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Exploring the cultural flexibility of the ACT model as an effective therapeutic group intervention for Turkish speaking communities in East London

Part of: Being an Anti-Racist CBT therapist

Published online by Cambridge University Press:  09 January 2019

Aradhana Perry ,
Chelsea Gardener ,
Joseph E. Oliver ,
Çiğdem Taş  and
Cansu Özenç
Aradhana Perry
Affiliation:
City and Hackney BME Access Service, East London NHS Foundation Trust, City and Hackney Directorate, Department of Psychology
Chelsea Gardener
Affiliation:
STEP Team, South London and Maudsley NHS Foundation Trust
Joseph E. Oliver
Affiliation:
University College London
Çiğdem Taş
Affiliation:
Mental Health Co-Ordinator, Derman
Cansu Özenç
Affiliation:
John Howard Centre, East London NHS Foundation Trust
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Abstract

This study describes a successful community-based partnership project between statutory and third-sector services in East London; The City and Hackney Black and Minority Ethnic (BME) Access Service [East London NHS Foundation Trust (ELFT)] collaborated with Derman, a local community organization supporting the well-being of Turkish-speaking communities, to explore the cultural adaptability of an empirically supported, third-wave cognitive behavioural intervention, Acceptance and Commitment Therapy (ACT). The aim was to develop a culturally acceptable group that was responsive to the therapeutic needs of participants from Turkish-speaking communities. The study implemented a mixed-method analysis with a one group pre/post-test design to examine the effectiveness of a 7-session culturally adapted ACT group intervention and a descriptive approach was implemented to assess usefulness, relevance and acceptability. Results demonstrated an overall positive effect of the culturally adapted ACT intervention in terms of both symptoms and patient-reported outcomes. Participants showed significant improvements on measures of depression (p = 0.014), anxiety (p = 0.041) and psychological distress (p = 0.003). The magnitude of these changes was categorized as large, with effect sizes from 0.90 to 2.03. Qualitative responses indicated that the group was experienced as enjoyable and useful and was considered to be an accessible and acceptable therapeutic format. Although a pilot within clinical practice, the findings provide preliminary support for the clinical utility of ACT as an effective, culturally acceptable therapeutic approach for Turkish-speaking communities living in an urban UK setting. The study highlights the importance of culturally appropriate service development and a need for further research within this area.

Keywords

ACTAcceptance and Commitment Therapycultural flexibilitycultural adaptationBMETurkish speaking communities

Information

Type
Special Issue: Cultural Adaptations of CBT
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e2
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

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Bhui, K, Aslam, RW, Palinski, A, McCabe, R, Johnson, MR, Weich, S, Singh, SP, Knapp, M, Ardino, V, Szczepura, A (2015). Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness, Health Technology Assessment 19, 1–173.Google Scholar
Fuchs, C, Lee, JK, Roemer, L, Orsillo, SM (2013). Using mindfulness-and acceptance-based treatments with clients from non-dominant cultural and/or marginalized backgrounds: clinical considerations, meta-analysis findings; and Introduction to the special series: clinical considerations in using acceptance-and mindfulness-based treatments with diverse populations. Cognitive and Behavioural Practice 20, 1–12.Google Scholar
Hayes, SC, Strosahl, K, Wilson, KG (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press.Google Scholar
Rathod, S, Kingdon, D, Pinninti, N, Turkington, D, Phiri, P (2015). Cultural Adaptation of CBT for Serious Mental Illness: A Guide for Training and Practice. Wiley-Blackwell.Google Scholar

References

Altman, DG, Bland, JM (1995). Absence of evidence is not evidence of absence. British Medical Journal 311, 485.Google Scholar
A-Tjak, JG, Davis, ML, Morina, N, Powers, MB, Smits, JA, Emmelkamp, PM (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics 84, 30–36.Google Scholar
Barkham, M, Bewick, B, Mullin, T, Gilbody, S, Connell, J, Cahill, J et al. (2013). The CORE-10: a short measure of psychological distress for routine use in the psychological therapies. Counselling and Psychotherapy Research 13, 3–13.Google Scholar
Bernal, G, Bonilla, J, Bellido, C (1995). Ecological validity and cultural sensitivity for outcome research: issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology 23, 67–82.Google Scholar
Bernal, G, Jiménez-Chafey, M, Domenech Rodríguez, M (2009). Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice 40, 361–368.Google Scholar
Berzon, B, Pious, C, Farson, RE (1963). The therapeutic event in group psychotherapy: a study of subjective reports by group members. Journal of Individual Psychology 19, 204–212.Google Scholar
Bhui, K, Aslam, RW, Palinski, A, McCabe, R, Johnson, MR, Weich, S, Singh, SP, Knapp, M, Ardino, V, Szczepura, A (2015). Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness, Health Technology Assessment 19, 1–173.Google Scholar
Bhui, K, Bhugra, D, McKenzie, K (2000). Maudsley discussion paper no. 8: Specialist services for minority ethnic groups. Available at: https://www.kcl.ac.uk/ioppn/contact/mentalhealth/publications/discussion-papers/assets/mdp08.pdf (accessed 10 February 2018).Google Scholar
Bhui, K, Olajide, D (eds) (1999). Mental Health Service Provision for a Multi-Cultural Society. London: WB Saunders.Google Scholar
Bloch, S, Reibstein, J, Crouch, E, Holroyd, P, Themen, J (1979). A method for the study of therapeutic factors in group psychotherapy. British Journal of Psychiatry 134, 257–263.Google Scholar
Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, HR (2009). Introduction to Meta-Analysis. West Sussex: Wiley.Google Scholar
Braun, V, Clarke, V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.Google Scholar
City and Hackney Clinical Commissioning Group (2015). Mental Health Programme Board minutes. Available at: http://www.cityandhackneyccg.nhs.uk/Downloads/About%20Us/Programme%20Boards/Mental%20Health/March%202015%20Meeting%20Pack.pdfGoogle Scholar
Cumming, G (2012). Understanding the New Statistics: Effect Sizes, Confidence Intervals and Meta-Analysis. New York, NY: Routledge.Google Scholar
Department of Health (2009). Improving Access to Psychological Therapies (IAPT). Available at: http://www.iapt.nhs.uk/silo/files/black-and-minority-ethnic-bme-positive-practice-guide.pdfGoogle Scholar
Enneli, P, Modood, T, Bradley, H (2005). Young Turks and Kurds: a set of ‘invisible’ disadvantaged groups. York, UK: Joseph Rowntree Foundation.Google Scholar
Eylem, O, van Bergen, DD, Rathod, S, van Straten, A, Bhui, K, Kerkhof, AJFM (2016). Canına kıymak – ‘crushing life energy’: a qualitative study on lay and professional understandings of suicide and help-seeking among Turkish migrants in the UK and in the Netherlands. Available at: https://research.vu.nl/en/publications/can%C4%B1na-k%C4%B1ymak-crushing-life-energy-a-qualitative-study-on-lay-andGoogle Scholar
Forman, EM, Herbert, JD, Moitra, E, Yeomans, PD, Geller, PA (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification 31, 772–799.Google Scholar
Fountain, J, Patel, K, Buffin, J (2007). Community Engagement: the Centre for Ethnicity and Health Model. Foundation Regenboog AMOC.Google Scholar
Fuchs, C, Lee, JK, Roemer, L, Orsillo, SM (2013). Using mindfulness-and acceptance-based treatments with clients from non-dominant cultural and/or marginalized backgrounds: clinical considerations, meta-analysis findings; and Introduction to the special series: clinical considerations in using acceptance- and mindfulness-based treatments with diverse populations. Cognitive and Behavioural Practice 20, 1–12.Google Scholar
Furnham, A, Malik, R (1994) Cross cultural beliefs about depression. International Journal of Social Psychiatry 40, 106–123.Google Scholar
Griner, D, Smith, T (2006) Culturally adapted mental health intervention: a meta-analytic review. Psychotherapy: Theory, Research, Practice, Training 43, 531–548.Google Scholar
Gyani, A, Shafran, R, Layard, R, Clark, DM (2013). Enhancing recovery rates: lessons from year one of IAPT. Behaviour Research and Therapy 51, 597–606.Google Scholar
Hall, GCN, Hong, JJ, Zane, NWS, Oanh, LM (2011) Culturally competent treatments for Asian Americans: the relevance of mindfulness and acceptance-based psychotherapies. Clinical Psychology 18, 215–231.Google Scholar
Hayes, SC, Luoma, JB, Bond, FW, Masuda, A, Lillis, J (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy 44, 1–25.Google Scholar
Hayes, SC, Strosahl, KD, Wilson, KG (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. New York: Guilford Press.Google Scholar
Hoseini, SM, Rezaei, AM, Azadim, MM (2014) Effectiveness of acceptance and commitment group therapy of the self-management of type 2 diabetes patients. Journal of Clinical Psychology 5, 55–64.Google Scholar
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12– 19.Google Scholar
Johns, LC, Oliver, JE, Khondoker, M, Byrne, M, Jolley, S, Wykes, T, Joseph, C, Butler, L, Craig, T, Morris, EM (2016). The feasibility and acceptability of a brief Acceptance and Commitment Therapy (ACT) group intervention for people with psychosis: the ‘ACT for life’ study. Journal of Behavior Therapy and Experimental Psychiatry 50, 257–263.Google Scholar
Kroenke, K, Spitzer, RL (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals 32, 509–515.Google Scholar
Kuzulugil, SS (2010). A classification Turkish cultural values. Paper presented at the International Conference on Social Sciences, ICSS.Google Scholar
La Roche, M, Lustig, K (2013). Being mindful about the assessment of culture: a cultural analysis of culturally adapted acceptance-based behavior approaches. Cognitive and Behavioral Practice 20, 60–63.Google Scholar
Lakens, D (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in Psychology 4, 863.Google Scholar
Lieberman, M, Yalom, I, Miles, M (1973). Encounter Groups: First Facts. New York: Basic Books.Google Scholar
Livheim, F (2014). ‘ACT – promoting mental health and resilience’ Group. Life Compass. ACT Organisation.Google Scholar
Lundgren, T, Dahl, J, Melin, L, Keis, B (2006). Evaluation of acceptance and commitment therapy for drug refactory epilepsy: a randomized controlled trial in South Africa. Epilepsia 47, 2173– 2179.Google Scholar
Lundgren, T, Dahl, J, Yardi, N, Melin, J (2008) Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: a randomized controlled trial. Epilepsy and Behavior 13, 102–108.Google Scholar
Masuda, A (2014). Psychotherapy in cultural context: an overview. In Masuda, A (ed), Mindfulness and Acceptance in Multicultural Competency. Context Press.Google Scholar
Mirdal, GM (2012). Mevlana Jalāl-ad-Dīn Rumi and Mindfulness. Journal of Religion and Health, 51, 1202–1215.Google Scholar
Powers, MB, Zum Vörde Sive Vörding, MB, Emmelkamp, PM (2009). Acceptance and commitment therapy: a meta-analytic review. Psychotherapy and Psychosomatics 78, 73–80.Google Scholar
Rathod, S (2017). Contemporary psychotherapy and cultural adaptations. Journal of Contemporary Psychotherapy 47, 61–63.Google Scholar
Rathod, S, Phiri, P, Harris, S, Underwood, C, Thagadur, M, Padmanabi, U, Kingdon, D (2013). Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophrenia Research 143, 319–326.Google Scholar
Ruiz, FJ (2010). A review of Acceptance and Commitment Therapy (ACT) empirical evidence: correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy 10, 125–162.Google Scholar
Spitzer, RL, Kroenke, K, Williams, JB, Lowe, B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 1092–1097.Google Scholar
Stewart, C, White, R, Ebert, B, Mays, I, Nardozzi, J, Bockarie, H (2016). A preliminary evaluation of acceptance and commitment therapy (ACT) training in Sierra Leone. Journal of Contextual Behavioral Science 5, 16–22.Google Scholar
Tas, N, Guden, M, Tekin, H, Guler, I, Doner, F, Kalen, G (2008) Voice of men: mental health needs assessment of Turkish, Kurdish and Cypriot men in Hackney. Community Engagement Project, NIMHE Mental Health Programme.Google Scholar
Tseng, W-S (2004). Culture and psychotherapy: Asian perspectives. Journal of Mental Health 13, 151–161.Google Scholar
Thabane, L, Ma, J, Chu, R, Cheng, J, Ismaila, A, Rios, LP et al. (2010). A tutorial on pilot studies: the what, why and how. BMC Medical Research Methodology 10, 1.Google Scholar
Vøllestad, J, Nielsen, MB, Nielsen, GH (2012). Mindfulness-and acceptance-based interventions for anxiety disorders: a systematic review and meta-analysis. British Journal of Clinical Psychology 51, 239–260.Google Scholar
White, R, Ebert, B (2014). Working globally, thinking locally: providing psychosocial intervention training in Sierra Leone. Clinical Psychology Forum 258, 41–45.Google Scholar
Woidneck, MR, Pratt, KM, Gundy, JM, Nelson, CR, Twohig, MP (2012). Exploring cultural competence in acceptance and commitment therapy outcomes. Professional Psychology: Research and Practice 43, 227–233.Google Scholar
Yalom, ID (1975). The Theory and Practice of Group Psychotherapy, 2nd edn. New York: Basic Books.Google Scholar
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