Drake and colleagues (2014) make an excellent case for culturally adapted, relevant services and interventions for mental illness in low and middle income countries. Cognitive behaviour therapy (CBT) is now recognised as a key evidence-based therapy that is widely used across the globe for various illnesses (Hoffman et al. 2012). However the concepts and constructs used in therapy have been criticised as being rooted in Western cultures and not consistent with cultural beliefs elsewhere. Cultural relevance is essential (Rathod et al, 2008) and practice needs to be adapted to fit a variety of cultural backgrounds (Rathod, 2014). Adapting an intervention carries inherent challenges and risks like presuming global understanding from knowledge of the culture or subculture – stereotyping - when the intervention should allow latitude and flexibility for an assessment of every individual's personal values. Cultural adaptation also inevitably modifies evidence based treatments and the dilemma exists as to when fidelity to the core intervention is lost and when adaptation compromises the effectiveness of an intervention.
We found that outcomes were significantly worse in African Caribbean and Black African groups participating in a large randomised controlled trial of CBT for psychosis (Rathod et al. 2005) and this led to qualitative (Rathod et al. 2010) and quantitative (Rathod et al, 2013) research. Experiences of patients, clinicians and lay members from minority cultural communities were used to adapting CBT using a framework proposed by Tseng et al. (2005). Trials of adapted therapies have been performed with positive results in psychosis and depression in the UK, United States, Pakistan and China and this is expanding to other countries (Rathod et al, 2015). Such work now needs replicating, developing and implementing.
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Competing interests: No competing interests