Research suggests that attributing mental illness to moral causes and perceiving it as dangerous relates to greater stigma, whereas belief in biomedical factors is associated with less. Within the family-centric Orthodox Jewish community, mental illness is perceived as a risk to family functioning and future generations, and is therefore stigmatizing of the individual and their family. Since biomedical models may exacerbate these concerns, we hypothesized that unlike within the general population, biological causal attributions would relate to increased stigma among Orthodox Jews. Consequently, we also examined the attitudinal correlates of stigmatization of obsessive-compulsive disorder within the Orthodox community, as measured by both social distance and family/marriage concerns. Results indicated that, unlike previous research, biological models were associated with greater marriage/family stigma, and did not predict less social distance. This suggests that biomedical approaches may increase salient aspects of stigma within the Orthodox community, and clinical practice should be sensitive to these concerns.

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Cognitive behavioural therapy (CBT) is an evidence-based treatment for various psychopathologies. CBT has also been used in psychosis, however relatively few articles deal with the culturally competent adaptation of CBT for psychosis, and none for the Orthodox Jewish population. We analysed cases of messianic delusion among Orthodox Jews, for whom we used a culturally competent adaptation of CBT. Our therapeutic work consisted of sorting out acceptable beliefs from delusions, and to acknowledge those acceptable beliefs. We recognised how patients themselves reframe their views when they become less delusional. We tried to accompany the patients in this reframing process. We advocate an approach in CBT where therapists can use a few culturally appropriate ideas taken from the patient's grossly delusional thinking, and help the patient reframe their frankly delusional thoughts into more culturally or socially accepted ideas.

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