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Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

A qualitative study to explore views of patients’, carers’ and mental health professionals’ to inform cultural adaptation of CBT for psychosis (CBTp) in China

Authors: Weihui Li, Li Zhang, Xuerong Luo, Bangshan Liu, Zhipeng Liu, Fang Lin, Zhiling Liu, Yuhuan Xie, Melissa Hudson, Shanaya Rathod, David Kingdon, Nusrat Husain, Xudong Liu, Muhammad Ayub, Farooq Naeem

Published in: BMC Psychiatry | Issue 1/2017

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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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Literature
1.
go back to reference Habib N, Dawood S, Kingdon D, Naeem F. Preliminary evaluation of culturally adapted CBT for psychosis (CA-CBTp): findings from developing culturally-sensitive CBT project (DCCP). Behav Cogn Psychother. 2015;43:200–8.CrossRefPubMed Habib N, Dawood S, Kingdon D, Naeem F. Preliminary evaluation of culturally adapted CBT for psychosis (CA-CBTp): findings from developing culturally-sensitive CBT project (DCCP). Behav Cogn Psychother. 2015;43:200–8.CrossRefPubMed
2.
go back to reference Kumar D, Haq MZU, Dubey I, Dotivala KN, Siddiqui SV, Prakash R, et al. Effect of meta-cognitive training in the reduction of positive symptoms in schizophrenia. Eur J Psychother Couns. 2010;12:149–58.CrossRef Kumar D, Haq MZU, Dubey I, Dotivala KN, Siddiqui SV, Prakash R, et al. Effect of meta-cognitive training in the reduction of positive symptoms in schizophrenia. Eur J Psychother Couns. 2010;12:149–58.CrossRef
3.
go back to reference Li Z-J, Guo Z-H, Wang N, Xu Z-Y, Qu Y, Wang X-Q, et al. Cognitive-behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China. Psychol Med. 2015;45:1893–905. Li Z-J, Guo Z-H, Wang N, Xu Z-Y, Qu Y, Wang X-Q, et al. Cognitive-behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China. Psychol Med. 2015;45:1893–905.
4.
go back to reference Naeem F, Saeed S, Irfan M, Kiran T, Mehmood N, Gul M, et al. Brief culturally adapted CBT for psychosis (CaCBTp): a randomized controlled trial from a low-income country. Schizophr Res. 2015;164:143–8.CrossRefPubMed Naeem F, Saeed S, Irfan M, Kiran T, Mehmood N, Gul M, et al. Brief culturally adapted CBT for psychosis (CaCBTp): a randomized controlled trial from a low-income country. Schizophr Res. 2015;164:143–8.CrossRefPubMed
5.
go back to reference Shriharsh V, Sippy R, Nijhawan A, Bhatia T, Mukit SR, Garg K, et al. Effect of cognitive behaviour therapy on adjustment, intensity of symptoms and automatic thoughts in schizophrenia. Indian J Psychiatry. 2003;45:221–8.PubMedPubMedCentral Shriharsh V, Sippy R, Nijhawan A, Bhatia T, Mukit SR, Garg K, et al. Effect of cognitive behaviour therapy on adjustment, intensity of symptoms and automatic thoughts in schizophrenia. Indian J Psychiatry. 2003;45:221–8.PubMedPubMedCentral
6.
go back to reference Naeem F, Gobbi M, Ayub M, Kingdon D. Psychologists experience of cognitive behaviour therapy in a developing country: a qualitative study from Pakistan. Int J Ment Health Syst. 2010;4:2.CrossRefPubMedPubMedCentral Naeem F, Gobbi M, Ayub M, Kingdon D. Psychologists experience of cognitive behaviour therapy in a developing country: a qualitative study from Pakistan. Int J Ment Health Syst. 2010;4:2.CrossRefPubMedPubMedCentral
7.
go back to reference Hwang W-C. The psychotherapy adaptation and modification framework: application to Asian Americans. Am Psychol. 2006;61:702–15.CrossRefPubMed Hwang W-C. The psychotherapy adaptation and modification framework: application to Asian Americans. Am Psychol. 2006;61:702–15.CrossRefPubMed
8.
go back to reference Hwang W-C, Wood JJ, Lin K-M, Cheung F. Cognitive-behavioral therapy with Chinese Americans: research, theory, and clinical practice. Cogn Behav Pract. 2006;13:293–303.CrossRef Hwang W-C, Wood JJ, Lin K-M, Cheung F. Cognitive-behavioral therapy with Chinese Americans: research, theory, and clinical practice. Cogn Behav Pract. 2006;13:293–303.CrossRef
9.
go back to reference Rathod S, Phiri P, Harris S, Underwood C, Thagadur M, Padmanabi U, et al. Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophr Res. 2013;143:319–26.CrossRefPubMed Rathod S, Phiri P, Harris S, Underwood C, Thagadur M, Padmanabi U, et al. Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophr Res. 2013;143:319–26.CrossRefPubMed
10.
go back to reference Liu J, Ma H, He Y-L, Xie B, Xu Y-F, Tang H-Y, et al. Mental health system in China: history, recent service reform and future challenges. World psychiatry off. J. World Psychiatr. Assoc. WPA. 2011;10:210–6. Liu J, Ma H, He Y-L, Xie B, Xu Y-F, Tang H-Y, et al. Mental health system in China: history, recent service reform and future challenges. World psychiatry off. J. World Psychiatr. Assoc. WPA. 2011;10:210–6.
11.
go back to reference Hodges J, Oei TPS. Would Confucius benefit from psychotherapy? The compatibility of cognitive behaviour therapy and Chinese values. Behav Res Ther. 2007;45:901–14.CrossRefPubMed Hodges J, Oei TPS. Would Confucius benefit from psychotherapy? The compatibility of cognitive behaviour therapy and Chinese values. Behav Res Ther. 2007;45:901–14.CrossRefPubMed
12.
go back to reference Chen SW-H, Davenport DS. Cognitive-behavioral therapy with Chinese American clients: cautions and modifications. Psychother Theory Res Pract Train. 2005;42:101–10.CrossRef Chen SW-H, Davenport DS. Cognitive-behavioral therapy with Chinese American clients: cautions and modifications. Psychother Theory Res Pract Train. 2005;42:101–10.CrossRef
13.
go back to reference Chen CP. Counseling applications of RET in a Chinese cultural context. J Ration-Emotive Cogn Behav Ther. 1995;13:117–29.CrossRef Chen CP. Counseling applications of RET in a Chinese cultural context. J Ration-Emotive Cogn Behav Ther. 1995;13:117–29.CrossRef
14.
go back to reference Naeem F, Gul M, Irfan M, Munshi T, Asif A, Rashid S, et al. Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. J Affect Disord. 2015;177:101–7.CrossRefPubMed Naeem F, Gul M, Irfan M, Munshi T, Asif A, Rashid S, et al. Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. J Affect Disord. 2015;177:101–7.CrossRefPubMed
15.
go back to reference Naeem F, Phiri P, Munshi T, Rathod S, Ayub M, Gobbi M, et al. Using cognitive behaviour therapy with South Asian Muslims: findings from the culturally sensitive CBT project. Int Rev Psychiatry Abingdon Engl. 2015;27:233–46. Naeem F, Phiri P, Munshi T, Rathod S, Ayub M, Gobbi M, et al. Using cognitive behaviour therapy with South Asian Muslims: findings from the culturally sensitive CBT project. Int Rev Psychiatry Abingdon Engl. 2015;27:233–46.
16.
go back to reference Naeem F, Waheed W, Gobbi M, Ayub M, Kingdon D. Preliminary evaluation of culturally sensitive CBT for depression in Pakistan: findings from developing culturally-sensitive CBT project (DCCP). Behav Cogn Psychother. 2011;39:165–73.CrossRefPubMed Naeem F, Waheed W, Gobbi M, Ayub M, Kingdon D. Preliminary evaluation of culturally sensitive CBT for depression in Pakistan: findings from developing culturally-sensitive CBT project (DCCP). Behav Cogn Psychother. 2011;39:165–73.CrossRefPubMed
17.
go back to reference Naeem F, Ayub M, Gobbi M, Kingdon D. Development of Southampton Adaptation Framework for CBT (SAF-CBT): a framework for adaptation of CBT in non-western culture. [Internet]. J Pak Psychiatr Soc. 2009. Available from: http://www.pakmedinet.com/15940. Naeem F, Ayub M, Gobbi M, Kingdon D. Development of Southampton Adaptation Framework for CBT (SAF-CBT): a framework for adaptation of CBT in non-western culture. [Internet]. J Pak Psychiatr Soc. 2009. Available from: http://​www.​pakmedinet.​com/​15940.
18.
go back to reference Naeem F, Habib N, Gul M, Khalid M, Saeed S, Farooq S, et al. A qualitative study to explore patients’, Carers’ and health professionals’ views to culturally adapt CBT for psychosis (CBTp) in Pakistan. Behav Cogn Psychother. 2016;44:43–55.CrossRefPubMed Naeem F, Habib N, Gul M, Khalid M, Saeed S, Farooq S, et al. A qualitative study to explore patients’, Carers’ and health professionals’ views to culturally adapt CBT for psychosis (CBTp) in Pakistan. Behav Cogn Psychother. 2016;44:43–55.CrossRefPubMed
19.
go back to reference Atkinson PA, Delamont S, Coffey AJ, Lofland J, Lofland LH, editors. Handbook of Ethnography. Paperback Edition. London: Sage Publications Ltd; 2007. Atkinson PA, Delamont S, Coffey AJ, Lofland J, Lofland LH, editors. Handbook of Ethnography. Paperback Edition. London: Sage Publications Ltd; 2007.
20.
go back to reference Hammersley M, Atkinson P. Ethnography: Principles in Practice. 2nd Revised edition. Abingdon: Routledge; 1994. Hammersley M, Atkinson P. Ethnography: Principles in Practice. 2nd Revised edition. Abingdon: Routledge; 1994.
21.
go back to reference Jorgensen DL. Participant observation: a methodology for human studies. Thousand Oaks: SAGE; 1989. Jorgensen DL. Participant observation: a methodology for human studies. Thousand Oaks: SAGE; 1989.
22.
go back to reference Morse JM, Field PA. Nursing Research: the Application of Qualitative Approaches Janice M. Morse and Peggy Anne Field. Cheltenham: Stanley Thornes Ltd.; 1996. Morse JM, Field PA. Nursing Research: the Application of Qualitative Approaches Janice M. Morse and Peggy Anne Field. Cheltenham: Stanley Thornes Ltd.; 1996.
23.
go back to reference Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. Sage Publications; 2009. Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. Sage Publications; 2009.
24.
go back to reference Zhang Y, Young D, Lee S, Zhang H, Xiao Z, Hao W, et al. Chinese Taoist cognitive psychotherapy in the treatment of generalized anxiety disorder in contemporary China. Transcult Psychiatry. 2002;39:115–29.CrossRef Zhang Y, Young D, Lee S, Zhang H, Xiao Z, Hao W, et al. Chinese Taoist cognitive psychotherapy in the treatment of generalized anxiety disorder in contemporary China. Transcult Psychiatry. 2002;39:115–29.CrossRef
25.
go back to reference Naeem F, Ayub M, Mcguire N, Kingdon D. Culturally adapted CBT (CaCBT) for depression. Therapy manual for use with South Asian Muslims [Kindle Edition]. 2013. Naeem F, Ayub M, Mcguire N, Kingdon D. Culturally adapted CBT (CaCBT) for depression. Therapy manual for use with South Asian Muslims [Kindle Edition]. 2013.
Metadata
Title
A qualitative study to explore views of patients’, carers’ and mental health professionals’ to inform cultural adaptation of CBT for psychosis (CBTp) in China
Authors
Weihui Li
Li Zhang
Xuerong Luo
Bangshan Liu
Zhipeng Liu
Fang Lin
Zhiling Liu
Yuhuan Xie
Melissa Hudson
Shanaya Rathod
David Kingdon
Nusrat Husain
Xudong Liu
Muhammad Ayub
Farooq Naeem
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1290-6

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