ◽  
Emotional Disorders ◽  
Treatment Plan ◽  
Behavioural Therapy ◽  
Open Trial ◽  
Limited Resources ◽  
List Type ◽  
Low Intensity ◽  
Cognitive Behavioural ◽  
Potential Benefits

AbstractTransdiagnostic cognitive behavioural therapy (T-CBT) provides potential for improving psychotherapy services in countries with limited resources. The primary aim of this study was to assess the feasibility and potential benefits of using T-CBT in Saudi Arabia to treat adult emotional disorders in a naturalistic open trial. A secondary aim was to measure the effect of this approach when delivered by junior psychologists as a low-intensity intervention. The overall sample consisted of 198 patients (160 in the low-intensity group). Only 33 (16.7%) patients had completed the treatment plan, 55 (27.3%) were still active in treatment, and 109 (55%) had disengaged from the treatment. The pre- and post-assessments for the clients who completed the treatment showed a significant decrease in all outcome measures. This result held true for the whole sample and the low-intensity group. This study provides initial evidence that T-CBT is suitable for clients with emotional disorders in Saudi Arabia. The study also provides support for the effect of T-CBT as a low-intensity intervention delivered by junior psychologists. However, one of the study limitations was the sample size for the group who completed the treatment and was properly discharged from service. Implications and recommendations are discussed.Key learning aims(1)To examine the feasibility and potential benefits of using T-CBT in Saudi Arabia.(2)To measure the effect of T-CBT as low-intensity interventions delivered by junior psychologists.(3)To establish evidence-based practice for T-CBT in Saudi Arabia.

Mending a broken heart: a single case study on cognitive behavioural therapy for depression after romantic relationship break-up

2020 ◽  
Vol 13 ◽  
Author(s):  
Muthmainah Mufidah Gozan ◽  
Adhityawarman Menaldi
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Romantic Relationship ◽  
Single Case ◽  
Behavioural Therapy ◽  
Depression Symptoms ◽  
List Type ◽  
Cognitive Behavioural ◽  
Negative Thoughts ◽  
Break Up

Abstract Having and building a romantic relationship is an important aspect of development in young adulthood. However, there are some challenges in relationships, including basic principle differences such as faith and culture that lead to fights and break-ups. Going through a break-up is not easy for some people and is considered to be one of the stress sources in people’s lives that often links to depression symptoms. It is crucial to focus on intervention aiming at the cognitive aspects, including negative thoughts and bias when dealing with depression, such as cognitive behavioural therapy (CBT). However, CBT in the Indonesian context, especially with religious and ethnic problems in a romantic relationship before marriage, is limited. This study aims to explore this by presenting the case of a 26-year-old Indonesian male with depressive episodes after a painful break-up due to religious and cultural differences. The previous history of childhood abuse and problems in social adjustment and communication had also worsened his conditions. CBT was used for treatment as he developed many negative thoughts about himself and had maladaptive beliefs about his conditions and his future. This case study report shows the effectiveness of CBT intervention in decreasing depression symptoms, such as sadness and the thought of being unworthy, as well as increasing self-confidence in facing difficulties. Key learning aims (1) To understand delivering CBT in a single case with mild depression triggered by relationship break-up. (2) To understand the applicability of CBT in the Indonesian context with a cultural and religious background. (3) To reflect on the challenges faced and treatment strategies in implementing an adapted CBT technique.

Cultural adaptation of cognitive–behavioural therapy

2019 ◽  
Vol 25 (6) ◽  
pp. 387-395 ◽  
Author(s):  
Farooq Naeem ◽  
Peter Phiri ◽  
Shanaya Rathod ◽  
Muhammad Ayub
Keyword(s):  
Cultural Values ◽  
Cognitive Behavioural Therapy ◽  
Cultural Adaptation ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
Cultural Factors ◽  
Full Potential ◽  
List Type ◽  
The West ◽  
Cognitive Behavioural

SUMMARYThe 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.LEARNING OBJECTIVESAfter 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.

To Jurassic Park via Australia: A case study showing how dramatherapy enabled the creation and maintenance of embodied metaphors to support recovery from early psychosis

Dramatherapy ◽  
2020 ◽  
Vol 41 (1) ◽  
pp. 37-49
Author(s):  
Louise Combes ◽  
Lauren A Bradley
Keyword(s):  
Alcohol Misuse ◽  
Behavioural Therapy ◽  
Drama Therapy ◽  
Supported Accommodation ◽  
Life Challenges ◽  
Cognitive Behavioural ◽  
Communication Difficulties ◽  
Residential Rehabilitation ◽  
Early Intervention In Psychosis

This case study shows how Dramatherapy can engage clients with communication difficulties, which exclude them from standard mental health pathways in early intervention in psychosis services. Deliberately prioritising the client’s newfound modes of expression to shape the narrative within, it is evident Dramatherapy processes; embodiment, projection and role enabled this client to create and then inhabit his own playful metaphors. These metaphors continued to facilitate every-day life challenges. During his Dramatherapy relationship, the client within this case study transitioned from supported accommodation to his own property, progressed to residential rehabilitation for alcohol misuse and finally engaged in cognitive behavioural therapy. From feedback interviews we know he continued to create and use his own protective metaphors 10 months after drama therapy ended. He returned to education as part of his plan to seek appropriate employment and was discharged to his GP.

scholarly journals Evaluation of a Trauma-Focused CBT Training Programme for IAPT services

2017 ◽  
Vol 45 (5) ◽  
pp. 467-482 ◽  
Author(s):  
Hannah Murray
Keyword(s):  
Training Programme ◽  
Behavioural Therapy ◽  
Routine Practice ◽  
Post Traumatic Stress ◽  
Training Interventions ◽  
Psychological Therapies ◽  
Cognitive Behavioural ◽  
Co Morbidity ◽  
Early Life Trauma ◽  
Post Traumatic

Background: Therapists in Improving Access to Psychological Therapies (IAPT) services are often expected to treat complex presentations of post-traumatic stress disorder (PTSD), such as individuals with multiple, prolonged or early life trauma histories and significant co-morbidity, for which they have received minimal training. Although high recovery rates for PTSD have been demonstrated in randomized controlled trials, these are not always replicated in routine practice, suggesting that training interventions are required to fill the research–practice gap. Aims: This study investigated the outcomes of a therapist training programme on treating PTSD with trauma-focused cognitive behavioural therapy (TF-CBT). Method: Twenty therapists from ten IAPT services participated in the training, which consisted of workshops, webinars and consultation sessions over a 6-month period. Results: Feedback indicated that participants found the training highly acceptable. PTSD knowledge and self- and supervisor-rated competence on TF-CBT measures improved following the training and improvements were maintained a year later. Client outcomes on a PTSD measure improved following the training. Participants reported attempts to disseminate learning from the course back to their teams. Conclusions: The findings indicate that the training programme was successful in improving TF-CBT knowledge, skills and outcomes for IAPT therapists. Tentative support for training ‘trauma experts’ within IAPT services was found, although institutional constraints and staff turnover may limit the sustainability of the model.

Critical issues in cognitive behavioural therapy (CBT) with gender and sexual minorities (GSMs)

2022 ◽  
Vol 15 ◽  
Author(s):  
Sérgio A. Carvalho ◽  
Paula Castilho ◽  
Daniel Seabra ◽  
Céu Salvador ◽  
Daniel Rijo ◽  
...  
Keyword(s):  
Mental Health ◽  
Cognitive Behavioural Therapy ◽  
Minority Stress ◽  
Sexual Minorities ◽  
Clinical Work ◽  
Behavioural Therapy ◽  
List Type ◽  
Cognitive Behavioural ◽  
Critical Issues ◽  
Societal Structure

Abstract In a cisheteronormative culture, gender and sexual minorities (GSMs) may experience additional challenges that get in the way of a meaningful life. It is crucial that clinicians are mindful of these challenges and cognizant about the specificities of clinical work with GSMs. This article points out how societal structure interferes with mental health, and clarifies what clinicians must take into account when using affirmative cognitive behavioural therapy (CBT) interventions. Knowledge of up-to-date terminology and use of affirmative language are the first steps that contribute to clients’ experience of respect, which is paramount for the development of a good therapeutic relationship. Considering a conceptual framework of minority stress to understand vulnerability in GSM, specificities in formulation and key psychological processes are discussed. Moreover, guidelines and practical tools for intervention are presented within a CBT approach. Some reflections on therapists’ own personal biases are encouraged, in order to increase the efficacy of interventions. Key learning aims After reading this article you will be able to: (1) Recognize the uniqueness of gender and sexual minorities (GSM) stressors in broad and specific contexts, and their impact on mental health. (2) Identify the underlying key processes and specificities in therapeutic work with GSMs, from a CBT perspective. (3) Recognize the importance of a culturally sensitive approach in affirmative CBT interventions.

scholarly journals Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural Adaptation of CBT

2019 ◽  
Vol 12 ◽  
Author(s):  
Farooq Naeem
Keyword(s):  
Cultural Adaptation ◽  
Behavioural Therapy ◽  
Vital Role ◽  
Sufficient Evidence ◽  
Future Research ◽  
Full Potential ◽  
Special Issue ◽  
Current Form ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour

AbstractCognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working with diverse populations. Contributors to this special issue of theCognitive Behaviour Therapisthave tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. Here, I briefly summarize and discuss the papers in this special issue. I start with a systematic review of CBT for social anxiety across cultures. Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Three papers discuss the issues of gender and sexuality when using CBT, while another three papers focus on refugees, asylum seekers and the homeless, and two papers describe the application of CBT with religious populations. Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Collectively, papers in this special issue provide us with sufficient evidence that cultural considerations play a vital role when using CBT, offer practical suggestions for improving cultural competence and most importantly, can catalyse future research. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers.

What are the recovery and attrition outcomes for group CBT and individual CBT for generalised anxiety disorder in an IAPT service? An exploratory study

2020 ◽  
Vol 13 ◽  
Author(s):  
Marianne Fanous ◽  
Jo Daniels
Keyword(s):  
Anxiety Disorder ◽  
Behavioural Therapy ◽  
Anxiety And Depression ◽  
List Type ◽  
Generalised Anxiety Disorder ◽  
Post Intervention ◽  
Attrition Rates ◽  
Clinical Recovery ◽  
Psychological Therapies ◽  
Group Cbt

Abstract Group cognitive behavioural therapy (gCBT) is commonly used in Increasing Access to Psychological Therapies (IAPT) services. However, there is limited knowledge of the efficacy of gCBT as a delivery format for generalised anxiety disorder (GAD). To address gaps in literature, this study aims to explore the efficacy and attrition of individual and group CBT interventions, respectively, at Step 3 for GAD using data from a routine IAPT service over a 24-month period. Data were retrospectively derived from a routine serviceʼs IAPTus database, separating those eligible for comparison into group (n = 44) and individual (n = 55) CBT for GAD. Outcomes were differences in pre–post self-reported anxiety (GAD-7) and depression (PHQ-9) scores, clinical recovery and attrition for gCBT and individual CBT. Both gCBT and individual CBT yielded significant reductions in self-reported anxiety and depression scores over time. Results indicate that 53% of patients attending individual CBT achieved clinical recovery, with similar but less competitive rates of 41% in gCBT. Attrition rates were similar between gCBT (29.5%) and individual CBT (27.3%), respectively. Preliminary results suggest that both individual and gCBT are effective interventions for GAD patients in IAPT, offering symptom alleviation and comparable recovery and attrition rates post-intervention. This observational design offers credibility and insight into a pragmatic evaluative and explorative comparison. gCBT may offer an acceptable and potentially economical alternative. Key learning aims (1) To explore whether gCBT and individual CBT yield significant symptom reduction in self-reported anxiety and depression in GAD patients from a routine IAPT service. (2) To explore gCBT and individual CBT clinical recovery rates in non-optimum routine conditions. (3) To explore whether gCBT for GAD produces unacceptable attrition rates and if this differs from attrition rates in individual CBT for GAD in a routine IAPT service.

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