Cultural Adaptation of Scalable Psychological Interventions: A New Conceptual Framework

Abstract

The worldwide mental health treatment gap calls for scaling-up psychological interventions, which requires effective implementation in diverse cultural settings. Evidence from the field of global mental health and cultural clinical psychology indicates cultural variation in how symptoms of common mental disorders are expressed, and how culturally diverse groups explain the emergence of such symptoms. An increasing number of studies have examined to what extent cultural adaptation enhances the acceptability and effectiveness of psychological interventions among culturally diverse groups. To date, this evidence is inconclusive, and there is a lack of studies that dismantle the multiple types of modifications involved in cultural adaptation. Based on empirical evidence from ethnopsychological studies, cultural adaptation research, and psychotherapy research, the present paper offers a new conceptual framework for cultural adaptation that lays the groundwork for future empirical research. The cultural adaptation framework encompasses three elements: i) cultural concepts of distress; ii) treatment components; and iii) treatment delivery. These three elements have been discussed in literature but rarely tested in methodologically rigorous studies. Innovative research designs are needed to empirically test the relevance of these adaptation elements, to better understand the substantial modifications that enhance acceptability and effectiveness of psychological interventions. Using a theory-driven approach and innovative experimental designs, research on cultural adaptation has the potential not only to make psychological treatments more accessible for culturally adverse groups, but also to further advance empirical research on the basic question about the “key ingredients” of psychotherapy. The phenomenology of common mental disorders, as well as mind-body concepts, vary across cultures. Cultural adaptation may enhance the acceptability and effectiveness of psychological interventions. There is a lack of empirical evidence on the substantial modifications in cultural adaptation. Theory-driven, experimental approaches are needed in cultural adaptation research. The phenomenology of common mental disorders, as well as mind-body concepts, vary across cultures. Cultural adaptation may enhance the acceptability and effectiveness of psychological interventions. There is a lack of empirical evidence on the substantial modifications in cultural adaptation. Theory-driven, experimental approaches are needed in cultural adaptation research.

Features, Functionality, and Acceptability of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States

“…The appropriateness of these changes, as well as the adequacy of cultural adaptations related to the way tinnitus is perceived across cultures, requires testing during subsequent clinical trials. (Heim & Kohrt, 2019).…”

“…Beukes et al, 2020). When making cultural adaptations, it was necessary to consider aspects relevant to the general population as well as the population of interest (i.e., tinnitus patients) to ensure that the intervention was appropriate for the targeted culture (Heim & Kohrt, 2019). For this intervention cultural adaptions included matching the materials with the ethnic, cultural and social context of the population.…”

Challenges and lessons learned in re-filming the WHO mhGAP training videos for Sri Lankan context - a qualitative study

“…Cultural adaptation of instruments used for mental health intervention has growing importance in the light of increased sensitivity for intercultural differences. Frameworks have paid attention to the details of the concepts of distress, treatment components and treatment delivery [18]. The themes which emerged from this study were united under five general concepts: overall perception of process, technical issues, knowledge, barriers, and working as a team.…”

Development of a Systematic Framework for Cultural Adaptation and Contextualization of Evidence-Based Psychological Interventions

“…Despite the clarity brought about by identifying three key distinctions in the literature, these aspects of cultural adaptations are not straightforward. For example, common factors in psychotherapy such as therapeutic alliance, changing expectations of personal effectiveness, and encouragement (22,23) could be classi ed as peripheral, or supportive components, but in fact may be core and integral to the success of the treatment.…”