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Cultural adaptation of cognitive behavioural therapy (CBT) for patients with depression and anxiety in Saudi Arabia and Bahrain: a qualitative study exploring views of patients, carers, and mental health professionals

Part of: Being an Anti-Racist CBT therapist

Published online by Cambridge University Press:  19 September 2019

Haifa Mohammad Saleh Algahtani ,
Abdullah Almulhim ,
Fatema Ali AlNajjar ,
Mazen Khalil Ali ,
Muhammad Irfan Open the ORCID record for Muhammad Irfan [Opens in a new window] ,
Muhammad Ayub  and
Farooq Naeem
Haifa Mohammad Saleh Algahtani*
Affiliation:
College of Medicine & Medical Sciences, Psychiatry Department, Arabian Gulf University, Bahrain
Abdullah Almulhim
Affiliation:
Psychiatry Department, Imam Abdulrahman Bin Faisal University, Saudi Arabia
Fatema Ali AlNajjar
Affiliation:
College of Medicine & Medical Sciences, Psychiatry Department, Arabian Gulf University, Bahrain
Mazen Khalil Ali
Affiliation:
College of Medicine & Medical Sciences, Psychiatry Department, Arabian Gulf University, Bahrain
Muhammad Irfan
Affiliation:
Department of Mental Health, Psychiatry & Behavioural Sciences, Peshawar Medical College, Riphah International University, Islamabad, Pakistan
Muhammad Ayub
Affiliation:
Division of Developmental Disabilities, Department of Psychiatry, Queen’s University, 191 Portsmouth Avenue, Kingston, Ontario, Canada
Farooq Naeem
Affiliation:
Psychiatry Department, University of Toronto and Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, Canada
*
*Corresponding author. Email: haifamsg@agu.edu.bh
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Abstract

Western values influence cognitive behavioural therapy (CBT) as it was primarily developed and practised in the West. As understanding the cultural context has been linked to better therapy outcomes, it has been suggested that CBT might need modification to non-Western clients’ cultural backgrounds. Previously we developed a cost-effective approach to adapt CBT for clients in China and Pakistan. In this study, we applied the same methodology for local clients suffering from depression and anxiety in the Kingdom of Saudi Arabia and Bahrain. This study aimed to understand the views of patients with depression and anxiety, caregivers and mental health professionals about CBT to develop guidelines for culturally adapting CBT for depression and anxiety. We conducted semi-structured interviews with the patients (n = 42), caregivers (n = 11), and psychiatrists and psychologists (n = 16). The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The themes emerging from the analyses of interviews by each interviewer were compared and contrasted with those of other interviewers. The results highlighted barriers of access to and strengths of CBT while working with these patient groups. Patients and their caregivers in both countries use a bio-psycho-spiritual-social model of illness and seek help from multiple sources. Therapists emphasized the need for using local idioms, culturally appropriate translation and minor adjustments in therapy. There were no thematic differences between the two sites. These findings will be used to culturally adapt a CBT manual, which will be tested in a randomized controlled trial.

Key learning aims

After reading this article, readers will be able to:

  1. (1) Understand the need for cultural adaptation of CBT.

  2. (2) Identify the necessary steps to adapt CBT for the Muslim Arab population.

  3. (3) Understand the modifications required to deliver culturally adapted CBT for the Muslim Arab population.

Keywords

Arab MuslimadaptationCBTcognitive therapyculturequalitative

Information

Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e44
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Further reading

Abudabbeh, N., & Hays, P. A. (2006). Cognitive-behavioral therapy with people of Arab heritage. In Hays, P. A. & Iwamasa, G. Y. (eds), Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, and Supervision (pp. 141–159). Washington, DC, USA: American Psychological Association.CrossRefGoogle Scholar
Naeem, F., Phiri, P., Nasar, A., Munshi, T., Ayub, M., & Rathod, S. (2016). An evidence-based framework for cultural adaptation of cognitive behaviour therapy: process, methodology and foci of adaptation. World Cultural Psychiatry Research Review, 11, 67–70.Google Scholar

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