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Chapter 9 - Transcultural Issues in Mood Disorders
- Edited by Allan Young, Institute of Psychiatry, King's College London, Marsal Sanches, Baylor College of Medicine, Texas, Jair C. Soares, McGovern Medical School, The University of Texas, Mario Juruena, King's College London
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- Clinical Textbook of Mood Disorders
- Published online:
- 16 May 2024
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- 23 May 2024, pp 95-102
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Summary
Cultural background influences multiple aspects of human experience, including perceptions of mental illness and symptom expression. Incidence and prevalence of mood disorders appear to differ between cultures, with higher rates reported for developing compared to developed areas, although this is limited by differences diagnostic classification, as well as methodological inconsistencies in epidemiological studies. Social constructs about the self and others, beliefs, norms, and customs may affect not only the occurrence but also shape the profile of mood disorders and the extent of help seeking. The impact of culture on illness presentation may even extend to treatment selection and service use. Culture plays an important role in treatment outcomes, with racial disparities in antidepressant efficacy and fewer talking therapy referrals for minorities being prominent examples. Access to health services may also vary between cultural groups, even within regions and countries. A personalised approach matching patients with clinicians may provide a framework for shared understanding and experiences of illness to improve provided care.
Exploring the supervisory relationship in the context of culturally responsive supervision: a supervisee’s perspective
- Bianca Vekaria, Tessa Thomas, Peter Phiri, Margarita Ononaiye
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- Journal:
- The Cognitive Behaviour Therapist / Volume 16 / 2023
- Published online by Cambridge University Press:
- 07 September 2023, e22
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Clinical supervision is a relationship-based education, considered crucial in providing clinicians with emotional support, skill development and improving client outcomes. Culturally responsive supervision assumes that culture permeates clinical practice and supervision. Culturally responsive supervisors promote the development of cultural competence in supervision, through modelling, reflective discussion and responsivity. Research has demonstrated that greater perceived cultural responsivity in supervision may result in greater satisfaction for supervisees, particularly those from racially or ethnically minoritised (REM) backgrounds. The current study explores supervisee perceptions of culturally responsive supervision and supervisory relationships between different supervisory dyads, comprising supervisees from REM and White backgrounds. This was a cross-sectional design incorporating a between-groups comparison. Trainee and qualified clinical psychologists, counselling psychologists and CBT therapists (n = 222) completed an online survey. Perceptions of cultural responsivity and the supervisory relationship were explored. Participants provided information about their supervisor’s race and ethnicity and their own, and were organised into four supervisory dyads. Participants from REM backgrounds in dyads with White supervisors perceived their supervision as significantly less culturally responsive, with significantly lower quality supervisory relationships. Greater perceived cultural responsivity in supervision significantly predicted better supervisory relationships (regardless of participant cultural background). Findings suggest that culturally responsive supervisory practices may play an important role in developing cultural competence and strengthening the supervisory relationship, particularly in cross-cultural supervisory dyads. Findings present important clinical and theoretical implications.
Key learning aims(1) To understand the need for cultural responsivity within the context of clinical supervision.
(2) To explore the differences between cross-cultural and culturally similar supervisory dyads in perceptions of cultural responsivity in supervision.
(3) To explore the differences between cross-cultural and culturally similar supervisory dyads in perceptions of the quality of the supervisory relationship.
(4) How does culturally unresponsive supervision impact supervisee experiences?
Progression and Retention of Psychiatric Trainees in Wessex
- Zoe Clough, Peter Phiri, Lizi Graves, Mayura Deshpande, Jane Hazelgrove
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S15-S16
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Aims
To explore factors influencing the progression and retention of Psychiatric trainees in training posts within the Health Education England Wessex region. Specifically: To understand what trainees value most in their training; to determine the degree to which trainees feel supported and valued in their training; to determine self-reported burnout measures in trainees; to understand factors that have a negative impact on training experience; to understand factors that are important to trainees when considering future job roles.
MethodsOnline questionnaire survey, capturing both qualitative and quantitative data, open to all Wessex Psychiatric trainees and doctors who had left or completed a Wessex Psychiatry training scheme since 1.1.2018. Responses were collected between 7.6.2021 and 31.7.2021. The survey included a burnout scale, questions about how supported and valued trainees felt during training, and questions regarding career intentions. This project received approval from the Health Research Authority (IRAS 296985).
Results• 50 participants completed the survey and were included in analysis.
• 38% were at risk or high risk of burnout.
• Trainees felt more supported and valued by individuals such as clinical supervisors (70% felt well or very well supported and valued) than by organisations (41% felt well supported and 34% felt well valued by their Trust and Deanery).
• Trainees rated ‘work-life balance’ as the thing they valued most in training (64%).
• Poorly resourced services, trainee workload, lack of role models, experiences of aggression, and defensive practice of seniors were cited as reasons trainees considered leaving Psychiatric training.
• The three most important factors cited by participants when considering a consultant post were ‘Position available with flexible working’(62%), ‘Position available within a supportive team of colleagues’ (54%) and ‘Positive experience working in the Trust as a Trainee’ (46%).
• 81% of higher trainees wished to work less than full time in a consultant position once they had completed training.
ConclusionFlexible working arrangements and work life balance need to be considered in workforce planning. Measures to reduce burnout in psychiatric trainees need to be pro-actively explored by employing Trusts and Deaneries. Mentoring schemes, facilitation of peer support, and clear processes for how to raise concerns regarding supervision are recommended to enhance support for trainees. Junior doctor awards, improved feedback between Trusts and junior doctors and engagement of the Trust board with junior doctors are proposed to improve the sense of value trainees feel. Positive experiences as a trainee are likely to improve retention of local trainees into the local consultant workforce.
Results of a qualitative study of patient, carer and clinician views on the experience of caring for individuals with psychosis in Pakistan
- Shanaya Rathod, Afzal Javed, Rehmina Iqbal, Ayaat Al-Sudani, Akansha Vaswani-Bye, Imran Haider, Peter Phiri
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- The Cognitive Behaviour Therapist / Volume 16 / 2023
- Published online by Cambridge University Press:
- 21 June 2023, e17
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Cultural relevance is a core element of effective psychological interventions like cognitive behaviour therapy (CBT) or family intervention (FI), which can be considered Eurocentric. There have been few studies that have examined explanatory models of mental illness and its management in Pakistan to date. This study elicited patient- and carer-related health beliefs on psychosis including attributions to illness, and help-seeking behaviours to inform development of culturally sensitive treatment and improve outcomes in a unit in Lahore (Pakistan). The study group completed 45 semi-structured qualitative interviews at a mental health rehabilitation centre in Lahore. Data were analysed thematically using emerging themes and content analysis. Participants’ explanatory models for psychosis included religion or faith-driven beliefs, like previous wrong-doing and supernatural ideas such as black magic. Social factors that impacted families included high expectations, social stigma, and discriminations. Families first sought help from faith leaders and then medical or psychological sources of care. Participants had generally positive attitudes about their experience of psychological interventions.
Key learning aims-
(1) The need to consider cultural influences to ensure relevance of interventions like cognitive behaviour therapy (CBT) or family interventions (FI) in different countries.
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(2) The need for cultural adaptation of interventions like CBT and FI in different countries to make them accessible and acceptable.
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(3) When adapting therapy to a particular culture or country, recognizing the importance of engaging the local cultural population in the adaptation process.
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Culturally adapted CBT – the evolution of psychotherapy adaptation frameworks and evidence
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- Farooq Naeem, Sana Sajid, Saiqa Naz, Peter Phiri
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- The Cognitive Behaviour Therapist / Volume 16 / 2023
- Published online by Cambridge University Press:
- 20 March 2023, e10
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Culture plays a significant role in psychotherapy practice, with cultural adaptations being implemented more commonly as globalisation and cultural awareness increase. An abundance of systematic reviews, meta-analyses and randomised controlled trials exploring culturally adapted interventions have been published across the globe. In this paper, we present the historical background to cultural adaptation by summarising and evaluating previous frameworks, as well as reviewing current evidence for such adaptations and highlighting routes for further research. Around twenty cultural adaptation frameworks have been published, covering various population demographics and intervention types, providing general guidelines for the implementation of cultural adaptations to psychosocial interventions. Nearly all the frameworks used previous literature and research to develop models on culturally adapted interventions. Some even implemented stakeholder discussions, randomised control trials, and even pilot studies. A variety of cultural adaptation factors have been outlined and discussed; however, there is no agreement on which elements work and which do not. Existing evidence indicates that culturally adapted interventions are effective, regardless of intervention type or population. While cognitive behavioural therapy (CBT) was the most common intervention in trials, there are, at present, no high-quality comprehensive meta-analyses or systematic reviews on culturally adapted CBT which include all literature on this topic. This is needed in order to provide a holistic and detailed comprehension of where current understanding lies. We conclude our paper with recommendations for researchers, trainers and commissioners.
Key learning aims-
(1) Current theoretical frameworks guiding the development of culturally adapted frameworks will be outlined. Gaps in current literature will be highlighted.
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(2) An overview of the current literature of culturally adapted psychotherapies, specifically CBT and its efficacy in improving outcomes for patients, will be provided.
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(3) The need for culturally adapted CBT and comprehensive guidelines for the development of these interventions will also be discussed, with clinical implications highlighted.
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The Psychological Impact of COVID-19 Pandemic on Suicidal Thoughts in the United Kingdom
- Shanaya Rathod, Peter Phiri, Saseendran Pallikadavath, Elizabeth Graves, Ashlea Brooks, Pranay Rathod, Sharon Lin
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S69
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Aims
Background: The impact of the pandemic and resultant restrictions on suicidal thoughts may vary across populations, geographical areas, between high and low socio-economic groups and vulnerable populations. Aim: To investigate the psychological impact of COVID-19 and resultant restrictions on suicidal thoughts in the United Kingdom.
MethodsThe study group conducted a cross sectional survey using a questionnaire based on published approaches (Generalised Anxiety Disorder 7, Patient Health Questionnaire 9, Impact of Events Scale-Revised) to understand the psychological impact of COVID-19 and the resultant restrictions on suicidal thoughts. The study was conducted in 3 phases to capture the different phases of the pandemic restrictions:
Phase 1: 1st May 2020 to 31st July 2020
Phase 2: 12th November 2020 to 12th February 2021
Phase 3: 1st July 2021 to 30th September 2021
Analysis strategy: Descriptive analysis and logistic regression is applied in this study.
ResultsThe study recruited 29133 participants in phase 1; 83851 participants in phase 2 and 75204 participants in phase 3. The largest age group of participants was 45–64 years. About two thirds of respondents were female. Majority of participants were of White British ethnicity. 31% participants in phase 1, 30% in phase 2 and 19% in phase 3 reported suicidal thoughts.
The preliminary regression analysis indicates that younger and male participants reported more suicidal thoughts among other findings which will be reported in the presentation.
Limitations: The non-probability sample design and time limited surveys meant that longitudinal changes were not possible to elicit.
ConclusionThere is mixed evidence on whether rates of suicidal thoughts increased during the pandemic. The results of this study will add to the evidence base and influence future pandemic planning and efforts to developing resilience and good mental health in society.
Associated Mortality Risk of Atypical Antipsychotic Medication in Individuals With Dementia (AMRAAD): A Clinical Cohort Study
- Peter Phiri, Tomas Engelthaler, Hannah Carr, Gayathri Delanerolle, Clive Holmes, Shanaya Rathod
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S67
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Aims
Antipsychotic medications such as risperidone, olanzapine and aripiprazole are used to treat psychological and behavioural symptoms among dementia patients. Current evidence indicate prescription rates for antipsychotics vary and wider consensus to evaluate clinical epidemiological outcomes is limited. This study aims to investigate the potential impact of atypical antipsychotics on the mortality of patients with dementia.
MethodsA retrospective clinical cohort study was developed to review United Kingdom Clinical Record Interactive Search system based data between January 1, 2013 to December 31, 2017. A descriptive statistical method was used to analyse the data. Mini Mental State Examination (MMSE) scores were used to assess the severity and stage of disease progression. A study specific cox proportional hazards model was developed to evaluate the relationship between survival following diagnosis and other variables.
ResultsA total sample size of 1692 patients were identified using natural language processing of which, 587 were prescribed olanzapine, quetiapine, or risperidone (common group) whilst 893 (control group) were not prescribed any antipsychotics. Patients prescribed olanzapine and Risperidone showed similar risk of death [hazard ratio (HR) = 1.32; 95% confidence interval (CI): 1.08–1.60; P < 0.01], (HR = 1.35; 95%CI: 1.18–1.54; P < 0.001). Patients prescribed Quetiapine showed no significant association (HR = 1.09; 95%CI: 0.90–1.34; P = 0.38). Factors associated with a lower risk of death were elevated MMSE score at diagnosis (HR = 0.72; 95%CI: 0.62–0.83; P < 0.001) along with other demographic factors such as women (HR = 0.73; 95%CI: 0.64–0.82; P < 0.001) and being of a Caucasian British group (HR = 0.82; 95%CI: 0.72–0.94; P < 0.01).
ConclusionA significant mortality risk was identified among those prescribed olanzapine and risperidone which contradicts previous findings although the study designs used were different. Comprehensive research should be conducted to better assess clinical epidemiological outcomes associated with diagnosis and therapies to improve clinical management of these patients.
Preliminary evaluation of a culturally adapted CBT-based online programme for depression and anxiety from a lower middle-income country
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- Madeeha Latif, Falahat Awan, Mirrat Gul, M. Omair Husain, M. Ishrat Husain, Kumail Sayyed, Taj Magsi, Saiqa Naz, Ozlem Aylem, Peter Phiri, Muhammad Irfan, Muhammad Ayub, Farooq Naeem
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- The Cognitive Behaviour Therapist / Volume 14 / 2021
- Published online by Cambridge University Press:
- 26 November 2021, e36
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Online cognitive behaviour therapy (CBT), self-help and guided self-help (GSH) interventions have been found to be efficacious and cost-effective for treatment of anxiety and depression, but there are limited data from low- and middle-income countries on culturally adapted digital interventions for these common mental disorders. The aim of this study was to investigate the feasibility and acceptability of an online culturally adapted CBT-based guided self-help (CaCBT-GSH) for patients with anxiety and depression in Pakistan. This randomized controlled trial recruited 39 participants from primary care in Karachi, Pakistan and randomized them to two groups. The intervention group received seven modules of CaCBT-GSH plus treatment as usual (TAU) over 12 weeks. The control group was a waitlist control plus TAU. The primary outcomes were feasibility and acceptability. Clinical outcomes included results from the Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHODAS 2). Assessments were carried out at baseline and at 12 weeks. All 39 individuals who met eligibility criteria for the study agreed to participate. Adherence to the intervention was excellent, with 85% (17/20) completing more than five modules. Statistically significant improvements were found in all clinical outcomes in the intervention group. This was the first trial of an online CaCBT-GSH intervention, which was found to be feasible and acceptable to Pakistani patients with anxiety and depression. CaCBT-GSH may help improve symptoms, depression, anxiety and overall functioning in this population. The results provide rationale for a larger, confirmatory randomized controlled trial of digital CaCBT-GSH.
Key learning aims(1) Leveraging digital and virtual platforms to deliver psychosocial interventions may contribute to addressing the significant treatment gap in low-resource settings.
(2) CBT-informed guided self-help is feasible and acceptable in the treatment of common mental disorders in Pakistan.
(3) The results of this study merit a larger, appropriately powered confirmatory randomized controlled trial to determine clinical and cost effectiveness.
Mental Health and Social Connectedness Across the Adult Lifespan in the Context of the COVID-19 Pandemic
- Madeline A. Gregory, Nicole K. Legg, Zachary Senay, Jamie-Lee Barden, Peter Phiri, Shanaya Rathod, Brianna J. Turner, Theone S. E. Paterson
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- Journal:
- Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 40 / Issue 4 / December 2021
- Published online by Cambridge University Press:
- 11 October 2021, pp. 554-569
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The coronavirus disease (COVID-19) pandemic has had profound consequences on collective mental health and well-being, and yet, older adults appear better off than younger adults. The current study examined mental health impacts of the pandemic across adult age groups in a large sample (n = 5,320) of Canadians using multiple hierarchical regression analyses. Results suggest older adults are experiencing better mental health and more social connectedness relative to younger adults. Loneliness predicted negative mental health outcomes across all age groups, while the negative association between social support and mental health was only significant at average and high levels of loneliness in the 65–69 age group. Results point towards differential mental health impacts of the pandemic across adult age groups and indicate that loneliness and social support may be key intervention targets during the COVID-19 pandemic. Future research should further examine mechanisms of resiliency among older Canadian adults during the pandemic.
Culture and therapist self-disclosure
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- Peter Phiri, Shanaya Rathod, Mary Gobbi, Hannah Carr, David Kingdon
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- The Cognitive Behaviour Therapist / Volume 12 / 2019
- Published online by Cambridge University Press:
- 11 April 2019, e25
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Cognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist’s reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists’ cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training.
Key learning aims(1) To develop a dialogue and practice with confidence when addressing issues of self-disclosure with diverse populations.
(2) To appreciate the impact therapist self-disclosure has in early stages of engagement, in particular when working with patients from BME communities.
(3) To understand the impact and role of self-disclosure as initiated by patients.
(4) To increase therapist awareness on cultural differences in self-disclosure and develop ways to address this in therapy.
(5) To challenge therapists to adapt psychological therapies to diverse cultures and be cognisant that ‘one size does not fit all’.
Cultural adaptation of cognitive–behavioural therapy
- Farooq Naeem, Peter Phiri, Shanaya Rathod, Muhammad Ayub
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- BJPsych Advances / Volume 25 / Issue 6 / November 2019
- Published online by Cambridge University Press:
- 10 April 2019, pp. 387-395
- Print publication:
- November 2019
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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.
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.
An evidence-based framework to culturally adapt cognitive behaviour therapy
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- Shanaya Rathod, Peter Phiri, Farooq Naeem
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- The Cognitive Behaviour Therapist / Volume 12 / 2019
- Published online by Cambridge University Press:
- 09 January 2019, e10
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Cognitive behaviour therapy (CBT) in its current form might not be applicable in non-Western cultures. Differences between Western and non-Western cultures have been reported widely. Most psychotherapeutic interventions have been developed in the West and are underpinned by the values that might be specific only to Western culture. To adapt CBT, we need to understand whether the concepts associated with CBT may conflict with cultural beliefs, identifying barriers to the success of the therapy using the views of experts by experience, public and practitioners. This paper discusses the process, foci and framework of cultural adaptation of CBT. We describe an evidence-based framework for adapting CBT for individuals from non-Western cultures that will benefit clinicians who practise CBT and individuals from different cultural backgrounds.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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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
- Shanaya Rathod, David Kingdon, Peter Phiri, Mary Gobbi
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 38 / Issue 5 / October 2010
- Published online by Cambridge University Press:
- 15 July 2010, pp. 511-533
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- October 2010
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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.
Expansion of psychological therapies
- Shanaya Rathod, Farooq Naeem, Peter Phiri, David Kingdon
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- Journal:
- The British Journal of Psychiatry / Volume 193 / Issue 3 / September 2008
- Published online by Cambridge University Press:
- 02 January 2018, pp. 256-257
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- September 2008
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