Vitosha Hall - Marinela

Cultural adaptations of CBT with diverse populations: “Making it Meaningful”.

Peter Phiri, Valentyna Parobiy, Andrew Karachevsky, Hakon Stenmark, Paul Salkovskis Speaker

Despite abundant evidence that cognitive behavioural therapies can effectively treat many psychological disorders, mental health problems among much of the world’s population are not properly addressed. This inspiring symposium showcases creative new approaches to expanding the geographical reach and cultural appropriateness of these interventions to those who are currently underserved. The first speaker will present on the development of cultural adaptations of CBT for Psychosis in Black and minority ethnic groups in the UK. The second speaker will present on the recent establishment of an accredited CBT training program in Ukraine. The presentation will discuss the substantial need for psychotherapy services after the war in eastern Ukraine began in 2014, the considerable barriers that were met, and the solutions that have been developed to reach those in need. The third speaker will present data on the effectiveness of narrative approaches in reducing symptoms of posttraumatic stress disorder among refugees in Norway, Republic of Congo, and Rwanda. In contexts of ongoing adversity and minimal resources, the acceptability and feasibility of this approach may be critical to promoting healing. The final speaker will present on the development of a lay-led Islamic Trauma Healing program in Seattle, USA. The program addresses a treatment gap for Somali refugees who rarely access help through established care pathways. It is located within local mosques and targets trauma-related difficulties by combining components of exposure-based therapy with Islamic principles, including Prophet stories and talking to Allah about traumatic experiences.

1. Peter Phiri, 2. Valentyna Parobiy and Andrew Karachevsky, 3. Hakon Stenmark, 4. Belinda Graham. [Discussant: Paul Salkovskis]

1. Southern Health NHS Foundation Trust and University of Southampton, Southampton, UK., 2. Ukrainian Catholic University, Lviv, Ukraine.,
3. Center on Violence, Stress and Suicide Prevention, Universitetssykehuset i Trondheim, Norway.,
4. Centre for Anxiety Disorders and Trauma, University of Oxford, UK.


1. Development and piloting of a lay-led Islamic Trauma Healing program

 Belinda Graham – Wellcome Trust Clinical Research Training Fellow, Centre for Anxiety Disorders and Trauma, University of Oxford, UK.

Several interventions effectively address symptoms of posttraumatic stress disorder (PTSD) but despite substantial need there are considerable barriers to access and uptake by refugee groups. This project took place in northwest USA, where there is a relatively large Somali refugee population with substantial trauma exposure but limited uptake of existing services. Culturally appropriate interventions are needed that are accessible and consistent with the Islamic faith and worldview. To address this need, a small pilot study examined feasibility and utility of a six-session group intervention for healing after trauma. The Islamic Trauma Healing program is led by members of the community within local mosques and specifically targets emotional wounds of trauma. The program incorporates elements of cognitive and exposure therapies, with Islamic-informed principles using Prophet stories and talking to Allah about trauma. Pre- to post-group pilot data is presented for men's (n = 6) and women's (n = 7) groups, assessing PTSD, depression, somatic symptoms, well-being, and satisfaction. In addition, qualitative analysis of feedback from group members and leaders was conducted. Results indicated large effects across all measures from pre- to post-group (g = 0.76 to 3.22). Qualitative analysis identified high perceived need for culturally appropriate interventions and suggested that Islamic Trauma Healing operates on themes of community, faith integration, healing, and growth. The program was well received by participants and offers a community-based model for delivering a trauma-focused intervention to Somali refugee communities. Combining culturally appropriate components including faith-based principles with cognitive behavioural therapies could increase relevance, accessibility, and sustainability.


2. Development and formation of CBT in Ukraine: 7 years of challenges and successes

Valentyna Parobii, psychotherapist, CBT lecturer and supervisor at UICBT, head of Ethical committee UACBT

Andriy Karachevskyy, psychiatrist, CBT lecturer and supervisor at UICBT, vice-president UACBT

The historical background of CBT development in Ukraine is very controversial. There is still a continuation of the stigmatization of mental illness, which extends from the Soviet era of punitive psychiatry. On the other hand, there is currently a "wild west" provision of psychotherapeutic services that can be provided privately by almost anyone. The state still does not control this situation. Therefore, when in 2011 the Ukrainian Institute of CBT (UACBT), with the support of the Ukrainian CBT Association, started its first course, nobody suspected that it was something qualitatively different. It can be concluded that these qualitative advantages have made it possible to make CBT education in Ukraine authoritative and a desirable aspiration.

The war in eastern Ukraine, which began in 2014, was a huge challenge for the Ukrainian psychotherapeutic community. The waves of internally displaced persons, families that have suffered from losses, soldiers with PTSD needed and still need quality interventions. Our students and graduates can apply these interventions successfully.

The Ukrainian Association for Cognitive-Behavioral Therapy actively participates in the reform of the existing system of psychiatric care in the country. UACBT and the Ukrainian Union of Psychotherapists initiated the signing of the "Declaration on Psychotherapy in Ukraine".



3. Adapting Cognitive Behaviour Therapy for Psychosis for Black and Minority Ethnic Communities.

 Dr Peter Phiri, R&D Manager, Southern Health NHS Foundation Trust, Visiting Fellow, University of Southampton

Background: Culture significantly impacts all aspects of psychosis and although CBT is recommended for schizophrenia and associated psychotic symptoms (NICE, 2014; APA, 2004) it requires cultural adaptation (Kingdon & Turkingdon, 2005) given higher drop-out and poorer outcomes for African Caribbean and Black African patients.

 Aims: To produce a culturally sensitive adaption of a CBT manual for therapists working with patients with psychosis from African-Caribbean, Black-African/Black British, and South Asian Muslim communities, and assess its effectiveness.

 Method: Part 1: Qualitative study of semi-structured interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n=15); focus groups with lay members (n=52); CBT therapists (n=22) and mental health practitioners (n=25). Part 2: Adaptation of CaCBTp, tested in a multi-site RCT in the UK (n=35). Participants randomised to receive 16 sessions of therapy (n=16) or Treatment as Usual (TAU; n=17). Patients completed Comprehensive Psychopathological Rating Scale (CPRS), Patient Experience Questionnaire (PEQ).


4. "Does my experience match that of the patient or am l being indulgent?” Culture and Therapist Self-Disclosure

 Dr Peter Phiri, R&D Manager, Southern Health NHS Foundation Trust, Visiting Fellow, University of Southampton

Traditionally, the attitude towards self-disclosure in psychotherapy has been based on the Freudian concept that psychoanalysts should be “impenetrable to the patient…reflect nothing but what is shown to him” (Freud, 1912/1958, p.118).

 CBT as a treatment for schizophrenia and psychotic disorders has significantly greater dropout rates in clients of Black and Minority ethnic (BME) groups (NHS Digital, 2017). Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients with psychosis (Rathod et al., 2010). The two centre study consisted of individual in-depth face to face interviews and focus groups (n=114).

 Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. This talk explores one of these themes (client initiated therapist self-disclosure - TSD) in greater detail. This theme has provoked debate and challenged therapists faced with disclosure of personal issues. This talk highlights key elements of how this could impact on a) therapists reaction towards TSD, b) therapeutic alliance and c) outcomes of therapy.