CROSSCROSSCROSSCROSS----CULTURAL CULTURAL CULTURAL CULTURAL INTEGRATION IN CBT:INTEGRATION IN CBT:INTEGRATION IN CBT:INTEGRATION IN CBT:

WHY, HOW, AND FUTURE WHY, HOW, AND FUTURE WHY, HOW, AND FUTURE WHY, HOW, AND FUTURE DIRECTIONSDIRECTIONSDIRECTIONSDIRECTIONSDIRECTIONSDIRECTIONSDIRECTIONSDIRECTIONS

Arthur M. Nezu, Ph.D., ABPPArthur M. Nezu, Ph.D., ABPPArthur M. Nezu, Ph.D., ABPPArthur M. Nezu, Ph.D., ABPPDrexel University, USADrexel University, USADrexel University, USADrexel University, USA

CrossCrossCrossCross----Cultural Integration Cultural Integration Cultural Integration Cultural Integration in CBT : Some Definitionsin CBT : Some Definitionsin CBT : Some Definitionsin CBT : Some Definitions

“Cross“Cross“Cross“Cross----Cultural”Cultural”Cultural”Cultural”

• Definition: “Concerned with exchange beyond Definition: “Concerned with exchange beyond Definition: “Concerned with exchange beyond Definition: “Concerned with exchange beyond boundaries of a nation or cultural group”boundaries of a nation or cultural group”boundaries of a nation or cultural group”boundaries of a nation or cultural group”

• Caution: “culture ” Caution: “culture ” Caution: “culture ” Caution: “culture ” ≠≠≠≠ nationnationnationnation• Caution: “culture ” Caution: “culture ” Caution: “culture ” Caution: “culture ” ≠≠≠≠ nationnationnationnation• ********Need to address diversity and Need to address diversity and Need to address diversity and Need to address diversity and “multiculturalism” (sub“multiculturalism” (sub“multiculturalism” (sub“multiculturalism” (sub----cultures within cultures within cultures within cultures within nations)nations)nations)nations)

“Cognitive“Cognitive“Cognitive“Cognitive----Behavior Therapy”Behavior Therapy”Behavior Therapy”Behavior Therapy”

• Cognitive and behavioral therapCognitive and behavioral therapCognitive and behavioral therapCognitive and behavioral therapiesiesiesies

• Caution: Don’t forget fundamentals!Caution: Don’t forget fundamentals!Caution: Don’t forget fundamentals!Caution: Don’t forget fundamentals!• Caution: Don’t forget fundamentals!Caution: Don’t forget fundamentals!Caution: Don’t forget fundamentals!Caution: Don’t forget fundamentals!

• Roots in behavior therapy, behavior Roots in behavior therapy, behavior Roots in behavior therapy, behavior Roots in behavior therapy, behavior modification, modification, modification, modification, and and and and cognitive therapycognitive therapycognitive therapycognitive therapy

Cognitive, Behavioral, etc.Cognitive, Behavioral, etc.Cognitive, Behavioral, etc.Cognitive, Behavioral, etc.(Nezu & Nezu)(Nezu & Nezu)(Nezu & Nezu)(Nezu & Nezu)

• CBT is a world view that emphasizes an empirical CBT is a world view that emphasizes an empirical CBT is a world view that emphasizes an empirical CBT is a world view that emphasizes an empirical approach to clinical case formulation, intervention, approach to clinical case formulation, intervention, approach to clinical case formulation, intervention, approach to clinical case formulation, intervention, and evaluation regarding human problemsand evaluation regarding human problemsand evaluation regarding human problemsand evaluation regarding human problems

• It incorporates a It incorporates a It incorporates a It incorporates a broadbroadbroadbroad definition of human definition of human definition of human definition of human • It incorporates a It incorporates a It incorporates a It incorporates a broadbroadbroadbroad definition of human definition of human definition of human definition of human functioning that includes functioning that includes functioning that includes functioning that includes overt actionsovert actionsovert actionsovert actions, , , , internal internal internal internal cognitive phenomenacognitive phenomenacognitive phenomenacognitive phenomena, , , , affectaffectaffectaffect, underlying , underlying , underlying , underlying biological biological biological biological phenomenaphenomenaphenomenaphenomena, and , and , and , and social interactionssocial interactionssocial interactionssocial interactions

• Follows a bioFollows a bioFollows a bioFollows a bio----psychopsychopsychopsycho----social modelsocial modelsocial modelsocial model

Cognitive & Behavioral Cognitive & Behavioral Cognitive & Behavioral Cognitive & Behavioral TherapiesTherapiesTherapiesTherapies

• Various conceptual and treatment models exist for Various conceptual and treatment models exist for Various conceptual and treatment models exist for Various conceptual and treatment models exist for a given disorder that are under a CBT umbrellaa given disorder that are under a CBT umbrellaa given disorder that are under a CBT umbrellaa given disorder that are under a CBT umbrellaa given disorder that are under a CBT umbrellaa given disorder that are under a CBT umbrellaa given disorder that are under a CBT umbrellaa given disorder that are under a CBT umbrella

• Depression:Depression:Depression:Depression:– Cognitive therapy (Beck)Cognitive therapy (Beck)Cognitive therapy (Beck)Cognitive therapy (Beck)

– Behavioral activation (Jacobson, Martell)Behavioral activation (Jacobson, Martell)Behavioral activation (Jacobson, Martell)Behavioral activation (Jacobson, Martell)

– ProblemProblemProblemProblem----solving therapy (Nezu & Nezu)solving therapy (Nezu & Nezu)solving therapy (Nezu & Nezu)solving therapy (Nezu & Nezu)

– Acceptance & commitment therapy (Hayes)Acceptance & commitment therapy (Hayes)Acceptance & commitment therapy (Hayes)Acceptance & commitment therapy (Hayes)

Cognitive & Behavioral Cognitive & Behavioral Cognitive & Behavioral Cognitive & Behavioral TherapiesTherapiesTherapiesTherapies

• NomotheticNomotheticNomotheticNomothetic vs.idiographicvs.idiographicvs.idiographicvs.idiographic crosscrosscrosscross----cultural cultural cultural cultural integrationintegrationintegrationintegrationintegrationintegrationintegrationintegration

• Importance of models of case formulationImportance of models of case formulationImportance of models of case formulationImportance of models of case formulation

CrossCrossCrossCross----Cultural Cultural Cultural Cultural Integration: Why?Integration: Why?Integration: Why?Integration: Why?

• Increased need and demand for mental health Increased need and demand for mental health Increased need and demand for mental health Increased need and demand for mental health resources across Asian countriesresources across Asian countriesresources across Asian countriesresources across Asian countries– Increased acceptance of Western ideasIncreased acceptance of Western ideasIncreased acceptance of Western ideasIncreased acceptance of Western ideas– Increased acceptance of Western ideasIncreased acceptance of Western ideasIncreased acceptance of Western ideasIncreased acceptance of Western ideas

– Lessened social stigmaLessened social stigmaLessened social stigmaLessened social stigma

– High rates of “pathology”High rates of “pathology”High rates of “pathology”High rates of “pathology”

– Increased problems due to Western influence Increased problems due to Western influence Increased problems due to Western influence Increased problems due to Western influence

• Culturally adapted treatments are Culturally adapted treatments are Culturally adapted treatments are Culturally adapted treatments are

potentially more effective potentially more effective potentially more effective potentially more effective ((((Griner & Smith, 2006)Griner & Smith, 2006)Griner & Smith, 2006)Griner & Smith, 2006)

Why CBT?Why CBT?Why CBT?Why CBT?

• CBT = evidencedCBT = evidencedCBT = evidencedCBT = evidenced----based approachbased approachbased approachbased approach

• ShortShortShortShort----termtermtermterm• ShortShortShortShort----termtermtermterm

• Cost effectiveCost effectiveCost effectiveCost effective

• FlexibleFlexibleFlexibleFlexible

CBT CrossCBT CrossCBT CrossCBT Cross----Cultural Cultural Cultural Cultural Integration: How?Integration: How?Integration: How?Integration: How?

• As CBT professionalAs CBT professionalAs CBT professionalAs CBT professional---- first first first first • As CBT professionalAs CBT professionalAs CBT professionalAs CBT professional---- first first first first identify challenges or identify challenges or identify challenges or identify challenges or obstaclesobstaclesobstaclesobstacles

CrossCrossCrossCross----Cultural Integration of Cultural Integration of Cultural Integration of Cultural Integration of CBT: ChallengesCBT: ChallengesCBT: ChallengesCBT: Challenges

• Differences in values/worldviews/behaviors Differences in values/worldviews/behaviors Differences in values/worldviews/behaviors Differences in values/worldviews/behaviors between Asian and Western culturesbetween Asian and Western culturesbetween Asian and Western culturesbetween Asian and Western culturesbetween Asian and Western culturesbetween Asian and Western culturesbetween Asian and Western culturesbetween Asian and Western cultures

• Lack of basic researchLack of basic researchLack of basic researchLack of basic research

• Lack of outcome researchLack of outcome researchLack of outcome researchLack of outcome research

• “Integrative impulsivity”“Integrative impulsivity”“Integrative impulsivity”“Integrative impulsivity”

Differences in WorldviewsDifferences in WorldviewsDifferences in WorldviewsDifferences in Worldviews

• Holistic vs. Holistic vs. Holistic vs. Holistic vs. • Holistic vs. Holistic vs. Holistic vs. Holistic vs. analyticanalyticanalyticanalytic

Dealing with ContradictionsDealing with ContradictionsDealing with ContradictionsDealing with Contradictions

• Rational vs. Rational vs. Rational vs. Rational vs. dialecticdialecticdialecticdialectic

A: My racing heart is the sign of a heart attackA: My racing heart is the sign of a heart attackA: My racing heart is the sign of a heart attackA: My racing heart is the sign of a heart attackB: My racing heart is due to anxiety in B: My racing heart is due to anxiety in B: My racing heart is due to anxiety in B: My racing heart is due to anxiety in

anticipation of my business meeting.anticipation of my business meeting.anticipation of my business meeting.anticipation of my business meeting.

Differences in ValuesDifferences in ValuesDifferences in ValuesDifferences in Values

• Collectivist Collectivist Collectivist Collectivist

• vs. Individualistic vs. Individualistic vs. Individualistic vs. Individualistic

Differences in ValuesDifferences in ValuesDifferences in ValuesDifferences in Values

• Hierarchical family orientationHierarchical family orientationHierarchical family orientationHierarchical family orientation

Differences in Help SeekingDifferences in Help SeekingDifferences in Help SeekingDifferences in Help Seeking

• Low adherence to Asian values is associated Low adherence to Asian values is associated Low adherence to Asian values is associated Low adherence to Asian values is associated with more helpwith more helpwith more helpwith more help----seeking from professionalsseeking from professionalsseeking from professionalsseeking from professionals(shea (shea (shea (shea

& Yeh, 2008)& Yeh, 2008)& Yeh, 2008)& Yeh, 2008)

• Asians and AsianAsians and AsianAsians and AsianAsians and Asian----Americans Americans Americans Americans • Asians and AsianAsians and AsianAsians and AsianAsians and Asian----Americans Americans Americans Americans do not ask for social support due do not ask for social support due do not ask for social support due do not ask for social support due to potential negative consequences to potential negative consequences to potential negative consequences to potential negative consequences on relationship on relationship on relationship on relationship (Kim et al., 2008)(Kim et al., 2008)(Kim et al., 2008)(Kim et al., 2008)

Challenge: Lack of Basic ResearchChallenge: Lack of Basic ResearchChallenge: Lack of Basic ResearchChallenge: Lack of Basic Research

• Influence of cultural differences/influences on Influence of cultural differences/influences on Influence of cultural differences/influences on Influence of cultural differences/influences on pathology are unknownpathology are unknownpathology are unknownpathology are unknown

• CultureCultureCultureCulture----bound disordersbound disordersbound disordersbound disorders– TaijinTaijinTaijinTaijin kyofushokyofushokyofushokyofusho (Japan)(Japan)(Japan)(Japan)– TaijinTaijinTaijinTaijin kyofushokyofushokyofushokyofusho (Japan)(Japan)(Japan)(Japan)

– NeckNeckNeckNeck----focused panic disorder (Cambodia)focused panic disorder (Cambodia)focused panic disorder (Cambodia)focused panic disorder (Cambodia)

– HwabyungHwabyungHwabyungHwabyung (Korea)(Korea)(Korea)(Korea)

• What factors are transcultural vs. multicultural?What factors are transcultural vs. multicultural?What factors are transcultural vs. multicultural?What factors are transcultural vs. multicultural?

• Culture: cause, symptom, effect, mediator, Culture: cause, symptom, effect, mediator, Culture: cause, symptom, effect, mediator, Culture: cause, symptom, effect, mediator, moderator? Under what circumstances?moderator? Under what circumstances?moderator? Under what circumstances?moderator? Under what circumstances?

Challenge: Lack of Culturally Challenge: Lack of Culturally Challenge: Lack of Culturally Challenge: Lack of Culturally Responsive RCTsResponsive RCTsResponsive RCTsResponsive RCTs

• RCTs of CBT for diverse groups within US or other RCTs of CBT for diverse groups within US or other RCTs of CBT for diverse groups within US or other RCTs of CBT for diverse groups within US or other countries are fewcountries are fewcountries are fewcountries are few

• Almost none compare “regular” CBT vs. “culturallyAlmost none compare “regular” CBT vs. “culturallyAlmost none compare “regular” CBT vs. “culturallyAlmost none compare “regular” CBT vs. “culturally----• Almost none compare “regular” CBT vs. “culturallyAlmost none compare “regular” CBT vs. “culturallyAlmost none compare “regular” CBT vs. “culturallyAlmost none compare “regular” CBT vs. “culturally----responsive CBT”responsive CBT”responsive CBT”responsive CBT”

• Few guiding models exist to direct treatment developmentFew guiding models exist to direct treatment developmentFew guiding models exist to direct treatment developmentFew guiding models exist to direct treatment development

• Lack of identifying how CBT approach is Lack of identifying how CBT approach is Lack of identifying how CBT approach is Lack of identifying how CBT approach is

made culturally responsive whenmade culturally responsive whenmade culturally responsive whenmade culturally responsive when

evaluated in nonevaluated in nonevaluated in nonevaluated in non----western countries western countries western countries western countries

Challenge: Impulsive AdaptationsChallenge: Impulsive AdaptationsChallenge: Impulsive AdaptationsChallenge: Impulsive Adaptations

• Need to conduct basic researchNeed to conduct basic researchNeed to conduct basic researchNeed to conduct basic research

• Need to conduct methodologically strong Need to conduct methodologically strong Need to conduct methodologically strong Need to conduct methodologically strong RCTsRCTsRCTsRCTsRCTsRCTsRCTsRCTs

• Need to develop evidencedNeed to develop evidencedNeed to develop evidencedNeed to develop evidenced----based models of based models of based models of based models of integrationintegrationintegrationintegration

• “Cross“Cross“Cross“Cross----cultural” vs. “multicultural” vs. “multicultural” vs. “multicultural” vs. “multi----cultural” cultural” cultural” cultural”

CrossCrossCrossCross----Cultural Cultural Cultural Cultural Integration: HowIntegration: HowIntegration: HowIntegration: How→→→→ FFFFuture uture uture uture

Directions?Directions?Directions?Directions?CONDUCT MORE RESEARCHCONDUCT MORE RESEARCHCONDUCT MORE RESEARCHCONDUCT MORE RESEARCHCONDUCT MORE RESEARCHCONDUCT MORE RESEARCHCONDUCT MORE RESEARCHCONDUCT MORE RESEARCH

Potential Areas: Potential Areas: Potential Areas: Potential Areas: AssessmentAssessmentAssessmentAssessment

• Develop culturallyDevelop culturallyDevelop culturallyDevelop culturally----relevant instrumentsrelevant instrumentsrelevant instrumentsrelevant instruments– Go beyond East AsiaGo beyond East AsiaGo beyond East AsiaGo beyond East Asia

– Develop new measuresDevelop new measuresDevelop new measuresDevelop new measures– Develop new measuresDevelop new measuresDevelop new measuresDevelop new measures

• Develop psychometrically sound measuresDevelop psychometrically sound measuresDevelop psychometrically sound measuresDevelop psychometrically sound measures

• Assess crossAssess crossAssess crossAssess cross----cultural applicabilitycultural applicabilitycultural applicabilitycultural applicability

• Publish crossPublish crossPublish crossPublish cross----culturallyculturallyculturallyculturally

• Collaborate crossCollaborate crossCollaborate crossCollaborate cross----culturallyculturallyculturallyculturally

Research Areas: Effects of Research Areas: Effects of Research Areas: Effects of Research Areas: Effects of CulturallyCulturallyCulturallyCulturally----Relevant FactorsRelevant FactorsRelevant FactorsRelevant Factors

• ValuesValuesValuesValues– Filial pietyFilial pietyFilial pietyFilial piety

– CollectivismCollectivismCollectivismCollectivism

– Respect for authorityRespect for authorityRespect for authorityRespect for authority

• Language Language Language Language

• Health beliefsHealth beliefsHealth beliefsHealth beliefs

• Social behaviorsSocial behaviorsSocial behaviorsSocial behaviors– Respect for authorityRespect for authorityRespect for authorityRespect for authority

– Religion/spiritualityReligion/spiritualityReligion/spiritualityReligion/spirituality

– GenderGenderGenderGender

• HistoryHistoryHistoryHistory– ImmigrationImmigrationImmigrationImmigration

– DiscriminationDiscriminationDiscriminationDiscrimination

• Social behaviorsSocial behaviorsSocial behaviorsSocial behaviors

• Ethnic selfEthnic selfEthnic selfEthnic self----identityidentityidentityidentity

• Socioeconomic statusSocioeconomic statusSocioeconomic statusSocioeconomic status

• Perceived minority Perceived minority Perceived minority Perceived minority statusstatusstatusstatus

• PoliticsPoliticsPoliticsPolitics

Research Areas: RCTsResearch Areas: RCTsResearch Areas: RCTsResearch Areas: RCTs

• CulturallyCulturallyCulturallyCulturally----relevant treatment goalsrelevant treatment goalsrelevant treatment goalsrelevant treatment goals

• Relevant collaborationRelevant collaborationRelevant collaborationRelevant collaboration

• “Standard” vs. culturally sensitive “Standard” vs. culturally sensitive “Standard” vs. culturally sensitive “Standard” vs. culturally sensitive • “Standard” vs. culturally sensitive “Standard” vs. culturally sensitive “Standard” vs. culturally sensitive “Standard” vs. culturally sensitive treatmenttreatmenttreatmenttreatment

• Develop modelsDevelop modelsDevelop modelsDevelop models---- role of CBT role of CBT role of CBT role of CBT case formulation case formulation case formulation case formulation

• Integrative approachesIntegrative approachesIntegrative approachesIntegrative approaches

RCTsRCTsRCTsRCTs• Methodological issuesMethodological issuesMethodological issuesMethodological issues

– Participants/random assignmentParticipants/random assignmentParticipants/random assignmentParticipants/random assignment

– MeasuresMeasuresMeasuresMeasures– MeasuresMeasuresMeasuresMeasures

– Control and comparison conditions Control and comparison conditions Control and comparison conditions Control and comparison conditions

– Therapist characteristicsTherapist characteristicsTherapist characteristicsTherapist characteristics

– Treatment integrityTreatment integrityTreatment integrityTreatment integrity

Relevant ExamplesRelevant ExamplesRelevant ExamplesRelevant Examples

• Related research in U.S. regarding diversity Related research in U.S. regarding diversity Related research in U.S. regarding diversity Related research in U.S. regarding diversity & multicultural integration & multicultural integration & multicultural integration & multicultural integration

• Conceptual analysisConceptual analysisConceptual analysisConceptual analysis

• Clinical guidelines Clinical guidelines Clinical guidelines Clinical guidelines • Clinical guidelines Clinical guidelines Clinical guidelines Clinical guidelines

• Values assessment Values assessment Values assessment Values assessment

• RCT of CBT approach with Asians RCT of CBT approach with Asians RCT of CBT approach with Asians RCT of CBT approach with Asians

• “Construct validity” assessment“Construct validity” assessment“Construct validity” assessment“Construct validity” assessment

Research in U.S. on Research in U.S. on Research in U.S. on Research in U.S. on Multicultural AdaptationMulticultural AdaptationMulticultural AdaptationMulticultural Adaptation

• Hinton et al. (2006)Hinton et al. (2006)Hinton et al. (2006)Hinton et al. (2006)---- CBT for neckCBT for neckCBT for neckCBT for neck----focused panic focused panic focused panic focused panic attacks and PTSD among Cambodian refugeesattacks and PTSD among Cambodian refugeesattacks and PTSD among Cambodian refugeesattacks and PTSD among Cambodian refugees

• Describes ways to develop culturally sensitive CBT Describes ways to develop culturally sensitive CBT Describes ways to develop culturally sensitive CBT Describes ways to develop culturally sensitive CBT interventions; e.g., using a culturally appropriate interventions; e.g., using a culturally appropriate interventions; e.g., using a culturally appropriate interventions; e.g., using a culturally appropriate interventions; e.g., using a culturally appropriate interventions; e.g., using a culturally appropriate interventions; e.g., using a culturally appropriate interventions; e.g., using a culturally appropriate visualization (lotus bloom that spins in the wind at visualization (lotus bloom that spins in the wind at visualization (lotus bloom that spins in the wind at visualization (lotus bloom that spins in the wind at the end of a stem while enacting analogous the end of a stem while enacting analogous the end of a stem while enacting analogous the end of a stem while enacting analogous rotational movements at the neck to enhance rotational movements at the neck to enhance rotational movements at the neck to enhance rotational movements at the neck to enhance relaxation)relaxation)relaxation)relaxation)

CBT Integration:CBT Integration:CBT Integration:CBT Integration:Conceptual Analysis Conceptual Analysis Conceptual Analysis Conceptual Analysis

• Hodges & Hodges & Hodges & Hodges & OeiOeiOeiOei (2007): compared distinctive (2007): compared distinctive (2007): compared distinctive (2007): compared distinctive processes of CBT (as compared to other therapies) processes of CBT (as compared to other therapies) processes of CBT (as compared to other therapies) processes of CBT (as compared to other therapies) with common values of Chinese culturewith common values of Chinese culturewith common values of Chinese culturewith common values of Chinese culture

• Concluded there is a high degree of compatibilityConcluded there is a high degree of compatibilityConcluded there is a high degree of compatibilityConcluded there is a high degree of compatibility• Concluded there is a high degree of compatibilityConcluded there is a high degree of compatibilityConcluded there is a high degree of compatibilityConcluded there is a high degree of compatibility

• Example: CBT aspect of directive approach is Example: CBT aspect of directive approach is Example: CBT aspect of directive approach is Example: CBT aspect of directive approach is compatible with cultural value of respect of compatible with cultural value of respect of compatible with cultural value of respect of compatible with cultural value of respect of authorityauthorityauthorityauthority

Clinical GuidelinesClinical GuidelinesClinical GuidelinesClinical Guidelines

• FooFooFooFoo & & & & KazantzisKazantzisKazantzisKazantzis (2007): provides guidelines (2007): provides guidelines (2007): provides guidelines (2007): provides guidelines regarding the use of homework for Chinese patients regarding the use of homework for Chinese patients regarding the use of homework for Chinese patients regarding the use of homework for Chinese patients

• Provide rationale for HW capitalizing on various Provide rationale for HW capitalizing on various Provide rationale for HW capitalizing on various Provide rationale for HW capitalizing on various Chinese value s. such as “extending therapy between Chinese value s. such as “extending therapy between Chinese value s. such as “extending therapy between Chinese value s. such as “extending therapy between Chinese value s. such as “extending therapy between Chinese value s. such as “extending therapy between Chinese value s. such as “extending therapy between Chinese value s. such as “extending therapy between sessions, education is important; hard work is sessions, education is important; hard work is sessions, education is important; hard work is sessions, education is important; hard work is important, etc.”important, etc.”important, etc.”important, etc.”

Values AssessmentValues AssessmentValues AssessmentValues Assessment

• ReinkeReinkeReinkeReinke----ScorzelliScorzelliScorzelliScorzelli (2001) assessed compatibility (2001) assessed compatibility (2001) assessed compatibility (2001) assessed compatibility between cultural values and beliefs and CBT between cultural values and beliefs and CBT between cultural values and beliefs and CBT between cultural values and beliefs and CBT

• One study found perceived differences among a One study found perceived differences among a One study found perceived differences among a One study found perceived differences among a • One study found perceived differences among a One study found perceived differences among a One study found perceived differences among a One study found perceived differences among a sample of graduate students in India, but a second sample of graduate students in India, but a second sample of graduate students in India, but a second sample of graduate students in India, but a second found little perceived differences among a sample found little perceived differences among a sample found little perceived differences among a sample found little perceived differences among a sample of Thai professionalsof Thai professionalsof Thai professionalsof Thai professionals

RCTs of CBT in Asian CountriesRCTs of CBT in Asian CountriesRCTs of CBT in Asian CountriesRCTs of CBT in Asian Countries

• NakataniNakataniNakataniNakatani et al. (2005): RCT of behavior therapy et al. (2005): RCT of behavior therapy et al. (2005): RCT of behavior therapy et al. (2005): RCT of behavior therapy and and and and fluvoxaminefluvoxaminefluvoxaminefluvoxamine in treating Japanese patients with in treating Japanese patients with in treating Japanese patients with in treating Japanese patients with OCDOCDOCDOCD

• BT better than BT better than BT better than BT better than fluvoxaminefluvoxaminefluvoxaminefluvoxamine• BT better than BT better than BT better than BT better than fluvoxaminefluvoxaminefluvoxaminefluvoxamine

• One problemOne problemOne problemOne problem---- little description of how BT (exposure little description of how BT (exposure little description of how BT (exposure little description of how BT (exposure + response prevention) was culturally adapted if at + response prevention) was culturally adapted if at + response prevention) was culturally adapted if at + response prevention) was culturally adapted if at all (highlights need to do so)all (highlights need to do so)all (highlights need to do so)all (highlights need to do so)

Construct ValidityConstruct ValidityConstruct ValidityConstruct Validity

• Research needs to focus on determining the Research needs to focus on determining the Research needs to focus on determining the Research needs to focus on determining the applicability of various CBTapplicability of various CBTapplicability of various CBTapplicability of various CBT----related constructs and related constructs and related constructs and related constructs and models of psychopathology and therapymodels of psychopathology and therapymodels of psychopathology and therapymodels of psychopathology and therapy

• Example: Construct of social problem solving as Example: Construct of social problem solving as Example: Construct of social problem solving as Example: Construct of social problem solving as • Example: Construct of social problem solving as Example: Construct of social problem solving as Example: Construct of social problem solving as Example: Construct of social problem solving as measured by the Social Problemmeasured by the Social Problemmeasured by the Social Problemmeasured by the Social Problem----Solving Solving Solving Solving InventoryInventoryInventoryInventory----Revised: multiple translations and Revised: multiple translations and Revised: multiple translations and Revised: multiple translations and factor analyses reveal same factor structurefactor analyses reveal same factor structurefactor analyses reveal same factor structurefactor analyses reveal same factor structure----includes Chinese, Japanese, & Korean studiesincludes Chinese, Japanese, & Korean studiesincludes Chinese, Japanese, & Korean studiesincludes Chinese, Japanese, & Korean studies

Collaborate?Collaborate?Collaborate?Collaborate?

“Khamp Khun Makh”“Khamp Khun Makh”“Khamp Khun Makh”“Khamp Khun Makh”

“Thank you”