Current use of cultural adaptations of CBT by UK-based practitioners

Introduction and Aims: CBT, while widely used as the first line of treatment for multiple mental health issues, has not been tested rigorously on ethnic minority groups. Recent decades have brought a revolution of cultural competency and adaptation research for psychotherapies considering the large proportion of ethnic minority groups residing within the UK who tend not to respond as well to un-adapted interventions. Research in this field, however, continues to be limited or heterogeneous, training in cultural competence is not mandatory, and existing training programs tend to not be as effective.
Questions: This study aimed to explore the CBT therapists’ use of adaptations in their own practice, the elements they tend to adapt, the impact and feasibility of their approaches, and the obstacles faced in trying to adapt.
Methods: A survey was developed using secondary research and distributed to UK-based CBT therapists via online platforms.
Results: 71% of therapists in our sample adapted their CBT practice for ethnic minority clients. Of those, 46% believed that using culturally significant idioms and stories, and 42% believed that adapting CBT techniques and implementation are impactful for their clients. It was also observed that current barriers to adapting CBT for ethnic minority clients involves a lack of resources to study the efficacy of adaptations as well as a lack of well-established evidence-based adaptations in existing literature.
Discussion: The authors recommend that policymakers and service managers prioritise the regulation of and training in cultural competence for psychotherapists, and afford resources and incentive to researchers and clinicians to develop and test effective adaptations, which could eventually help to enhance mental health outcomes for ethnic minority groups. Such steps could minimise the mistrust that ethnic minorities tend to have for NHS services as well (NHS Race and Health Observatory, 2021). Future research could build on this study using qualitative methods or creating more robust surveys, using random sampling, and drawing larger sample sizes.