Experience of psychologists in the delivery of cognitive behaviour therapy in a non-western culture for treatment of substance abuse: a qualitative study

Abstract

Background Psychotherapy is the preferred form of treatment for psychological disorders worldwide. Cognitive behaviour therapy (CBT) is one of the most widely used psychotherapies due to its proven efficacy for psychological disorders, including substance abuse. However, CBT was developed in the West according to the culture of developed countries. Therefore, it requires cross-cultural adaptation for non-Western countries. Pakistan is one of the developing non-Western countries where substance use disorders are increasing at an alarming rate. Despite the proven efficacy of CBT for substance use disorders, there is a dearth of its utilization in Pakistan. Therefore, in the present study, in-depth qualitative interviews were conducted with CBT practitioners in Pakistan to understand barriers and challenges in this regard. The study was a part of a broader project aimed at cultural adaptation of CBT for people with substance use disorders (SUDs) in Pakistan. Methods In-depth qualitative interviews were conducted with CBT practitioners (N = 8) working in rehabilitation centres and hospitals in Islamabad, Pakistan. Thematic content analysis was conducted to develop core themes from the data. Results CBT for SUDs requires some adjustments according to Pakistani culture for successful utilization. The challenges in providing CBT for SUDs revolved around three main themes, i.e., the mental health system, societal practices, and therapeutic issues, and 10 subthemes. Conclusion In order to utilize the benefits of CBT for SUDs in Pakistan, cultural adaptation is necessary as an initial step. However, its delivery requires stringent modifications in the health care system to address these challenges.

The Application of Cognitive Behavioral Therapy (CBT) in Drug Abuse Victims

“…In subsequent sessions, psychiatrists should provide information about the truth and benefits of medical and psychiatric treatment, as well as discuss superstitious beliefs and clarify unfounded denials. The patient's family should be involved in therapy as they play an important role in treatment decisions and the process (Azad et al, 2022).…”

“…The findings revealed three main themes: mental health system, community practices, and therapeutic issues. Cultural adaptation is needed in the implementation of CBT, and its delivery requires strict modifications within the healthcare system to address challenges (Azad et al, 2022). A study was conducted to examine the effectiveness of Cognitive-Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) in reducing mood symptoms among patients with substance abuse, and the results were effective (Haghighat & Mohammadi, 2018).…”

Health humanities for inclusive, globally interdependent, supportive and decolonised health professional education: The future is health humanities!

“…The first is to provide an intellectually sharper means for engaging with patients, carers and colleagues as situated beings. Much contemporary discussions of health and illness emphasise the importance of social determinants of health, without health professionals having many means for going beyond the "bio" in "biopsychosocial" (Bartz, 1999) or going beyond narrowly cognitive, overly-and culturally inappropriately (Azad et al, 2022)-individualised approaches for the "psycho" (Crossley, 2008). Being able to critically assess and move between knowledges about single factors and individual bodies, knowledges about populations and social structures, and knowledges about dynamics in (complex, adaptive) systems (such as human bodies!)…”