Cultural Adaptation Of Evidence-based Treatments Research Articles

Lessons learned in adapting an online intervention program for posttraumatic stress for use in Egypt.

Cultural adaptation of evidence-based treatments is a pressing priority for global health, and previous research has informed recommendations for guiding the process of translation and adaptation. As research in the domain of cultural adaptation and evaluation of evidence-based treatments progresses, it is critical that researchers communicate key lessons learned, so that models of adaptation can be continuously refined and reconsidered. The work described in this article aimed to translate and culturally adapt an online intervention to address symptoms of posttraumatic stress-the PTSD Coach Online-for use with young adults in Egypt. The cultural adaptation framework proposed by Bernal and colleagues (1995) was used, and focus groups and interviews with members of the target population, mental health professionals, and service users were conducted. The authors encountered a number of challenges in treatment adaptation that generated important insights for future work. Specifically, this case study highlights the importance of translation teams with diverse backgrounds and experiences, the critical nature of iterative feedback throughout the adaptation process, and the importance of a long time-horizon for optimal adaptation.

Conditioned Fear Extinction, Neuropsychological, and Psychological Aspects of OCD in Latinos

Background: Although culture can affect emotional and behavioral reactions, there is little research on the manifestations of obsessive-compulsive disorder (OCD) among Latinos. Previous studies using a fear extinction model with a non-Latino population showed that individuals with OCD have difficulty maintaining safety memories. Their neuropsychological performance has shown inconsistent findings. We compared Puerto Ricans with OCD and healthy controls on fear extinction retention, neuropsychological performance, and psychological self-reports. Methods: 17 healthy and 11 Puerto Rican adults with OCD underwent a fear conditioning and extinction paradigm using neutral visual cues that were paired or unpaired with an electric stimulus to elicit skin conductance responses. Neuropsychological tests (WCST,EST,MSIT) and psychological self-reports (BAI,BDI,STAI,PANAS,EDS)were administered. Results: OCD subjects did not show impaired extinction recall. However, they showed higher reaction times towards neutral than threat-related words on the EST, compared to healthy controls. No differences on neuropsychological tests that lacked emotional content were observed. OCD subjects showed increased symptoms of anxiety, trait anxiety, depression, negative affect, and emotional dysregulation. Conclusions: Puerto Ricans with OCD may have physiological and neuropsychological characteristics that are similar to healthy subjects, but a different psychological profile, which can be used to tailor cultural adaptations of evidence-based treatments for OCD.

Addressing Diversity in PTSD Treatment: Disparities in Treatment Engagement and Outcome Among Patients of Color

Posttraumatic stress disorder (PTSD) is a prevalent mental disorder characterized by difficulty recovering from exposure to a traumatic event. The prevalence of PTSD varies by race/ethnicity, with studies in US samples indicating higher prevalence and lower treatment use among some racial and ethnic minority groups compared with Whites. Clarifying the extent to which race and ethnicity influence PTSD treatment outcomes is crucial to delivering treatments that are equitably effective and culturally relevant. There are few rigorous studies of racial/ethnic differences in PTSD treatment-related outcomes, making it difficult to draw conclusions. Evidence suggests that, compared with Whites, there may be lower treatment initiation and retention among Black/African American and Hispanic/Latino/a individuals. The bulk of evidence does not support racial/ethnic differences in treatment-related symptom reduction, though findings are contradictory. Cultural adaptations of evidence-based treatments for PTSD warrant further research. There is a critical need for research that is designed to answer questions about racial/ethnic differences and the experiences of People of Color in PTSD treatment. In clinical settings, widely implementing culturally relevant assessment and treatment, enhancing cultural competence of clinicians, and increasing representation of clinicians of Color are crucial steps toward improving PTSD treatment for People of Color.

Cultural Adaptation of Evidence-Based Treatments: An Example From Aphasia

Few evidence-based treatments (EBTs) for impairments of speech, language, cognition, or swallowing have been designed or evaluated scientifically for effectiveness with culturally and linguisticall...

Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States.

We reviewed the recent literature on prevalence rates, and application of evidence-based treatments for eating disorders among Hispanics/Latinos residing in the United States. Lifetime prevalence rates of anorexia nervosa are lower among Hispanic/Latinos than non-Hispanic Whites. There are comparable rates of bulimia nervosa and binge eating disorder (BED) among Hispanic/Latinos and non-Hispanic Whites. BED is the most common eating disorder among Hispanic/Latinos. Evidence-based treatments have begun to be implemented with Hispanics/Latinos. The core concepts of cognitive behavioral therapy for bulimia nervosa and BED apply to this population. Culture-specific adaptations include strengthening the collectivistic framework within an individualistic treatment, psychoeducation of immediate and extended family, and adjustment of meal plans that incorporated cultural foods. There are more similarities than differences in the prevalence of eating disorders across Hispanics/Latinos and non-Hispanic Whites. However, the social context such as immigration status and acculturation is important to consider in the development of eating disorders. In addition, the Westernization of Latin America may change the future relationship of immigration status and development of eating disorder within the United States. Overall, cultural adaptations of evidence-based treatments involved the inclusion of family within treatment, acculturation-related issues, and managing family conflicts that arise because of the changes in eating patterns.

A randomized controlled trial of culturally adapted motivational interviewing for Hispanic heavy drinkers: Theory of adaptation and study protocol

BackgroundThe NIH Strategic Plan prioritizes health disparities research for socially disadvantaged Hispanics, to reduce the disproportionate burden of alcohol-related negative consequences compared to other racial/ethnic groups. Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and response to alcohol treatment. However, the lack of rigorous clinical trials designed to test the efficacy and theoretical underpinnings of cultural adaptation has made proof of concept difficult. ObjectiveThe CAMI2 (Culturally Adapted Motivational Interviewing) study design and its theoretical model, is described to illustrate how MI adapted to social and cultural factors (CAMI) can be discriminated against non-adapted MI. Methods and designCAMI2, a large, 12month randomized prospective trial, examines the efficacy of CAMI and MI among heavy drinking Hispanics recruited from the community (n=257). Outcomes are reductions in heavy drinking days (Time Line Follow-Back) and negative consequences of drinking among Hispanics (Drinkers Inventory of Consequences). A second aim examines perceived acculturation stress as a moderator of treatment outcomes in the CAMI condition. SummaryThe CAMI2 study design protocol is presented and the theory of adaptation is presented. Findings from the trial described may yield important recommendations on the science of cultural adaptation and improve MI dissemination to Hispanics with alcohol risk.

Mexican American women’s perspectives on a culturally adapted cognitive-behavioral therapy guided self-help program for binge eating.

The prevalence of bulimia nervosa (BN) and binge eating disorder (BED) among Latinas is comparable to those of the general population; however, few interventions and treatment trial research have focused on this group. Cognitive-behavioral therapy (CBT) is the treatment of choice for binge eating related disorders. CBT-based guided self-help (CBTgsh)-a low-cost minimal intervention-has also been shown effective in improving binge eating related symptom, but the effectiveness of the CBTgsh among ethnic minority women is not well understood. Cultural adaptation of evidence-based treatments can be an important step for promoting treatment accessibility and engagement among underserved groups. This qualitative study was part of a larger investigation that examined the feasibility and efficacy of a culturally adapted CBTgsh program among Mexican American women with binge eating disorders. Posttreatment focus groups were conducted with 12 Mexican American women with BN or BED who participated in the intervention. Data were analyzed with the grounded theory methodology (Corbin & Strauss, 2008). Three themes emerged from the data: (a) eating behavior and body ideals are socially and culturally constructed, (b) multifaceted support system is crucial to Mexican American women's treatment engagement and success, and (c) the culturally adapted CBTgsh program is feasible and relevant to Mexican American women's experience, but it can be strengthened with increased family and peer involvement. The findings provide suggestions for further adaptation and refinement of the CBTgsh, and implications for future research as well as early intervention for disordered eating in organized care settings.

Finding Harmony Between the Evidence-Based Treatment and Cultural Adaptation Movements

Since the concept of cultural adaptations of evidence-based treatments was introduced in the 1990s, it has been dismissed by some as unnecessary, unfeasible, and inconsistent with the tenets of methodologically rigorous interventions. Guillermo Bernal and Melanie Domenech Rodriguez address many of these critiques, providing a compelling rationale for cultural adaptation in their edited volume Cultural Adaptations: Tools for Evidence-Based Practice With Diverse Populations. Collectively, the work showcased in this volume represents some of the most innovative and exciting studies that can be found at the intersection of intervention research and multicultural psychology.

Adapting Pediatric Psychology Interventions: Lessons Learned in Treating Families From the Middle East

Pediatric psychologists are increasingly called upon to treat children from non-Western countries, whose cultures may contrast with a Western medical setting. Research on cultural adaptations of evidence-based treatments (EBTs), particularly for individuals from the Middle East, is sparse. To address this need, we discuss clinical issues encountered when working with patients from the Middle East. Synthesis of the literature regarding culturally adapted EBTs and common themes in Middle Eastern culture. Case vignettes illustrate possible EBT adaptations. Integrating cultural values in treatment is an opportunity to join with patients and families to optimize care. Expectations for medical and psychological treatment vary, and collaborations with cultural liaisons are beneficial. Critical next steps include systematic development, testing, and training in culturally adapting EBTs in pediatric medical settings. Increased dialogue between clinicians, researchers, and cultural liaisons is needed to share knowledge and experiences to enhance patient care.

Violence and the Effects of Trauma on American Indian and Alaska Native Populations

Violence and the resulting trauma has had a major impact on American Indian/Alaska Native (AI/AN) children and their families, creating hardships that have been very difficult to address or overcome. This article provides a brief description of the cultures and shared beliefs of the indigenous people. A review of the recent published literature on poverty and historical trauma, including a discussion on oppression and hegemony, is presented. Additionally, recent research on violence and the resulting trauma, suicide, domestic violence, and post-traumatic stress disorder is described. A brief description of select cultural adaptations of evidence-based treatments is also provided.

Accessibility and Attitudes: Comment on Lau (2006).

Lau (2006) offers a viable approach toward cultural adaptation of evidence-based treatments. Progress in the development of culturally relevant interventions, however, has been slow. In this commentary, I consider reasons for this slow progress, including accessibility for diverse groups and clinical psychologists’ attitudes. The limited representation of diverse groups in research samples and in the psychology workforce may be a result of limited funding for diversification. Another reason for the lack of diversification may be psychologists’ resistant attitudes. Lau (2006) has created a road map to diversify clinical psychology science and practice, and it is our responsibility as individuals and a field to use this road map to diversify clinical psychology.

Making the Case for Selective and Directed Cultural Adaptations of Evidence-Based Treatments: Examples From Parent Training.

With prevailing concerns about the generalizability of evidence-based treatments (EBTs) in real-world practice settings, there has been increased attention to the potential of cultural adaptations of treatments to ensure fit with diverse consumer populations. However, it could also be argued that there has been insufficient dissemination and evaluation of our existing EBTs with minority populations to warrant and guide adaptation efforts. This article discusses a framework (a) for identifying instances where cultural adaptation of EBTs may be most indicated, and (b) for using research to direct the development of treatment adaptations to ensure community engagement and the contextual relevance of treatment content. Ongoing work in the area of parent training is highlighted to illustrate key issues and recommendations.