I would like to thank Richard Thwaites and Cambridge University Press for inviting me to write this blog about the imminent Special Issue of the Cognitive Behaviour Therapist (tCBT) on Cultural Adaptations. I have taken a short piece that I wrote for the EABCT 2018 conference and adapted it for this blog. No need to overthink it and create something new right?

Saiqa Naz

Having being involved in the review process for several of the articles submitted for this special issue, I am really excited that this Special Issue is going to fill a gap in research literature and help us to improve the quality of care we provide to people from diverse communities.

I thought I would take this opportunity to highlight some of the work we are doing with BABCP’s Equality and Culture Special Interest Group (SIG) and some personal reflections as to how the SI fits in with what we are trying to achieve with BABCP’s Equality and Culture SIG.

For many years, we (therapists and communities) have been given the narrative that those who are typically underrepresented in mental health services are so because of stigma. I used to believe this too until I started doing outreach work in the community in my own time. Here is what I have learnt from doing this work and the work we are doing with the BABCP’s Equality and Culture Special Interest Group (SIG) :

1)    People do not fully understand what mental health is or what support is available to them– We need to help educate people.

2)    Those who do access support, do not always report positive experiences. This is partially due to feeling that the therapist does not fully understand them or they struggle to relate to the interventions being delivered. To support therapists, we are delivering workshops on this via the BABCPs Equality and Culture SIG. Dr Andrew Beck (previous chair of BABCPs Equality and Culture SIG) has also written a book ‘Transcultural Cognitive Behaviour Therapy for Anxiety and Depression,’ to support therapists and services.

3)    Lack of resources/materials e.g. translated materials is often what therapists ask me for. We are trying to raise awareness of this via the BABCPs Equality and Culture SIG.

4)    Lack of research– We need more research to demonstrate that CBT is not just a White Western concept, maybe the way mental health services are commissioned and developed are, but I don’t believe CBT is. For example:

  • I co-facilitated a workshop at the beginning of BABCPs annual conference in Glasgow this year with an Islamic scholar, Shaykh Abdul Aziz Ahmed. 50+ people (predominately Muslims) attended. The Shaykh used an 800year old Islamic text to talk about mental health. Lucy Maddox has kindly produced a podcast of this event, which can be found on BABCPs website. I also recently went to a mental health event in Bradford organised for the Sikh community at the Guru Nanak Dev Ji Gurdwara (Sikh temple) with an emphasis on what the Sikh scriptures say about mental health. The event was attended by at least 200 people.  The concepts covered in both these events were very similar to CBT. There was nothing in either of the events which made me think that they were not compatible with CBT.
  • Dr Ghazala Mir has experienced many rejected proposals about religion and Muslim mental health, involving highly skilled teams, to the NIHR Public Health and Health Services Research Boards as well as a rejection from the Medical Research Council. She told me that, “Lack of feedback on reasons for rejection was also an issue.” Regardless of our personal beliefs, many of those we work with do have religious beliefs which are important to them, therefore, research being conducted needs to reflect this.
  • Afsana Faheem shared some of her research at the BPS conference this year discussing, ‘Are evidence-based psychological interventions for depression and/or anxiety related disorders effective in improving mental health outcomes for Black and Minority Ethnic groups in England, UK? – A systematic Review.’ This is due to be published. In her initial database search which brought up 30,000 articles, Afsana was able to use only two articles that matched her criteria. Afsana found that the lack of research relating to anxiety related disorders was of most concern and in her abstract concludes that further research within this field is needed to ensure that mental health outcomes for this population can be adequately improved.
  • I agree with Afsana. More research will also help inform the care provided to diverse communities and how services are commissioned and delivered. Again, this is something we are raising awareness of via the Equality and Culture SIG. We need research to help strengthen our argument.
  • It is important to note that the SI did not charge anybody for sharing their ideas. The Guest Editors (Andrew Beck, Faramarz Hashempour and Lydia Stone) have given up their own time and provided support to those who are unfamiliar with the publication process to publish their papers. It is, therefore, important that we show our gratitude by acknowledging their contributions in not only preparing the SI, but also the additional support they have provided therapists over the past 12months, to myself included. The Equality and Culture SIG hopes to further support therapists develop these skills to disseminate their knowledge and enrich CBT.

How can the SI help us to start reducing inequalities in mental health? Here I briefly touch on some things we need to consider to start working with diverse communities.

  • Race– When we think of culture, we need to start thinking past our skin colour and connect with individuals we are working with. This is the approach we have taken for our article “Addressing Issues of Race, Ethnicity and Culture in CBT to support therapists and service managers to deliver culturally competent therapy and reduce inequalities in mental health provision for BME service users.”
  • Racism– I recently participated at an event organised by Kids of Colour on Racism and Mental Health based in Manchester. My impressions were that people’s mental health is affected by racism, however, this is not being addressed by mental health professionals, which in turn is being perceived to be due to racism.  Andrew Beck’s article explores this.
  • Deprivation– My hometown of Rochdale has some of the highest levels of deprivation in the country. It also has one of the highest levels of antidepressant prescribing rates in the country. We need to think about how we engage and work with more deprived communities. Some of their needs will be different to those from more affluent backgrounds, and therefore research and how services are commissioned needs to reflect this. When we talk about culture, we should not forget working class communities including the white working class communities although unfortunately there were no submissions on this for the SI.

By not including diversity and inclusion in our literature and clinical practice, we may inadvertently be reinforcing the divisions we have in society in general.

To conclude, psychology research needs to be reflective of and representative of its members and the diverse world we now live in and work to serve and has an important role to play in community cohesion. I firmly believe the BABCP tCBT is leading the way on points 2 and 4 that I make above. I hope it also educates the critics who lack knowledge of CBT and perceive CBT as being inflexible.

Finally, I am extremely excited and honoured that we will officially be launching tCBT Special Issue on Cultural Adaptations alongside the BABCPs Equality and Culture SIGs AGM and CPD event in January, 2019. The theme of the day is ‘Why Behaviour Change is required for inclusion and all of our wellbeing.’ We have exciting speakers lined up for the day including Roger Kline, author of the Snowy White Peaks report, Professor Paul Salkovskis, current president of BABCP and Richard Thwaites, Editor-in-chief at tCBT.  I hope to meet some of you then.

If you are a BABCP member and would like to join our SIG, please email [email protected].

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