Need For Cultural Adaptation Research Articles

Child mental health: Early detection and interventions in anxiety disorders and depression

Introduction: Child mental health is a critical public health issue, with disorders such as anxiety and depression affecting up to 20% of children worldwide. Early detection and effective interventions are essential to mitigate the effects of these disorders and improve the quality of life of affected children. This study conducted a systematic review to identify the most effective strategies for early detection and interventions in childhood anxiety disorders and depression. Methods: The systematic review was conducted in the PubMed, Scopus, PsycINFO, and Web of Science databases, using descriptors such as “Child Mental Health,” “Early Detection,” “Anxiety Disorders in Children,” and “Childhood Depression.” Empirical studies published between 2010 and 2024 were included. Study selection was performed by two independent reviewers, and methodological quality was assessed using the AMSTAR tool and the Newcastle-Ottawa Scale. Results: Thirteen studies were included that indicate the effectiveness of instruments such as the "Spence Children's Anxiety Scale" (SCAS) and the "Child Depression Inventory" (CDI) in the early detection of anxiety and depression in children. Interventions based on Cognitive-Behavioral Therapy (CBT) and multidisciplinary approaches were effective in reducing symptoms and improving the quality of life of children. However, the implementation of these strategies faces significant challenges, such as lack of resources and the need for cultural adaptations. Conclusion: Early detection and timely interventions are essential for the effective management of anxiety disorders and depression in children. The importance of public policies for training professionals and intersectoral collaboration to ensure quality mental health care is reinforced. Future research should focus on culturally adapted interventions and evaluate their long-term effectiveness.

The Semiotic Role of Color in Alcoholic Beverage Packaging and Its Advertising Synergy

This study explores the semiotic role of color in alcoholic beverage packaging and its synergy with advertising campaigns. Through a mixed-methods approach involving content analysis, case studies, and consumer surveys, we examine how color choices in packaging influence consumer perception, brand identity, and marketing effectiveness. This finding reveal that specific colors evoke distinct psychological responses and cultural meanings, which significantly impact brand recognition and consumer loyalty. The research highlights successful strategies used by brands such as Absolut Vodka, Coca-Cola, and Heineken, demonstrating the importance of color consistency across packaging and advertising in creating a cohesive and memorable brand image. Additionally, this study discusses the role of digital advertising in maintaining color synergy and the need for cultural adaptation in global marketing. This study provides valuable insights for brand managers and marketers, emphasizing the strategic use of color to enhance visual identity, brand recall, and consumer engagement.

Pragmatic Strategies in Artistic Translation: Balancing Creativity and Cultural Adaptation

This study investigates the communicative-pragmatic aspects of artistic translation, focusing on how translators navigate the complexities of preserving the original text's artistic and aesthetic integrity while adapting it to a different cultural and linguistic context. Despite extensive research in translation studies, a systematic exploration of pragmatic motivations and strategies in artistic translation remains underdeveloped. This research addresses this gap by employing a comprehensive methodological approach that includes descriptive-analytical, semantic-stylistic, and literary analysis of original texts and their translations. The findings highlight the critical role of the translator's creative interpretation in maintaining the balance between fidelity to the original text and the need for cultural adaptation. The results demonstrate that pragmatic strategies significantly influence the translation process, particularly in how verbal-artistic information is transformed to resonate with the target audience. The study also suggests that these strategies are essential for achieving functional equivalence and preserving the artistic value of the original work. The implications of this research are significant for both translation theory and practice, emphasizing the need for enhanced training programs that focus on the development of creative and pragmatic skills in translators. Further research is recommended to explore the emotional and experiential dimensions of translation, as these aspects remain crucial yet underexplored in current literature.

The image of a Japanese as seen by a Dutchman in the English novel and its Ukrainian translation

The article deals with the problem of rendering a literary image of a foreigner in translation. The object of research is the cumulative literary image of a Japanese on the material of David Mitchell’s novel “The Thousand Autumns of Jacob De Zoet” and the subject of research is the means and strategies of its reproduction in the Ukrainian translation. The aim of the research is to conceptualize the above strategies and determine the factors that have an impact on the translator’s decision-making. In particular, the attention is drawn to the factor of ethnic stereotypes that underline the formation of a foreigner’s image in a literary discourse. The article offers a hierarchic view of a literary image as an interaction of three levels of analysis: mega-image (correlated with the idea/theme/conception of a literary piece), macro-image (literary image per se) and micro-image (linguistic and/or stylistic means of a macro-image embodiment). Correspondingly, the translator’s attention should be concentrated on equivalent rendering micro-images, but in a manner consistent with corresponding macro-images and the mega-image of the whole text. Every literary image of a foreigner is based on certain ethno-stereotypes, also known as heterostereotypes that govern the author’s selection of micro-images and consequently the whole structure of a macro-image. Three aspects of a Japanese’s macro-image were singled out: appearance; speech characteristics; traditions, customs and rituals. At the next stage, the micro-images of these aspects’ verbalization were singled out and the translator’s strategies of their re-creation were analyzed. The conclusion was made that due to the similarity in foreigners’ stereotyping by the British and Ukrainians, the translator had no need for cultural adaptations and their strategy was predominantly aimed at overcoming interlinguistic asymmetry.

P24-026-23 The Need for Cultural Adaptations to Disordered Eating Scales for Indigenous Women

P24-026-23 The Need for Cultural Adaptations to Disordered Eating Scales for Indigenous Women

Challenges of transforming evidence-based management of osteoarthritis into clinical practice in rural central Western India. Perceptions of an educational program.

Osteoarthritis (OA) is a major threat to public health worldwide and is predicted to increase. Existing interventions to implement clinical practice guidelines (CPGs) seem to be used mainly in the Western world. We conducted a structured educational program on the evidence-based management of OA (BOA) for Indian physical therapists (PT). Our study aimed to describe Indian PTs' knowledge, attitudes and confidence on evidence-based management of OA, and their perceptions of a course on this subject. The 2-day course included didactic parts and practical skills training. Thirty-five PTs participated and answered a questionnaire. Fourteen of them participated in focus group interviews. Questionnaire data are presented as medians and full ranges. Manifest content analysis was used to analyze interview data that are presented as catagories illustrated by interview quotes. The formal ethics permission was granted. 74% of PTs agreed that radiography determines the type of treatment required, and 69% agreed that a prescription for exercise is enough to ensure adherence. PTs agreed (mean 5 on 6-point scale) that exercises increasing pain should be advised against. Confidence in guiding the physical activity was generally high (≥5 on 6-point scales). Five categories reflected participants' perceptions of the course content: Shift in management focus, Need for cultural adaptation, Importance of social support, Development of organization and collaboration, and Feelings of hesitation. Our results indicate that in order to facilitate the implementation of CPGs, PT curricula may consider the inclusion of knowledge on CPGs, focus more on students' own reflections on transforming theory into practice, and incorporate training of basic skills required for implementation of self-management, body awareness, and neuromuscular fitness. If given access and mandates, PTs may play a major role in the early diagnosis and treatment of OA and thus contribute to the prevention of an epidemic of OA in India.

Results of a qualitative study of patient, carer and clinician views on the experience of caring for individuals with psychosis in Pakistan

Abstract Cultural relevance is a core element of effective psychological interventions like cognitive behaviour therapy (CBT) or family intervention (FI), which can be considered Eurocentric. There have been few studies that have examined explanatory models of mental illness and its management in Pakistan to date. This study elicited patient- and carer-related health beliefs on psychosis including attributions to illness, and help-seeking behaviours to inform development of culturally sensitive treatment and improve outcomes in a unit in Lahore (Pakistan). The study group completed 45 semi-structured qualitative interviews at a mental health rehabilitation centre in Lahore. Data were analysed thematically using emerging themes and content analysis. Participants’ explanatory models for psychosis included religion or faith-driven beliefs, like previous wrong-doing and supernatural ideas such as black magic. Social factors that impacted families included high expectations, social stigma, and discriminations. Families first sought help from faith leaders and then medical or psychological sources of care. Participants had generally positive attitudes about their experience of psychological interventions. Key learning aims (1) The need to consider cultural influences to ensure relevance of interventions like cognitive behaviour therapy (CBT) or family interventions (FI) in different countries. (2) The need for cultural adaptation of interventions like CBT and FI in different countries to make them accessible and acceptable. (3) When adapting therapy to a particular culture or country, recognizing the importance of engaging the local cultural population in the adaptation process.

Screening performances of an 8-item UPSIT Italian version in the diagnosis of Parkinson’s disease

Hyposmia is a common finding in Parkinson’s disease (PD) and is usually tested through the University of Pennsylvania Smell Identification Test (UPSIT). The aim of our study is to provide a briefer version of the Italian-adapted UPSIT test, able to discriminate between PD patients and healthy subjects (HS). By means of several univariate and multivariate (machine-learning-based) statistical approaches, we selected 8 items by which we trained a partial-least-square discriminant analysis (PLS-DA) and a decision tree (DT) model: class predictions of both models performed better with the 8-item version when compared to the 40-item version. An area under the receiver operating characteristic (AUC-ROC) curve built with the selected 8 odors showed the best performance (sensitivity 86.8%, specificity 82%) in predicting the PD condition at a cut-off point of ≤ 6. These performances were higher than those previously calculated for the 40-item UPSIT test (sensitivity 82% and specificity 88.2 % with a cut-off point of ≤ 21). Qualitatively, our selection contains one odor (i.e., apple) which is Italian-specific, supporting the need for cultural adaptation of smell testing; on the other hand, some of the selected best discriminating odors are in common with existing brief smell test versions validated on PD patients of other cultures, supporting the view that disease-specific odor patterns may exist and deserve a further evaluation.

Is There a Need for Cultural Adaptation of the Last Aid Course?-A Mixed-Methods Study across the Danish-German Border.

Last Aid courses (LAC) have been established in 20 countries in Europe, Australia, and America to improve the public discourse about death and dying and to empower people to contribute to end-of-life care in the community. A mixed-methods approach was used to investigate the views of LAC participants about the course and cultural differences in relation to care and nursing at the end of life in the border region of Germany and Denmark. One-day workshops were held, including Last Aid courses in German and Danish, focus group interviews, and open discussions by the participants. The results show that almost all participants appreciate the LAC as an option to talk and learn about death and end-of-life care. The informants find individual differences more important than cultural differences in end-of-life care but describe differences connected to regulations and organization of services across the border. Suggestions for adaptation and improvement of the LAC include the topics of organization and support across the border, religions, and cultures, and supporting people in grief. The findings of the study will inform a revision of the Last Aid curriculum and future projects across the border and will help to include the views of minorities.

The measurement of war-related trauma amongst internally displaced men and women in South Sudan: Psychometric analysis of the Harvard Trauma Questionnaire

BackgroundStudies from armed conflict settings, including South Sudan, have revealed the deleterious mental health impact of exposure to war atrocities. However, there is little consensus on what is meant by war trauma, how it should be measured, and how levels of trauma vary across men and women. MethodsWe used psychometric analyses to measure war trauma among 1178 internally displaced adults (mean age = 39 years, 50% women) in the Malakal region of South Sudan. We used cross-sectional survey data and applied classical test theory, factor analysis, item response theory, and differential item functioning with the war events subscale (17 items) of the Harvard Trauma Questionnaire (HTQ). ResultsWe found good validity and internal consistency reliability for the HTQ. We found evidence for unidimensionality using factor analyses, and item response theory models showed that some war events (like witnessing the killing of family or friends) were more sensitive to the underlying ‘war-related trauma’ trait than others (like abduction). Differential item functioning analyses revealed that the measure performed differently for men and women, indicating the need for sex-stratified analysis in the measurement of trauma. LimitationsThe use of self-report may lead to recall and response bias, and the study sample may not be representative of the broader population in South Sudan. ConclusionThis study emphasizes the need for cultural adaptation and psychometric evaluation of commonly used measurement instruments, especially in humanitarian settings where survey data are used to set priorities for mental health and psychosocial support services.

The acceptability of cognitive behaviour therapy in Indonesian community health care

Abstract Cognitive behaviour therapy (CBT) is considered to be the most empirically supported treatment in the Western world. However, many authors emphasize the need for cultural adaptations of CBT for patients in a non-Western context. Before considering such adaptations, it is important to investigate the reasons and the degree to which this type of treatment should be adapted. One important factor is the acceptability of CBT by local health care consumers in non-Western countries, for which there is only very limited empirical evidence. This explorative study aimed to investigate the acceptability of CBT’s principles and specific interventions in Indonesia. Lectures and video clips were developed, demonstrating various mainstream CBT principles and procedures. These were presented to 32 out-patients and mental health volunteers from various Indonesian community health centres (Puskesmas), who were asked to rate to what extent they considered the presented materials to be acceptable in accordance with their personal, family, cultural and religious values. Acceptance in all four value domains was rated as very high for the general features of CBT, as well as for the content of the video clips. There were no significant differences in acceptability between the value domains. The presented study suggests that mainstream CBT applications, which are slightly culturally adapted in terms of language, therapist–patient interaction and presentation, might resonate well with consumers in community health centres in Indonesia. Key learning aims (1) Adapting CBT to non-Western patients should be based on empirical evidence. (2) The potential need for adaptation of CBT might depend on the acceptability of unadapted CBT. (3) Acceptability is assumed to be related to patients’ values.

Cultural adaptation of cognitive behaviour therapy for depression: a qualitative study exploring views of patients and practitioners from India

Abstract Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, culture can influence engagement and treatment efficacy of CBT. Several attempts have been made in Asian countries to develop a culturally adapted CBT for depression. However, research in the Indian context documenting the views on cultural influence of CBT is limited. The present study is an attempt to explore the views of patients and therapists in India by following an evidence-based approach that focuses on three areas for adaptation: (1) awareness of relevant cultural issues and preparation for therapy; (2) assessment and engagement; and (3) adjustments in therapy techniques. Semi-structured interviews with three consultant clinical psychologists/therapists, a focused group discussion with six clinical psychologists, and two patients undergoing CBT for depression were conducted. The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The results highlight therapists’ experiences, problems faced, and recommendations in all three areas of adaptation. The findings highlight the need for adaptation with understanding and acknowledging the culture differences and clinical presentation. Culturally sensitive assessment and formulation with minor adaptation in clinical practice was recommended. Therapists emphasised the use of proverbs, local stories and simplified terminologies in therapy. The findings will aid in providing culturally sensitive treatment to patients with depression in India. Key learning aims (1) To understand the views of Indian patients and therapists based on their experience of CBT. (2) To understand the need for cultural adaptation of CBT in India. (3) To understand the adaptations by therapists while using CBT in clinical practice. (4) To gain perspective on how CBT can be culturally adapted to meet the needs of the Indian population.

Mixed embeddedness of Brazilian entrepreneurs in Toronto

PurposeThe purpose of this article is to investigate how social integration, immigrant networks and barriers to ventureing affect the entrepreneurial activities of Brazilians in Canada, indicating how mixed embeddedness takes place in that context.Design/methodology/approachData were collected in Toronto, through the application of a survey with 74 Brazilian entrepreneur respondents and 42 semi-structured interviews with selected subjects, thus representing a multi-method approach. The analysis included descriptive statistics from the survey data and a qualitative analysis of the trajectories and life stories of Brazilian immigrants.FindingsOur sample comprises respondents with a high level of education and proficiency in English, coming predominantly from the southeast of Brazil, white, aged from 30 to 49. The majority of businesses are small and related to the service sector. The article contributes to the literature by discussing the elements related to mixed embeddedness, including the need for cultural adaptation and for the creation of networks as a crucial element for business venturing.Research limitations/implicationsThe study focuses on entrepreneurs regardless of their businesses sector or formality/informality status. It could be used as an instrument to support Canadian public policies for welcoming Brazilians and for the Brazilian government to prevent the evasion of potential entrepreneurs.Originality/valueThe article contributes to the body of knowledge of immigrant entrepreneurship in Canada and of Brazilian entrepreneurship overseas. The results suggest factors that may be relevant to the expansion of their business, such as social networking, cultural embeddedness and adaptation of the products/services to a wider range of target customers.

Adaptation of the Coping With Stress Course for Black Adolescents in Low-Income Communities: Examples of Surface Structure and Deep Structure Cultural Adaptations

Black adolescents in low-income communities are at increased risk of developing mental health problems due to the impact of cumulative poverty-related stressors and racial discrimination, yet Black youth have relatively low rates of mental health service utilization, resulting in significant unmet need. The Coping With Stress (CWS) Course is an evidence-based, cognitive behavioral intervention that has been shown to reduce the incidence of anxiety, mood, and conduct problems among predominantly White samples, as well as Asian and Latinx youth. In the past 25 years since the CWS Course was introduced, Black adolescents have either been severely underrepresented or conspicuously absent from program evaluation research on the CWS Course, with few exceptions. The purpose of this article is threefold: (1) to justify the need for cultural adaptations to the CWS Course for Black adolescents from low-income communities, (2) to describe the scientific basis for the specific surface structure and deep structure modifications made to the culturally adapted version of the CWS Course, known as Resilient In spite of Stressful Events or RISE, and (3) to illustrate the deep structure adaptations with a vignette drawn from implementation of the RISE program with Black adolescents in a low-income, urban community.

Clinicians' Views on the Need for Cultural Adaptation of Intervention for Children with ADHD from the Ultraorthodox Community.

Culture is a core context within occupational therapy, with a recent literature emphasizing the importance of cultural competence, as well as culturally sensitive assessment and intervention. The recent literature has indicated the efficacy of the Cognitive-Functional intervention (Cog-Fun) for children with ADHD among the general Israeli population, yet no studies to date have examined the necessity of cultural adaptations for minority groups. The current study examines the necessity of adapting the intervention protocol and process to the Ultraorthodox (UO) population, as perceived by occupational therapists. The study included 28 occupational therapists certified to use the Cog-Fun intervention, who reported using this approach with UO children. Participants responded to an online questionnaire developed for this study, regarding characteristics of the UO population and necessary adaptions to the Cog-Fun intervention process and protocol. Findings were analyzed using descriptive statistics and qualitative content analysis. Results of the study point to the necessity of addressing various features of the UO community, including daily routines and habits, cultural values, knowledge regarding ADHD, and accessibility of information. Participants also reported a need to adapt the graphic content of the intervention materials. The qualitative data expanded on the perceptions of the participants through four main themes: (a) knowledge regarding ADHD diagnosis and intervention; (b) perceptions and attitudes regarding ADHD diagnosis and medication; (c) factors affecting communication between the OT, parents, and teachers; and (d) adapting the intervention protocol to habits, routines, and lifestyle of UO families. This study has direct implications for therapists utilizing the Cog-Fun with UO children and may also provide insights relevant to occupational therapists using other treatment approaches with children from this culture, as well as other minority or traditional groups. Furthermore, this study may serve as an important addition to the limited literature describing cultural adaptations of evidence-based interventions.

Translation of the “F-Words Tools” into Brazilian Portuguese

Abstract Introduction: The International Classification of Functionality, Disability and Health (ICF) determines that for any health condition, functionality is the result of the multidirectional relationship between the positive aspects of the components of body structures and functions, activities, participation and contextual factors, encompassing personal and environmental factors. Objective: To translate and culturally adapt the “F-Words Tools” into Brazilian Portuguese. Methods: Permission to translate was granted by the authors. After reading and understanding the instruments, a researcher performed a non-certified translation into Brazilian Portuguese. Next, the back translation into English was done by a specialist in both languages without prior knowledge of the original versions. The result of the back translation was sent to the authors of the instrument for verification of semantics and content. Based on the authors' recommendations and the results of translation analyses, there was no need for cultural adaptation. Results: The back translation was approved by the authors, indicating that the Brazilian Portuguese version of all instruments was adequate. The translated titles are: Termo de Compromisso (Agreement), Colagem (Collage), Perfil (Profile) and Folha de Metas (Goal Sheet). The ICF framework was entitled: “The ICF model and My Favorite Words”. The material is available free of charge at the CanChild website. Conclusion: The translation into Brazilian Portuguese allows materials to be used in Brazil to disseminate the concepts of the ICF and the “F-words” in clinical and family settings.

Impact of a Culturally Adapted Version of Illness Management and Recovery on Israeli Arabs With Serious Mental Illness.

In recent years, there has been growing awareness of the need for cultural adaptation of evidence-based practices, which is essential for successful implementation in diverse cultural contexts. This study investigated the impact of a culturally adapted version of Illness Management and Recovery (IMR), an evidence-based practice developed in the United States, on Israeli Arabs with serious mental illness. Using a quasi-experimental design, we compared the outcomes of 86 people who completed the culturally adapted IMR version with outcomes from a matched control group (N=64) who received treatment as usual. Mixed repeated-measures analyses of variance demonstrated significant improvements in the domains of recovery, hope, self-efficacy, and quality of life among those who completed culturally adapted IMR. The culturally adapted Arabic version of IMR for Israeli Arabs was found to generate significant positive improvement. The findings are discussed with emphasis on the importance of cultural adaptation.

BRAZILIAN VERSION OF THE SHRINERS HOSPITAL UPPER EXTREMITY EVALUATION (SHUEE): TRANSLATION, CULTURAL ADAPTATION, AND EVALUATION OF PSYCHOMETRIC PROPERTIES.

ABSTRACTObjective: To validate the upper limb assessments tool, Shriners Hospital Upper Extremity Evaluation (SHUEE), for individuals with hemiplegic cerebral palsy in the Brazilian population.Methods: Validation study to translate and culturally adapt the Manual and the instrument. The psychometric properties evaluated were reliability and convergent validity. Reliability was determined by internal consistency (Cronbach’s α coefficient), ceiling and floor effect, sensitivity to changes, and intra- and interobserver agreement. Convergent validity was performed using the Pediatric Motor Activity Log, the self-care scale of the Pediatric Evaluation of Disability Inventory, and the Manual Ability Classification System.Results: We evaluated 21 individuals with hemiplegic cerebral palsy, with a mean age of 8.7±4.0 years. After the instrument was translated, there was no need for cultural adaptation. The total Cronbach’s α coefficient was 0.887 (95% confidence interval [95%CI] 0.745-0.970). We calculated sensitivity to changes in five subjects who underwent treatment with Botulinum Toxin Type A and physical therapy, with a significant difference between pre- and post-treatment evaluations in the Spontaneous Functional Analysis and Dynamic Positional Analysis. Convergent validity showed a significant correlation of the Spontaneous Functional Analysis and Dynamic Positional Analysis with the scales evaluated. All items of SHUEE presented high intra- and interobserver agreement.Conclusions: The results revealed that the Brazilian version of the SHUEE demonstrated good reliability and convergent validity, suggesting that it is an adequate and reliable tool for individuals with hemiplegic cerebral palsy in the Brazilian population.

Effects of Cultural and Educational Variables on a Computerized Continuous Performance Task: the EMBRACED CPT

Abstract Objective The continuous performance tests (CPTs) are the gold standard to assess vigilance or sustained attention. Many studies have shown that educational level is significantly associated with performance on the CPTs. However, very few studies have made comparisons that included cultural factors (Miranda et al, 2008). Given the breadth of educational systems in different parts of the world, it could be expected that the effect of educational level will vary depending on the culture of origin. The aim of this study was to examine the effect of education on performance on a CPT task in 3 ethnically diverse groups (Hispanic, Non-Hispanic and Spanish). Participants and Method This study includes 57 participants in the EMBRACED project: 12 Hispanic Americans, 26 non-Hispanics Americans, and 19 Spaniards (8.3%, 30% and 57% with high education respectively). Educational level was defined as high (university degree and above) or low (less than a university degree). The EMBRACED CPT is computerized and demands the participant to touch the iPad screen each time a target is presented. In 3 blocks of 100 stimuli each, the number of hits, omissions, and commissions is recorded. Results A mixed between-within subjects analysis of variance was conducted to compare scores in the three blocks of the CPT in relation to the three cultural groups and by education levels. Results showed no interaction effects between cultural groups and education, and no main effects of education for any of the studied variables. However, there was a significant main effect for cultural group for hits (F = 4.676, P = .014) and omissions (F = 5.614, p = .006). Conclusions The overall results for education in this study were not significant and would need further study. The variability in cultural group revealed a consistent effect across all studied variables. The non-Hispanics scored higher in hits and the Spaniards had more omissions. These results justify the need for cultural adaptation of neuropsychological measures. References Miranda, M. C., Sinnes, E. G., Pompeia, S., & Francisco Amodeo Bueno, O. (2008). A comparative study of performance in the Conners' Continuous Performance Test between Brazilian and North American children. Journal of Attention Disorders, 11(5), 588-598.

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

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.