Culturally Competent Cognitive Behavior Therapy

Culturally Competent CBT, also referred to as Culturally Adapted CBT, enjoys widespread use and has sparked considerable interest in research. Some examples:

  • Considerations for Culturally Competent Cognitive-Behavioral Therapy for Depression with Hispanic Patients

UMDNJ–Robert Wood Johnson Medical School, USA

Cognitive and Behavioral Practice (Impact Factor: 1.33). 02/2007; DOI: 10.1016/j.cbpra.2006.01.006


The purpose of this paper is to outline considerations for adapting cognitive-behavioral therapy (CBT) to Hispanic patients who have recently immigrated, particularly those presenting with depressive symptoms. Culturally competent CBT is framed within a model originally proposed by Rogler and his colleagues (1987). The considerations outlined by the model include ensuring that treatments provide access, are selected based on compatibility with Hispanic culture, and are adapted to fit the culture. Recommendations for culturally adapting CBT include consideration of each patient’s unique ethnocultural background and their treatment expectations, as well as culturally relevant interpersonal styles, values, and metaphors/language. In addition, specific strategies for conceptualizing and conducting CBT techniques are discussed.

  • Multicultural applications of CBT

Joye C. Anestis, October 30, 2009

Hays notes specific ways in which CBT may be particularly useful for multicultural clients:

  • CBT emphasizes the uniqueness of the individual: At its core, CBT argues that the treatment should be adapted to meet the needs of the individual.
  • CBT focuses on client empowerment:  The inherent belief that clients are in control and, therefore, capable of bringing about change themselves helps create a collaborative relationship which appreciates individual and cultural differences.
  • CBT focuses on conscious processes and specific behaviors (instead of unconscious  processes and abstract ideas):  Hays notes that this may be especially important when therapy is conducted in a client’s second (or third, etc.) language or with an interpreter.  Research indicates that fluency in a 2nd language is negatively affected by emotional distress.  A therapy that emphasizes theoretical and abstract ideas may result in a greater potential for misunderstanding between the therapist and a distressed client.
  • CBT integrates assessment throughout the course of therapy:  This cognitive-behavioral assessment maps progress from the client’s perspective.  In fact, assessment measures could easily be added to the battery that address concepts important to the client (e.g., the family’s views of the client’s progress).  Additionally, this emphasis on continuing assessment demonstrates therapist commitment and respect for the client’s opinion, which is important for all clients, but perhaps more so for the client and therapist whose backgrounds differ.

  • Culturally adapted cognitive-behavior therapy: integrating sexual, spiritual, and family identities in an evidence-based treatment of a depressed Latino adolescent

J Clin Psychol. 2010 Aug;66(8):895-906. doi: 10.1002/jclp.20710.

Duarté-Vélez Y1, Bernal G, Bonilla K


The article described and illustrated how a culturally adapted cognitive-behavioral therapy (CBT) can maintain fidelity to a treatment protocol while allowing for considerable flexibility to address a patient’s values, preferences, and context. A manual-based CBT was used with a gay Latino adolescent regarding his sexual identity, family values, and spiritual ideas. The adolescent suffered from a major depression disorder and identified himself as gay and Christian within a conservative and machista Puerto Rican family. CBT promoted personal acceptance and active questioning of homophobic thoughts in a climate of family respect. CBT enabled identity formation and integration, central to the development of a sexual identity for lesbian, gay, bisexual, and transgender youth, with remission of the patient’s depression and better family outcomes.

  • Brief Culturally Adapted Cognitive Behaviour Therapy for Depression

Cognitive behaviour therapy (CBT) has an effective evidence base in the west and is recommended by the national bodies in many countries in the West. Our group has adapted CBT for depression and psychosis in Pakistan for use with local clients. Initial evaluations have found that these therapies are effective. However, due to the financial restraints it would be useful if the investigators find that brief version of the CBT might be applicable and effective in non western cultures. Therefore in this study, the investigators will be testing effectiveness of brief version of culturally adapted CBT for depression in a randomized controlled trial (RCT) in Pakistan.

  • Cultural Adaptation of Cognitive Behavioral Therapy (CBT) for Puerto Rican Youth

Cultural Adaptation of Cognitive Behavioral Therapy (CBT) for Puerto Rican Youth is a short-term intervention for Puerto Rican adolescents aged 13-17 years who are primarily Spanish speaking and have severe symptoms of depression. The intervention focuses on improving an adolescent’s cognitions, behaviors, and relationships, with the goals of shortening the time that the adolescent feels depressed, reducing his or her depressive feelings, increasing the adolescent’s sense of control over his or her life, and teaching the adolescent how to prevent the onset of depression.

The intervention was adapted from a cognitive behavioral model, considering cultural, developmental, and socioeconomic factors. The adaptation was informed by a framework for ecological validity (i.e., familiarity between the adolescent’s experiences of his or her ethnocultural and linguistic context and the cultural properties of the treatment) and culturally sensitive criteria (i.e., language, persons, metaphors, content, concepts, goals, methods, context).

  • Culturally Adapted Cognitive Behavioural Therapy for Latin American Immigrants in Canada

Principal Investigators: Dr. Carolina Vidal. Dr. Kwame McKenzie. Akwatu Khenti.

Here’s the manual:

  • Culturally Competent Cognitive-Behavioral Therapy: Adapting CBT to African American and Cambodian Refugee Populations

Melanie Cabrera, March 11, 2013

These examples, drawing from a large pool of publications, show that CBT can be applied to a diverse patient population in a wide variety of settings and contexts. It goes without saying that the basic tenets of CBT have to be adapted to suit the needs of the patient. And this is where it is incumbent upon the clinician to not only being well-versed in CBT, but to be culturally competent, at least with the clientele he or she works with. This will call for ongoing study, seeking mentoring and mentoring others, and the opportunity to engage in peer supervision in groups that specialize in or take an interest in CBT.

I learned CBT at the Graduate School of Applied and Professional Psychology, Rutgers University, more than 30 years ago and have applied it extensively in my practice with quite a diverse patient population. And I still consider myself to be a student, for one can never be “culturally competent”; cultural competence is, after all, a lifelong journey.


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