Southampton Adaptation Framework to Culturally Adapt Cognitive Behavior Therapy: An Update

Abstract

Cultural values, traditions, and norms influence the practice of psychotherapy. It is now widely accepted that modern evidence-based therapies such as CBT need to be culturally adapted for them to be successfully applied to clients from a non-Western background. There are multiple factors to support cultural adaptations, such as evidence from research and an increase in cultural awareness and globalization. A number of meta-analyses supporting culturally adapted interventions have been published across the globe. A review of these meta-analyses reported that culturally adapted interventions have moderate to high effect sizes in favor of culturally adapted psychological interventions. We provide a brief background on cultural differences and suggest ways to address these differences. We also discuss the current state of science in this area. We also provide a brief description of factors that are generally accepted as important components of culturally adapted interventions. We discuss the Southampton Adaptation Framework widely used to Culturally adapt CBT (SAF-CaCBT). This framework has been used in South Asia, the Middle East, China, England, Africa, and Canada. More than 20 studies have used the framework to adapt CBT culturally. The framework has evolved based on lessons learned from research and consists of 3 major areas of concern: awareness of culture and religion, assessment and engagement, and adjustments in therapy. Each area has 8 subareas to consider when culturally adapting CBT. Finally, we discuss the limitations and barriers in this area and recommendations for future work. There is a need to develop universal guidelines on cultural adaptation as well as areas of adaptation, more research with better methodology and the use of active comparators in the assessment of culturally adapted interventions. There is also a need to further strengthen the evidence base by robust meta analyses.

Keywords: Cognitive therapy; Culturally adapted CBT; Culture; Southampton adaptation framework.