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Rolin SA, Caffrey D, Flores MG, Mootz J, Bello I, Nossel I, Compton MT, Stanley B, Wainberg ML, Dixon LB, Appelbaum PS, Pope LG. Qualitative Evaluation of Acceptability and Feasibility of a Behavioral Intervention to Reduce Violence Among Young Adults with Early Psychosis. Community Ment Health J 2024:10.1007/s10597-024-01343-x. [PMID: 39172311 DOI: 10.1007/s10597-024-01343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]
Abstract
Young adults with early psychosis are at higher risk of violent behavior, but no studies have explored using CBT-based interventions to reduce violence in specialized early intervention services (EIS) settings. This study describes formative research about the acceptability and feasibility of the Psychological Intervention for Complex PTSD and Schizophrenia-Spectrum disorder (PICASSO) to reduce violence, using interviews with EIS participants and staff. Generated themes regarding acceptability included negative experiences of violence and the desire to control and minimize violence. Themes regarding feasibility raised concerns about time constraints, consistency of participation in the intervention, and implementation issues in the context of stigma related to both psychosis and perpetration of violence. Findings from this study suggest there is a need for an intervention addressing violence risk. If adequate resources are devoted to addressing implementation issues, a CBT intervention for violence like PICASSO appears both acceptable and feasible for EIS participants and staff.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
| | - Deirdre Caffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
| | - Megan G Flores
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer Mootz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
| | - Iruma Bello
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
| | - Ilana Nossel
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Leah G Pope
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, USA
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alHarbi H, Farrand P, Laidlaw K. Understanding the beliefs and attitudes towards mental health problems held by Muslim communities and acceptability of Cognitive Behavioral Therapy as a treatment: systematic review and thematic synthesis. DISCOVER MENTAL HEALTH 2023; 3:26. [PMID: 37995058 PMCID: PMC10667170 DOI: 10.1007/s44192-023-00053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Muslims experience the lowest recovery rate from mental health difficulties across all religious groups. The aim of this research is to understand the barriers that prevent Muslims from accessing Cognitive Behavioral Therapy (CBT) and the extent to which these may vary across country of residence. METHODS Systematic review and thematic synthesis for quantitative, qualitative, and mixed methods studies published in English and Arabic informed by the SPIDER search tool. Methodological quality and risk of bias of included papers were critically appraised independently according to the Mixed Methods Appraisal Tool. RESULTS A search of seven databases in the Arabic and English language yielded 3836 studies with 210 studies assessed for eligibility. Employing the Mixed Methods Appraisal Tool resulted in 14 studies included in the thematic synthesis. Seven studies adopted a qualitative methodology employing semi-structured interviews and seven were quantitative descriptive studies. CONCLUSIONS Muslim communities experience barriers accessing Cognitive Behavioral Therapy at the level of the individual, culture, provider and management. The main barriers were experienced at the individual level which was dominated by the influence of Islam regarding the cause of mental health difficulties, which also influenced the way in which difficulties were managed. SYSTEMATIC REVIEW REGISTRATION PROSPERO and registration number: CRD42020192854.
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Affiliation(s)
- Hind alHarbi
- Clinical Education, Development and Research (CEDAR), Psychology, Faculty of Health and Life Sciences, University of Exeter, Perry Road, Exeter, EX4 4QG, UK.
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR), Psychology, Faculty of Health and Life Sciences, University of Exeter, Perry Road, Exeter, EX4 4QG, UK
| | - Ken Laidlaw
- School of Psychology, Faculty of Health and Life Sciences, University of Exeter, Perry Road, Exeter, EX4 4QG, UK
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Asif M, Khoso AB, Husain MA, Shahzad S, Van Hout MC, Rafiq NUZ, Lane S, Chaudhry IB, Husain N. Culturally adapted motivational interviewing with cognitive behavior therapy and mindfulness-based relapse prevention for substance use disorder in Pakistan (CAMAIB): protocol for a feasibility factorial randomised controlled trial. Pilot Feasibility Stud 2023; 9:67. [PMID: 37095571 PMCID: PMC10124001 DOI: 10.1186/s40814-023-01296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 04/10/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND The use of psychoactive substances significantly impacts the health, social and economic aspects of families, communities and nations. There is a need to develop and test psychological interventions aimed for individuals with substance use disorder (SUD) in lower- and middle-income countries (LMICs), such as in Pakistan. The aim of this exploratory trial is to test the feasibility and acceptability of two culturally adapted psychological interventions in a factorial randomised controlled trial (RCT). METHODS The proposed project will be conducted in three phases. The first phase of the study will focus on cultural adaptation of the interventions through qualitative interviews with key stakeholders. The second phase will be to refine and produce manually assisted interventions. Third and last stage would be to assess the feasibility of the culturally adapted interventions through a factorial RCT. The study will be carried out in Karachi, Hyderabad, Peshawar, Lahore and Rawalpindi, Pakistan. Recruitment of participants will take place from primary care and volunteer organisations/drug rehabilitation centres. A total of 260 individuals diagnosed with SUD (n = 65) in each of the four arms will be recruited. The intervention will be delivered weekly over a period of 12 weeks in both individual and group settings. Assessments will be carried out at baseline, at 12th week (after completion of intervention) and 24th week post-randomisation. The analysis will determine the feasibility of recruitment, randomisation, retention and intervention delivery. Acceptability of intervention will be determined in terms of adherence to intervention, i.e. the mean number of sessions attended, number of home assignments completed, attrition rates, as well as through process evaluation to understand the implementation process, context, participants' satisfaction, and impact of the study intervention. The health resource use and impact on the quality of life will be established through health economic data. DISCUSSION This study will provide evidence for feasibility and acceptability of culturally adapted manually assisted psychological interventions for individuals with SUD in the context of Pakistan. The study will have clinical implications if intervention is proven feasible and acceptable. TRIAL REGISTRATION Name of the registry: ClinicalTrials.gov, Trial registration number: NCT04885569 , Date of registration: 25th April 2021.
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Affiliation(s)
- Muqaddas Asif
- Pakistan Institute of Living and Learning, Karachi, Pakistan.
| | - Ameer B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | | | | | | | | | - Imran Bashir Chaudhry
- Ziauddin University Hospital, Karachi, Pakistan
- The University of Manchester, Manchester, UK
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Cross-cultural comparison of mental illness stigma and help-seeking attitudes: a multinational population-based study from 16 Arab countries and 10,036 individuals. Soc Psychiatry Psychiatr Epidemiol 2022; 58:641-656. [PMID: 36583767 DOI: 10.1007/s00127-022-02403-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is evidence that culture deeply affects beliefs about mental illnesses' causes, treatment, and help-seeking. We aimed to explore and compare knowledge, attitudes toward mental illness and help-seeking, causal attributions, and help-seeking recommendations for mental illnesses across various Arab countries and investigate factors related to attitudes toward help-seeking. METHODS We carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries among participants from the general public. RESULTS More than one in four individuals exhibited stigmatizing attitudes towards mental illness (26.5%), had poor knowledge (31.7%), and hold negative attitudes toward help-seeking (28.0%). ANOVA tests revealed a significant difference between countries regarding attitudes (F = 194.8, p < .001), knowledge (F = 88.7, p < .001), and help-seeking attitudes (F = 32.4, p < .001). Three multivariate regression analysis models were performed for overall sample, as well as Palestinian and Sudanese samples that displayed the lowest and highest ATSPPH-SF scores, respectively. In the overall sample, being female, older, having higher knowledge and more positive attitudes toward mental illness, and endorsing biomedical and psychosocial causations were associated with more favorable help-seeking attitudes; whereas having a family psychiatric history and endorsing religious/supernatural causations were associated with more negative help-seeking attitudes. The same results have been found in the Palestinian sample, while only stigma dimensions helped predict help-seeking attitudes in Sudanese participants. CONCLUSION Interventions aiming at improving help-seeking attitudes and behaviors and promoting early access to care need to be culturally tailored, and congruent with public beliefs about mental illnesses and their causations.
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Al Sawafi A, Lovell K, Renwick L, Husain N. Exploring views of relatives and mental health professionals to inform the cultural adaptation of a family intervention for schizophrenia in Oman: A qualitative study. Int J Soc Psychiatry 2022; 68:1795-1805. [PMID: 35057662 DOI: 10.1177/00207640211060694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family interventions (FI) for schizophrenia were primarily developed and practised in the West. It has been proven that cultural adaptation for FI facilitates its uptake and improves therapy outcomes; however, the majority of literature on the development of FI focussed on outpatient or community settings, and little attention has been paid to in-patient units. There is an opportunity to engage with the family during admission, particularly in Asia. AIMS To explore relatives' and mental health professionals' views and opinions to inform the cultural adaptation of FI for hospitalised patients with schizophrenia in Oman. It also aimed to gain consensus on items that need adaptation. METHODS We conducted semi-structured interviews with the caregivers (n = 20) and two separate focus groups with psychiatrists (n = 7) and nurses (n = 5). Another consensus group was a mix of both (n = 6) to develop agreement and solve discrepant issues. The data were analysed using framework analysis to identify the intervention components and delivery system. RESULTS Modifications to existing components indicated that the cultural adaption of the intervention focussed more on themes such as religious and spiritual causes of mental illness, simplified language, format of delivery as individual sessions and culturally relevant and acceptable problem solving and coping skills. The components of the intervention identified as psychoeducation, problem-solving and emotional support. The consensus group finalised the intervention's content and delivery system concerning training needs and issues and barriers to implementation. The proposed culturally adapted FI for hospitalised patients requires a flexible approach to meet the family's needs. CONCLUSIONS The findings of the study indicated that FI is an acceptable and feasible approach to be delivered during hospitalisation. The intervention will be accompanied with an intervention manual, which will be tested in a future feasibility study.
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Affiliation(s)
- Aziza Al Sawafi
- College of Nursing, Sultan Qaboos University, Muscat, Oman.,Division of Nursing Midwifery & Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing Midwifery & Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Laoise Renwick
- Division of Nursing Midwifery & Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Nusrat Husain
- Lancashire Care NHS Foundation Trust, Manchester, UK
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Morillo H, Lowry S, Henderson C. Exploring the effectiveness of family-based interventions for psychosis in low- and middle-income countries: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1749-1769. [PMID: 35699742 PMCID: PMC9375736 DOI: 10.1007/s00127-022-02309-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Of the 80% people with psychosis living in low- and middle-income countries (LMICs), up to 90% are left to the care of families. The World Health Organization has recommended the inclusion of families in community-based rehabilitation and while there is evidence of its implementation in LMICs, this has not been reviewed yet. This study aims to describe the key features and implementation strategies of family-based interventions in LMICs, and appraise their effectiveness. METHODS Included are people with psychosis in LMICs who receive any form of family-based intervention, compared to their usual or absence of treatment, with patient outcome measures. We searched (August 2021) through Embase, MEDLINE, Global Health, PsycInfo, Social Policy and Practice, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as from grey literature and hand-searched records. Risk of bias was assessed through the Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) and Consolidated Health Economic Evaluation Reporting Standards (CHEERS), then analyzed narratively. RESULTS 27 studies were included from the 5254 records. Psychotherapeutic features, systems approach and task-sharing were key intervention elements. Delivery strategies included preliminary research, sustained family engagement, and cultural adaptation. There were positive health impacts across four outcome domains. CONCLUSION All studies recommended family-based interventions, with limitations in heterogeneity and 70% of them rated high risk of bias. OTHER Review was registered in PROSPERO (CRD42021256856). The authors did not receive funding for this research.
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Affiliation(s)
- Hannah Morillo
- King’s College London, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
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Huggett C, Gooding P, Haddock G, Pratt D. The Relationship between the Therapeutic Alliance and Suicidal Experiences in People with Psychosis Receiving Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010706. [PMID: 34682451 PMCID: PMC8535896 DOI: 10.3390/ijerph182010706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/25/2023]
Abstract
Few studies have examined the relationship between the therapeutic alliance in therapy and suicidal experiences. No studies have examined this relationship with people with non-affective psychosis. The present study sought to redress this gap in the literature. Sixty-four participants with non-affective psychosis and suicidal experiences who were receiving a suicide-focused cognitive therapy were recruited. Self-reported suicidal ideation, suicide plans, suicide attempts, depression, and hopelessness were collected from participants prior to starting therapy. Suicidal experience measures were collected again post-therapy at 6 months. Therapeutic alliance ratings were completed by clients and therapists at session 4 of therapy. Dose of therapy was documented in number of minutes of therapy. Data were analyzed using correlation coefficients, independent samples t-tests, a multiple hierarchical regression, and a moderated linear regression. There was no significant relationship found between suicidal ideation prior to therapy and the therapeutic alliance at session 4, rated by both client and therapist. However, there was a significant negative relationship between the client-rated therapeutic alliance at session 4 and suicidal ideation at 6 months, after controlling for pre-therapy suicidal ideation, depression, and hopelessness. Furthermore, the negative relationship between the client-rated alliance and suicidal ideation was the strongest when number of minutes of therapy was 15 h or below. A stronger therapeutic alliance developed in the first few sessions of therapy is important in ameliorating suicidal thoughts in people with psychosis. Nevertheless, it is not necessarily the case that more hours in therapy equates to a cumulative decrease in suicidal ideation of which therapists could be mindful. A limitation of the current study was that the alliance was analyzed only at session 4 of therapy, which future studies could seek to redress.
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Affiliation(s)
- Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; (P.G.); (G.H.); (D.P.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, 3rd Floor, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester M13 9WL, UK
- Correspondence:
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; (P.G.); (G.H.); (D.P.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, 3rd Floor, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester M13 9WL, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; (P.G.); (G.H.); (D.P.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, 3rd Floor, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester M13 9WL, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; (P.G.); (G.H.); (D.P.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, 3rd Floor, Rawnsley Building, Manchester Royal Infirmary, Hathersage Road, Manchester M13 9WL, UK
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Naeem F, Tuck A, Mutta B, Dhillon P, Thandi G, Kassam A, Farah N, Ashraf A, Husain MI, Husain MO, Vasiliadis HM, Sanches M, Munshi T, Abbott M, Watters N, Kidd SA, Ayub M, McKenzie K. Protocol for a multi-phase, mixed methods study to develop and evaluate culturally adapted CBT to improve community mental health services for Canadians of south Asian origin. Trials 2021; 22:600. [PMID: 34488853 PMCID: PMC8419942 DOI: 10.1186/s13063-021-05547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Canadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”. South Asian Canadians are disproportionately impacted by the social determinants of health, and this can result in high rates of mood and anxiety disorders. These factors can negatively impact mental health and decrease access to care, thereby increasing mental health inequities. Cognitive Behavioural Therapy (CBT) in its current form is not suitable for persons from the non-western cultural backgrounds. Culturally adapted Cognitive Behavioural Therapy (CaCBT) is an evidence-based practice. CaCBT is more effective than standard CBT and can reduce dropouts from therapy compared with standard CBT. Thus, CaCBT can increase access to mental health services and improve outcomes for immigrant, refugee and ethno-cultural and racialized populations. Adapting CBT for growing SA populations in Canada will ensure equitable access to effective and culturally appropriate interventions. Methods The primary aim of the study is to develop and evaluate CaCBT for Canadian South Asian persons with depression and anxiety and to gather data from stakeholders to develop guidelines to culturally adapt CBT. This mixed methods study will use three phases: (1) cultural adaptation of CBT, (2) pilot feasibility of CaCBT and (3) implementation and evaluation of CaCBT. Phase 1 will use purposive sampling to recruit individuals from four different groups: (1) SA patients with depression and anxiety, (b) caregivers and family members of individuals affected by anxiety and depression, (c) mental health professionals and (d) SA community opinion leaders. Semi-structured interviews will be conducted virtually and analysis of interviews will be informed by an ethnographic approach. Phase 2 will pilot test the newly developed CaCBT for feasibility, acceptability and effectiveness via quantitative methodology and a randomized controlled trial, including an economic analysis. Phase 3 will recruit therapists to train and evaluate them in the new CaCBT. Discussion The outcome of this trial will benefit health services in Canada, in terms of helping to reduce the burden of depression and anxiety and provide better care for South Asians. We expect the results to help guide the development of better services and tailor existing services to the needs of other vulnerable groups. Trial registration ClinicalTrials.gov NCT04010890. Registered on July 8, 2019
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.
| | - Andrew Tuck
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Baldev Mutta
- Punjabi Community Health Services, Toronto, Canada
| | | | - Gary Thandi
- Moving Forward Family Services, Vancouver, Canada
| | | | - Nimo Farah
- Somerset West Community Health Centre, Ottawa, Canada
| | - Aamna Ashraf
- Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - M Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Science, Université de Sherbrooke, Research Center Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Montreal, Canada
| | - Marcos Sanches
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | - Tariq Munshi
- Department of Psychiatry, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | | | | | - Sean A Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada
| | | | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, 33 Ursula Franklin St., Toronto, Ontario, M5S 2S1, Canada.,Wellesley Institute, Toronto, Canada
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Choudhry FR, Khan N, Munawar K. Barriers and facilitators to mental health care: A systematic review in Pakistan. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021. [DOI: 10.1080/00207411.2021.1941563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Fahad Riaz Choudhry
- Department of Psychology, Kulliyyah of Islamic Revealed Knowledge and Human Sciences, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Nashi Khan
- Project Director/ Dean, FSS, Rashid Latif Khan University & Director, Counselling & Wellness Centre (CWC), Rashid Latif Medical Complex (RLMC), Lahore, Pakistan
| | - Khadeeja Munawar
- Department of Psychology, Faculty of Social Sciences & Liberal Arts, UCSI University, No. 1, Jalan Menara Gading, UCSI Heights (Taman Connaught), Cheras, Kuala Lumpur, Malaysia
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Omoronyia FR, Ndiok AE, Enang KO, Obande EI. Patients’ satisfaction with psychiatric nursing care in Benin, Nigeria. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Munawar K, Abdul Khaiyom JH, Bokharey IZ, Park MSA, Choudhry FR. A systematic review of mental health literacy in Pakistan. Asia Pac Psychiatry 2020; 12:e12408. [PMID: 32803860 DOI: 10.1111/appy.12408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/20/2020] [Indexed: 12/16/2022]
Abstract
Individual mental health has become a primary global concern. In Pakistan, the prevalence of mental health issues is still unclear, as not many studies have assessed the level of mental health literacy (MHL) in the country. This systematic review aims to bridge this gap by encouraging the early detection of mental disorders, lessening stigma, and improving help-seeking behavior. Nine electronic databases were searched to identify empirical literature in this area. Only studies that evaluated MHL efficacy and those published in English were selected. Non-peer reviewed articles and gray literature were excluded. From 613 studies retrieved, 59 studies met the inclusion criteria and were reviewed. Forty-three of the included studies mentioned mental health outcome measures (of which only four mentioned reliability indices), 13 discussed stigma, 18 examined help-seeking approaches to mental illness treatments, and 47 discussed mental health knowledge. Additionally, the outcome of the MHL measures had considerable heterogeneity and limited validity. Meta-analysis was not conducted due to a lack of MHL operationalization. Besides, the measurement tools in the studies lacked consistency and standardization. This review compiled the available studies on MHL to assist researchers currently studying the various dimensions of MHL, as well as those designing new studies or investigating effective methods to increase MHL. This review highlights the need for well-designed controlled intervention studies. Further implications for researchers, practitioners, and policymakers are mentioned.
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Affiliation(s)
- Khadeeja Munawar
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Jamilah Hanum Abdul Khaiyom
- Department of Psychology, Kulliyyah of Islamic Revealed Knowledge and Human Sciences, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Iram Zehra Bokharey
- Department of Psychiatry, Mayo Hospital, Neela Gumbad Lahore, Punjab, Pakistan
| | - Miriam Sang-Ah Park
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Fahad Riaz Choudhry
- Department of Psychology, Kulliyyah of Islamic Revealed Knowledge and Human Sciences, International Islamic University Malaysia, Kuala Lumpur, Malaysia
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Xanidis N, Gumley A. Exploring the implementation of cognitive behaviour therapy for psychosis using the Normalization Process Theory framework. Psychol Psychother 2020; 93:241-257. [PMID: 30672074 DOI: 10.1111/papt.12217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evidence suggests that only a minority of service users experiencing psychosis have access to Cognitive Behavioural Therapy for psychosis (CBTp). Normalization Process Theory (NPT) is a theoretical framework which focuses on processes by which interventions are implemented and normalized in clinical practice. This study explored the views and experiences of mental health professionals regarding the implementation of CBTp. Barriers and facilitators to implementation were explored using the NPT framework. DESIGN A qualitative methodology was adopted involving semi-structured focus groups and individual interviews. METHODS A total of 14 members of staff working in the community and crisis mental health teams were recruited. Thematic analysis was used to generate initial themes. The framework approach was utilized to map initial themes to the NPT framework. RESULTS Inductive coding generated five overarching themes consisting of 15 individual subthemes which captured the perceived barriers to engagement; contextual barriers to implementation; optimization of implementation; positive attitudes towards implementation; and expectations of implementing CBTp. All but two subthemes mapped on to the NPT framework. The deductive analysis suggested that difficulties in making sense of CBTp among professionals were reflected as service level barriers which impeded wider implementation. CONCLUSION The results of this study suggested a mixture of barriers and facilitators to CBTp implementation. Interpreting our findings within an NPT framework indicates the importance of strong clinical leadership to address difficulties in sense-making and service investment in CBTp. PRACTITIONER POINTS Findings indicate a mixture of barriers and facilitators to CBTp implementation. NPT analysis indicates difficulties in coherence among stakeholders regarding the purpose and value of CBTp. Difficulties making sense of CBTp translates into service level barriers and impede the collective action of stakeholders. The role of clinical leadership is crucial in increasing coherence and collective action in services.
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Affiliation(s)
- Nikos Xanidis
- Glasgow Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, UK
| | - Andrew Gumley
- Glasgow Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, UK
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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. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x1900028x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractWestern 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 aimsAfter reading this article, readers will be able to:(1)Understand the need for cultural adaptation of CBT.(2)Identify the necessary steps to adapt CBT for the Muslim Arab population.(3)Understand the modifications required to deliver culturally adapted CBT for the Muslim Arab population.
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Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural Adaptation of CBT. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Wong JPS, Ting KT, Wong AWS. Group cognitive behavioural therapy for psychosis in the Asian context: a review of the recent studies. Int Rev Psychiatry 2019; 31:460-470. [PMID: 31340692 DOI: 10.1080/09540261.2019.1634012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The cardinal symptoms of psychosis include hallucination and delusion, which can be both distressing and disabling. International guidelines recommend cognitive behavioural therapy for psychosis (CBTp) as an adjunctive intervention to medication management. Considering the difficulty in the widespread dissemination of the individual CBTp, group CBTp is an alternative in improving patients' access to psychological intervention. Although it has been found feasible and effective in various studies, systematic review on group CBTp, particularly in Asia, was not identified. Hence, this systematic review tried to examine the recent evidence of group CBTp in Asia in order to shed light on its implementation in routine psychiatric care. A relevant literature search was conducted in three databases (Pubmed, Web of Knowledge, and PsycINFO) during the period from January 2000 to December 2018. A total of 114 journal articles were identified. After a full-text review, four studies met our inclusion and exclusion criteria. Despite methodological shortcomings, positive results were found in terms of improvements on psychotic symptoms, functioning, and quality-of-life. These encouraging results indicate the need for future research studies with more rigorous methodology, leading to a better understanding on the applicability and effectiveness of group CBTp in the Asian context.
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Affiliation(s)
- Jade P S Wong
- Department of Psychiatry, The University of Hong Kong, HKSAR , Hong Kong , PR China
| | - Ka Tsun Ting
- Clinical Psychology Service, Kowloon Hospital, HKSAR , Hong Kong , PR China
| | - Agatha W S Wong
- Clinical Psychology Service, Kowloon Hospital, HKSAR , Hong Kong , PR China
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Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci 2019; 14:58. [PMID: 31171014 PMCID: PMC6554895 DOI: 10.1186/s13012-019-0898-y] [Citation(s) in RCA: 540] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This paper describes the process and results of a refinement of a framework to characterize modifications to interventions. The original version did not fully capture several aspects of modification and adaptation that may be important to document and report. Additionally, the earlier framework did not include a way to differentiate cultural adaptation from adaptations made for other reasons. Reporting additional elements will allow for a more precise understanding of modifications, the process of modifying or adapting, and the relationship between different forms of modification and subsequent health and implementation outcomes. DISCUSSION We employed a multifaceted approach to develop the updated FRAME involving coding documents identified through a literature review, rapid coding of qualitative interviews, and a refinement process informed by multiple stakeholders. The updated FRAME expands upon Stirman et al.'s original framework by adding components of modification to report: (1) when and how in the implementation process the modification was made, (2) whether the modification was planned/proactive (i.e., an adaptation) or unplanned/reactive, (3) who determined that the modification should be made, (4) what is modified, (5) at what level of delivery the modification is made, (6) type or nature of context or content-level modifications, (7) the extent to which the modification is fidelity-consistent, and (8) the reasons for the modification, including (a) the intent or goal of the modification (e.g., to reduce costs) and (b) contextual factors that influenced the decision. Methods of using the framework to assess modifications are outlined, along with their strengths and weaknesses, and considerations for research to validate these measurement strategies. CONCLUSION The updated FRAME includes consideration of when and how modifications occurred, whether it was planned or unplanned, relationship to fidelity, and reasons and goals for modification. This tool that can be used to support research on the timing, nature, goals and reasons for, and impact of modifications to evidence-based interventions.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University, 795 Willow Road NC-PTSD, Menlo Park, CA 94025 USA
| | - Ana A. Baumann
- Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130 USA
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR),VA Boston Healthcare System, Boston, MA 02130 USA
- Harvard Medical School Department of Psychiatry, Boston, MA 02115 USA
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Cognitive behavioural therapy training in Tanzania: a qualitative study of clinicians’ experiences. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractCognitive behaviour therapy (CBT) in an effective technique used widely in Western countries. However, there is limited evidence as to the utility, perception and understanding of CBT in developing countries. This study describes and investigates the experience of CBT training and practice in a group of practitioners in Tanzania. A qualitative approach to the investigation was used, and seven participants from Tanzania’s only psychiatric hospital who had completed CBT training were interviewed. The resulting verbatim transcripts were analysed via interpretative phenomenological analysis. Five superordinate themes emerged from the analysis: ‘the medical model’, ‘novelty’, ‘practicalities’, ‘process’ and ‘therapist effects’. The two themes ‘therapist effects’ and ‘process’ are discussed in detail as these may be particularly relevant to the clinical application of the therapy in a new culture and context. The implications for future development of CBT in Tanzania are considered. In developing CBT for dissemination in Tanzania, specific cultural and clinical issues highlighted by indigenous clinicians need consideration.Key learning aims(1)To identify what range of factors may influence clinicians’ perception of and learning about CBT when CBT training is delivered in a mental health setting in Tanzania, or to those with East African origins.(2)To consider the use of qualitative research approaches to inform the early stages of adapting CBT for use in new settings and applications.(3)To be able to apply knowledge about cultural differences to standard CBT in order to promote culturally sensitive practice.
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Naeem F, Phiri P, Rathod S, Ayub M. Cultural adaptation of cognitive–behavioural therapy. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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.
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Cognitive therapy of psychosis: Research and implementation. Schizophr Res 2019; 203:62-65. [PMID: 29129504 DOI: 10.1016/j.schres.2017.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 12/31/2022]
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Edge D, Degnan A, Cotterill S, Berry K, Baker J, Drake R, Abel K. Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundAfrican-Caribbean people in the UK experience the highest incidence of schizophrenia and the greatest inequity in mental health care. There is an urgent need to improve their access to evidence-based care and outcomes. Family intervention (FI) is a National Institute for Health and Care Excellence-approved psychosocial intervention. Although clinically effective and cost-effective for schizophrenia, it is rarely offered. Evidence for any research into FI is lacking for ethnic minority people generally and for African-Caribbean people specifically.Aims(1) To assess the feasibility of delivering a novel, culturally appropriate psychosocial intervention within a ‘high-risk’ population to improve engagement and access to evidence-based care. (2) To test the feasibility and acceptability of delivering FI via ‘proxy families’.DesignA mixed-methods, feasibility cohort study, incorporating focus groups and an expert consensus conference.SettingTwo mental health trusts in north-west England.ParticipantsWe recruited a convenience sample of 31 African-Caribbean service users. Twenty-six family units [service users, relatives/family support members (FSMs) or both] commenced therapy. Half of the service users (n = 13, 50%), who did not have access to their biological families, participated by working with FSMs.InterventionsAn extant FI model was culturally adapted with key stakeholders using a literature-derived framework [Culturally adapted Family Intervention (CaFI)]. Ten CaFI sessions were offered to each service user and associated family.Main outcome measuresRecruitment (number approached vs. number consented), attendance (number of sessions attended), attrition (number of dropouts at each time point), retention (proportion of participants who completed therapy sessions), and completeness of outcome measurement.ResultsOf 74 eligible service users, 31 (42%) consented to take part in the feasibility trial. The majority (n = 21, 67.7%) were recruited from community settings, seven (22.6%) were recruited from rehabilitation settings and three (9.7%) were recruited from acute wards. Twenty-four family units (92%) completed all 10 therapy sessions. The proportion who completed treatment was 77.42% (24/31). The mean number of sessions attended was 7.90 (standard deviation 3.96 sessions) out of 10. It proved feasible to collect a range of outcome data at baseline, post intervention and at the 3-month follow-up. The rating of sessions and the qualitative findings indicated that CaFI was acceptable to service users, families, FSMs and health-care professionals.LimitationsThe lack of a control group and the limited sample size mean that there is insufficient power to assess efficacy. The findings are not generalisable beyond this population.ConclusionsIt proved feasible to culturally adapt and test FI with a sample of African-Caribbean service users and their families. Our study yielded high rates of recruitment, attendance, retention and data completion. We delivered CaFI via FSMs in the absence of biological families. This novel aspect of the study has implications for other groups who do not have access to their biological families. We also demonstrated the feasibility of collecting a range of outcomes to inform future trials and confirmed CaFI’s acceptability to key stakeholders. These are important findings. If CaFI can be delivered to the group of service users with the most serious and persistent disparities in schizophrenia care, it has the potential to be modified for and delivered to other underserved groups.Future workA fully powered, multicentre trial, comparing CaFI with usual care, is planned.Trial registrationCurrent Controlled Trials ISRCTN94393315.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Dawn Edge
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Amy Degnan
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Cotterill
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Baker
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Richard Drake
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn Abel
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Abstract
PURPOSE OF REVIEW The aim was to synthesize recent evidence on schizophrenia illness experience and outcomes and models of care in low and middle-income countries (LMICs). RECENT FINDINGS There is a plurality of explanatory models for psychosis and increasing evidence that context influences experiences of stigma. People with schizophrenia in LMICs are vulnerable to food insecurity, violence and physical health problems, in addition to unmet needs for mental healthcare. Family support may help to improve outcomes if present, but caregivers may be overwhelmed by the challenges faced. Despite efforts to increase availability, evidence-based care remains inaccessible to many people with schizophrenia. Non-randomized evaluations in South Africa and Mexico indicate that psychosocial support groups for people with schizophrenia and caregivers may be acceptable and useful. Randomized controlled trials in Pakistan and China show that culturally adapted cognitive-behavioural therapy can reduce symptom severity. There is emerging evidence that alternative medicine, such as Tai Chi, may be beneficial, but to date most studies are of low quality. The challenges of biomedical-traditional provider collaborations have been highlighted. Evaluations of integrated mental healthcare in primary care are underway and promise to provide vital information about how to scale-up quality care. SUMMARY Acceptable and effective responses to schizophrenia in LMICs should be cognisant of both cultural context and universal concerns. Efforts to enhance the quality of family support should be central to models of care.
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Rathod S, Gega L, Degnan A, Pikard J, Khan T, Husain N, Munshi T, Naeem F. The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses. Neuropsychiatr Dis Treat 2018; 14:165-178. [PMID: 29379289 PMCID: PMC5757988 DOI: 10.2147/ndt.s138430] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In recent years, there has been a steadily increasing recognition of the need to improve the cultural competence of services and cultural adaptation of interventions so that every individual can benefit from evidence-based care. There have been attempts at culturally adapting evidence-based interventions for mental health problems, and a few meta-analyses have been published in this area. This is, however, a much debated subject. Furthermore, there is a lack of a comprehensive review of meta-analyses and literature reviews that provide guidance to policy makers and clinicians. This review summarizes the current meta-analysis literature on culturally adapted interventions for mental health disorders to provide a succinct account of the current state of knowledge in this area, limitations, and guidance for the future research.
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Affiliation(s)
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK
| | - Amy Degnan
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Jennifer Pikard
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Tasneem Khan
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Tariq Munshi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Farooq Naeem
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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Li W, Zhang L, Luo X, Liu B, Liu Z, Lin F, Liu Z, Xie Y, Hudson M, Rathod S, Kingdon D, Husain N, Liu X, Ayub M, Naeem F. A qualitative study to explore views of patients', carers' and mental health professionals' to inform cultural adaptation of CBT for psychosis (CBTp) in China. BMC Psychiatry 2017; 17:131. [PMID: 28390407 PMCID: PMC5385068 DOI: 10.1186/s12888-017-1290-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/29/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The evidence for effectiveness of Cognitive Behaviour Therapy (CBT) is robust and the national organizations in the United Kingdom and the United States recommend its use. It is not utilized to its full potential in low and middle-income countries. Adaptation of CBT treatment to the target culture may facilitate its uptake. This study explored views of patients with schizophrenia, their caregivers, and mental health professionals for the purpose of cultural adaptation of CBT. METHOD The project was conducted in a teaching hospital in China. Systematic content and question analysis were the techniques we used to analyse the data generated in a series of qualitative interviews (N 45) in China. After identification of emerging themes and categories we compared and contrasted the themes across different interviews recursively. Triangulation of themes and concepts was undertaken to compare further and contrast the data from the different participating groups. RESULTS This work highlighted the barriers in therapy as well as opportunities for use of CBT in that environment. Patients and their carers in China use a bio-psycho-spiritual-social model of illness. CBT is not commonly used to help those with schizophrenia in China. CONCLUSIONS This study will facilitate the therapists using CBT for people with psychosis in China. These results require to be tested in clinical trials.
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Affiliation(s)
- Weihui Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Li Zhang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xuerong Luo
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Bangshan Liu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Zhipeng Liu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
- Jiangxi mental health center, Changsha, China
| | - Fang Lin
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
- Xiangyang Anding Hospital, Changsha, China
| | - Zhiling Liu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
- Chuxiong Prefecture’s Mental Hospital, Changsha, China
| | - Yuhuan Xie
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
| | - Melissa Hudson
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Clinical Trials Facility, Tom Rudd Unit, Moorgreen Hospital, Southampton, SO30 3JB UK
| | | | | | - Xudong Liu
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
| | - Muhammad Ayub
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
| | - Farooq Naeem
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
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Irfan M, Saeed S, Awan NR, Gul M, Aslam M, Naeem F. Psychological Healing in Pakistan: From Sufism to Culturally Adapted Cognitive Behaviour Therapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2017. [DOI: 10.1007/s10879-016-9354-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brabban A, Byrne R, Longden E, Morrison AP. The importance of human relationships, ethics and recovery-orientated values in the delivery of CBT for people with psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2016. [DOI: 10.1080/17522439.2016.1259648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alison Brabban
- TEWV NHS Trust, EIP, Chester le Street HC, Chester le Street, UK
- Mental Health Research Centre, Durham University, Durham, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Eleanor Longden
- Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Anthony P. Morrison
- Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Naeem F, Saeed S, Irfan M, Kiran T, Mehmood N, Gul M, Munshi T, Ahmad S, Kazmi A, Husain N, Farooq S, Ayub M, Kingdon D. Brief culturally adapted CBT for psychosis (CaCBTp): A randomized controlled trial from a low income country. Schizophr Res 2015; 164:143-8. [PMID: 25757714 DOI: 10.1016/j.schres.2015.02.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/17/2015] [Accepted: 02/21/2015] [Indexed: 11/17/2022]
Abstract
Evidence for the effectiveness of Culturally adapted CBT for psychosis in Low And Middle Income Countries (LAMIC) is limited. Therefore, brief Culturally adapted CBT for psychosis (CaCBTp) targeted at symptoms of schizophrenia for outpatients plus treatment as usual (TAU) is compared with TAU. A total of 116 participants with schizophrenia were recruited from 2 hospitals in Karachi, Pakistan, and randomized into two groups with 1:1 allocation (CaCBTp plus TAU=59, TAU=57). A brief version of CaCBTp (6 individual sessions with the involvement of main carer, plus one session for the family) was provided over 4months. Psychopathology was measured using Positive and Negative Syndrome Scale of Schizophrenia (PANSS), Psychotic Symptom Rating Scales (PSYRATS), and the Schedule for Assessment of Insight (SAI) at baseline and end of therapy. Participants in treatment group, showed statistically significant improvement in all measures of psychopathology at the end of the study compared with control group. Participants in treatment group showed statistically significant improvement in Positive Symptoms (PANSS, Positive Symptoms Subscale; p=0.000), Negative Symptoms (PANSS, Negative Symptoms subscales; p=0.000), Delusions (PSYRATS, Delusions Subscale; p=0.000), Hallucinations (PSYRATS, Hallucination Subscale; p=0.000) and Insight (SAI; p=0.007). The results suggest that brief, Culturally adapted CBT for psychosis can be an effective treatment when provided in combination with TAU, for patients with schizophrenia in a LAMIC setting. This is the first trial of CBT for psychosis from outside the western world. These findings need replicating in other low and middle income countries.
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, Queens University, Kingston, Canada.
| | - Sofiya Saeed
- Pakistan Association of Cognitive Therapists, Karachi, Pakistan
| | - Muhammad Irfan
- Department of Psychiatry and Behavioural Sciences, Peshawar Medical College, Peshawar, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nasir Mehmood
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Mirrat Gul
- Sir Ganga Ram Hospital, Lahore, Pakistan
| | - Tariq Munshi
- Department of Psychiatry, Queens University, Kingston, Canada
| | - Sohail Ahmad
- Department of Psychiatry, Abbasi Shaheed Hospital, Karachi, Pakistan
| | - Ajmal Kazmi
- Department of Psychiatry, Karwan e Hayat Hospital, Karachi, Pakistan
| | - Nusrat Husain
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - Saeed Farooq
- Department of Psychiatry, PGMI Lady Reading Hospital Peshawar, Pakistan; Staffordshire University, UK
| | - Muhammad Ayub
- Department of Psychiatry, Queens University, Kingston, Canada
| | - David Kingdon
- Mental Health Care Delivery, University of Southampton, UK; Southern Health NHS Trust, UK
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