Cultural/ethnic/racial issues in CBT
 

The September 2005 issue of the Behavior Therapist features a special series of articles on treating co-morbid addictive behaviors in "Indigenous, African, Hispanic, and Asian American Groups." Each short article starts with a list of "Top Ten Recommendations" which I'll recap below:

1. One size will not fit all.
2. Traditional medicine practices may be preferred.
3. Respectful noncompliance.
4. Language.
5. Fatalism.
6. Sickness: a symptom of something else.
7. The cultural meaning of the behavior.
8. Spirit world and dreams.
9. Soul wounds.
10. Walking in beauty and peace.

1. Actively integrate the client's experiences of race, ethnicity, and culture into therapy.
2. Directly address racism and discrimination in the client's life.
3. Conceptualize racisim and discrimination as "triggers" for addictive behavior as well as relapse.
4. Evaluate the role of racism as a mediator between the client's comorbid disorder and substance abuse.
5. Address culturally-relevant factors related to initiation of substance use.
6. Assess the cultural context of substance use.
7. Assess the cultural context of the comorbid disorder.
8. Examine the client's engagement in therapy in order to enhance completion of therapy.
9. Consider the role of gender and race interactions, e.g., women with PTSD related to sexual trauma who also engage in addictive behaviors.
10. Address potential HIV risk, particularly in women who use cocaine and alcohol.

1. One size doesn't fit all.
2. Only penguins look alike.
3. Some Asian Americans believe in a genetic etiology of problems.
4. Some Asian Americans believe in a psychosocial etiology of problems.
5. There are limited data on comorbidity in Asian Americans.
6. Treatment is a form of acculturation.
7. Acculturation in treatment can be coercive.
8. Matching treatment with client etiological beliefs may be effective.
9. Clients having genetic etiological beliefs may benefit from a medical solution.
10. Clients having psychosocial etiological beliefs may benefit from a psychosocial solution.

• Assess the duration, severity, and type of psychiatric and substance abuse disorders.
• Consider within-group heterogeniety as related to levels of acculturation.
• Examine cultural orientations, personal identities, and ethnic pride.
• Consider traditionalism in cultural life views.
• Examine cultural and other forms of personal identity.
• Assess feelings of discrimination and victimization.
• Consider motivations for recovery and risk of relapse.
• Examine family connectedness and social support or its absence.

Special series on Cultural/ethnic/racial issues
 

The October, 2005 edition of the Journal of Consulting and Clinical Psychology includes a special section covering cultural/racial/ethnic issues in community and clinical psychology. While it isn't exclusively about CBT, a number of the articles are CBT-oriented and all are relevant.

Introduction to the special section on multicultural and community psychology: Clinical psychology in context. Nagayama Hall, Gordon C.

Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals. Muñoz, Ricardo F.; Mendelson, Tamar

Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems, and mental health service use. Yeh, May; McCabe, Kristen; Hough, Richard L.; Lau, Anna; Fakhry, Fatmé; Garland, Ann

Caregiver-Therapist Ethnic Similarity Predicts Youth Outcomes From an Empirically Based Treatment. Halliday-Boykins, Colleen A.; Schoenwald, Sonja K.; Letourneau, Elizabeth J.

Obstacles for rural American Indians seeking alcohol, drug, or mental health treatment. Duran, Bonnie; Oetzel, John; Lucero, Julie; Jiang, Yizhou; Novins, Douglas K.; Manson, Spero; Beals, Janette; American Indian Service Utilization and Psychiatric Epidemiology Risk and Protective Factors Project Team, University of Colorado Health Sciences Center

Ethnicity, culture, and sexual aggression: Risk and protective factors. Hall, Gordon C. Nagayama; Teten, Andra L.; DeGarmo, David S.; Sue, Stanley; Stephens, Kari A.

Effects of culturally adapted parent management training on Latino youth behavioral health outcomes. Martinez, Charles R.; Eddy, J. Mark

Cultural/ethnic/racial issues in CBT #3
 

The November, 2006 issue of Cognitive and Behavioral Practice is a special issue on "Culturally Sensitive CBT." Many of the articles focus on PTSD and other anxiety disorders among refugees. Ethnic groups studied include Cambodians, Vietnamese, Chinese-Americans, Native Americans, Bosnians, and multiethnic urban individuals.

Re: Cultural/ethnic/racial issues in CBT
 

The September 2007 edition of the American Psychologist has and article on "Cultural competence and evidence-based practice in mental health services: A complementary perspective." It includes info on some CBT treatments tailored to specific cultures.