A Cultural Adaptation of Dialectical Behavior Therapy in Nepal

被引:41
作者
Ramaiya, Megan K. [1 ,2 ]
Fiorillo, Devika [3 ]
Regmi, Upasana [4 ]
Robins, Clive J. [5 ]
Kohrt, Brandon A. [1 ,5 ]
机构
[1] Duke Global Hlth Inst, Durham, NC USA
[2] Univ Washington, Seattle, WA 98195 USA
[3] Emory Univ, Atlanta, GA 30322 USA
[4] Transcultural Psychosocial Org Nepal, Kathmandu, Nepal
[5] Duke Univ, Durham, NC 27706 USA
关键词
Dialectical behavior therapy; suicide; cultural adaptation; Nepal; global mental health; RANDOMIZED CONTROLLED-TRIAL; BORDERLINE PERSONALITY-DISORDER; MIDDLE-INCOME COUNTRIES; MENTAL-HEALTH; ANXIETY DISORDERS; ASIAN-AMERICANS; RURAL UGANDA; PSYCHOTHERAPY; INTERVENTION; DEPRESSION;
D O I
10.1016/j.cbpra.2016.12.005
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia.
引用
收藏
页码:428 / 444
页数:17
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