Cultural adaptations of dialectical behavior therapy: A systematic review.

Abstract

Objective: Adapting mental health-care interventions to the race, ethnicity, or culture of the target group can enhance the acceptance and effectiveness of the treatment. Dialectical behavior therapy (DBT) is an evidence-based treatment that is principle-driven, rendering it well-suited for adaptations across cultural contexts. This article conducts a systematic review of the literature to determine the nature and extent of cultural adaptations of DBT to date. Method: We searched databases for original articles describing cultural adaptations of DBT, as applied to both (a) people of color within Western countries and (b) populations within non-Western countries. Consistent with the focus on descriptively characterizing extant DBT cultural adaptations, we included both published and nonpublished studies, as well as both observational and experimental studies. Results: Our search yielded 18 articles that met inclusion criteria. Of these articles, half described adaptations made with people and communities of color within the U.S. Most adaptations involved modifications to language, metaphors, methods, and context. Conclusions: Culturally adapted DBT has been implemented and accepted among several racial, ethnic, and cultural groups, although there is insufficient evidence to determine whether culturally adapted DBT is more efficacious than nonadapted DBT. We conclude with recommendations for best practices for DBT researchers and clinicians, and situate our findings among larger efforts to render existing evidence-based psychotherapies more optimal for people of color and people from non-Western countries.What is the public health significance of this article? Dialectical behavior therapy (DBT) may require cultural adaptation to be efficacious and accepted by all racial, ethnic, and cultural groups. The studies reviewed detail a number of cultural adaptations of DBT, most commonly in terms of language translation and addition of culturally congruent metaphors and sayings. The field must continue to both train culturally competent DBT clinicians and further adapt DBT to different cultural contexts.

Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy.

“…However, research with larger samples and greater power to detect potential differences is needed before drawing firm conclusions about the effectiveness of DBT for sexual and racial/ethnic minority people. Research is also needed to determine whether potential adaptations to DBT for marginalized groups (e.g., Cohen et al, 2021; Haft et al, 2022) enhance outcomes even further.…”

A call to increase cultural responsiveness and accessibility of dialectical behavior therapy: Commentary on Jakubovic and Drabick (2023).

“…The authors also note a key limitation, which is that there have been no published studies to date that have examined the effectiveness of adapted versus nonadapted DBT in minoritized communities. And, while not specifically highlighted by Haft et al (2022), the review only included one study that focused on adolescent health, specifically a case study on the treatment of an adolescent Navajo girl. Effectiveness notwithstanding, representation matters, and we argue here that minoritized people may be more likely to seek out and engage in treatments that are tailored for people like them.…”

“…Additionally, Haft et al (2022) provided recommendations for “broader psychotherapy.” For example, the authors acknowledged the extensive and expensive training that adherent DBT requires and noted how this likely decreases accessibility for underserved communities due to high costs. Likewise, as Jakubovic and Drabick (2023) highlight, this is particularly true for adolescents who already have less access to evidence-based treatment options, which are further inaccessible to adolescents who live in impoverished communities, are homeless, or who are otherwise estranged from families of origin and other supportive resources, all of which are inequities that disproportionately impact BIPOC and LGBTQ+ adolescent communities (e.g., Castro-Ramirez et al, 2021).…”

“…This is especially the case for adolescents who are likely to be most negatively impacted by those systems of oppression. In a recent review examining cultural adaptations of DBT (Haft et al, 2022), the authors summarized different types of adaptations including language, persons (i.e., therapist/client matching), metaphors, content (e.g., adding or removing material based on cultural relevance), goals (e.g., learning skills to cope with stigma), method (e.g., culturally congruent diary cards), and context (e.g., addressing historical trauma). The authors also note a key limitation, which is that there have been no published studies to date that have examined the effectiveness of adapted versus nonadapted DBT in minoritized communities.…”

Introduction to the special issue of the Journal of Consulting and Clinical Psychology: “Best practices” in prevention and treatment for racial and ethnic minority people.

“…Most focus on people of diverse race/ethnicity, with two focusing specifically on Black/African American people and two on Latinx people. The majority of the articles address the development, acceptability, and/or efficacy of culturally adapted and culturally relevant interventions (Ellis et al, 2022; Bauer et al, 2022; Haft et al, 2022; Kaur et al, 2022; Singla et al, 2022; Sweeney et al, 2022; Wendt et al, 2022). The others address issues related to access to services (Joiner et al, 2022; López et al, 2022), treatment moderators (Patriarca et al, 2022), and effectiveness in the community (Joiner et al, 2022).…”