Coping with cognitive behaviour therapy for psychosis, adapting it for another culture, and community inclusion

The purpose of this paper is to highlight what helps and what is difficult about cognitive behaviour therapy for psychosis (CBTp) in relation to recovery and social inclusion, how it can be adapted for a non-western culture, and how inclusion in communities in which people feel comfortable can help their recovery.

Three journal articles are described. The first summarises six small qualitative studies involving interviews with UK service users about what they found helpful and challenging about CBTp. The second article reports on a pilot trial of CBTp adapted for the culture in Pakistan, where families are seen as more involved in service users’ care. The third article describes USA-based participants’ engagement with different communities as part of their recovery.

UK service users appreciated feeling equal to their therapist in CBTp, receiving an understandable explanation of their difficulties, and support for gradual steps towards activities they valued. However, it was difficult revisiting traumatic pasts to understand their difficulties, and UK mental health culture may hamper taking an active role in treatment. In Pakistan, CBTp can be successfully adapted to include a key family member and local spiritual beliefs. In a USA context, service users developed competencies in community groups they valued, and these could be minority or service user communities where people felt comfortable and could make a contribution.

The experiences of service users of CBTp are rarely collated from several qualitative studies, and important themes came from doing so. It may be important to understand current barriers to doing CBTp homework and the effect of some aspects of mental health services on people’s readiness to take an active role. Studies of adapting CBTp for non-western cultures are rare, but it seemed successful in Pakistan, adopting a bio-psycho-spiritual-social model. The qualitative study of people’s engagement in US community groups highlights the importance of not dismissing engagement in minority groups for people’s recovery, rather than only the “wider” community.