Improving the cultural sensitivity of cognitive–behavioral therapy for Chinese migrants with depression: Community members’ and clinicians’ perspectives.

Abstract

The aim of the present study was to document clinicians' and community members' perspectives on the cultural adaptation of cognitive-behavioral therapy (CBT) to Chinese migrants with depression. Thirty-four participants, recruited using snowballing and purposive sampling, participated in 12 individual semistructured interviews and 5 focus groups. Thematic analysis and a modified consensual qualitative research approach were used for data analysis. Five major themes were identified: mixed attitudes and perspectives toward CBT, improving the cultural sensitivity of cognitive restructuring, applications of behavioral strategies, attitudes toward mindfulness meditation, and the importance of incorporating core culturally sensitive strategies. The findings suggest that a client's interdependent self needs to be considered in future versions of CBT for Chinese migrants. In terms of therapy, this would involve an equal emphasis on adopting a culturally sensitive approach in using cognitive, behavioral, and focus techniques and cultivating cultural humility. As such, a key challenge for clinicians is to shift their clinical perspective from one of cultural competency (i.e., developing culture-specific expertise) to cultural humility (i.e., learning from clients about their culture and worldviews instead of assuming expertise). An emphasis on cultural sensitivity has the potential to improve clinical engagement and treatment outcomes of psychological interventions in an underrepresented population in counseling services. Public Significance StatementThe present study advances the idea that a client's interdependent self needs to be considered in future versions of cognitive-behavioral therapy for Chinese migrants. In practice, this would involve an equal emphasis on cognitive, behavioral, and focus techniques and cultivating cultural humility.

A Culturally Adapted Cognitive Behavioral Therapy Group: A Randomized Controlled Trial

“…This finding suggests that service components of the treatment group, that is, culturally adapted CBT group, are the only significant elements facilitating clinically significant improvement for people with clinical depression. When conducting the culturally adapted CBT group, social workers need to be sensitive to those cultural values in relation to depression (Bercean et al, 2020;Guo & Hanley, 2015). In particular, when providing the culturally adapted CBT group to Chinese people, the use of cognitive restructuring to work with Chinese traditional cultural values and beliefs requires caution.…”

“…In particular, when providing the culturally adapted CBT group to Chinese people, the use of cognitive restructuring to work with Chinese traditional cultural values and beliefs requires caution. Some studies suggest that the use of cognitive restructuring skills to replace Chinese traditional cultural core values, such as filial piety, may have adverse effects by destabilizing clients' identities and relationships with others (Bercean et al, 2020), Other studies indicate that the use of cognitive restructuring skills to replace Chinese traditional cultural core values is appropriate by facilitating clients to develop more flexible versions of these cultural values (Guo & Hanley, 2015). This study supports the latter notion (Guo & Hanley, 2015), and demonstrates that it is appropriate for the culturally adapted CBT group to transform and replace the negative beliefs of Chinese people with depression about themselves, the world, and their future, which are greatly influenced by traditional Chinese cultural values, including shame, being a family burden, self-devaluation, and fate, with more flexible versions of beliefs.…”

“…However, the Chinese cultural values that improve depressive symptoms, including those values that are shaped by traditional philosophies and religions, including Confucianism, Taoism, and Buddhism, will be used to facilitate mental health recovery. Very few randomized controlled trials have been conducted in this area (Bercean et al, 2020; Hwang et al, 2015).…”

“…In fact, CBT has been shown to be compatible with Chinese cultural values (Hodges & Oei, 2007; Lin, 2001), and culturally adapted CBT has been shown to be feasible for Chinese people (Guo & Hanley, 2015). However, many of these studies of culturally adapted CBT are done in Western countries (Bercean et al, 2020), and very few studies have been done in Chinese societies. A previous study has attempted to adapt CBT in Chinese society by expressing the technical terms and intervention skills of CBT in more culturally appropriate words to improve cultural relevance and acceptability (Wong, 2008) with positive outcomes.…”

“…In particular, the culturally adapted CBT group developed in this study aims to help Chinese people with depression transform their negative beliefs about themselves, the world, and their future, including shame, self-devaluation, being a family burden, and date, which are influenced by traditional Chinese cultural values. Very few randomized controlled trials have been conducted in this area (Bercean et al, 2020; Hwang et al, 2015).…”