Developing a culturally adapted Cognitive Behavioural Therapy for People with Schizophrenia in Saudi Arabia

  • Muteb Aljuhani

Student thesis: Phd


Introduction: Cognitive Behavioural Therapy (CBT) is considered one of the optimal psychosocial interventions that promote personal recovery and is highly recommended by NICE and the American Psychiatric Association. The majority of CBT studies were conducted in Western countries, and they demonstrated beneficial results in the reduction of positive and negative symptoms. However, CBT was developed and derived from Western cultural values, and these may not be appropriate for non-Western cultures, such as that of Saudi Arabia. The principles underlying CBT might cause conflict with individuals’ beliefs and cultural values in non-Western cultures. Therefore, it is advised that CBT be culturally adapted prior to its implementation in a non-Western culture, so as to be more effective. In Saudi Arabia, there is a paucity of published studies that assess cultural adaptations of cognitive behaviour therapy (CBT) for people with schizophrenia. Generally, in mental health practice in Saudi Arabia, psychosocial interventions are implemented by psychiatrists and psychologists, but there are not enough of these professionals to deliver these interventions. As the largest body of health professionals working in mental health services in Saudi Arabia, mental health nurses are in an optimal position to address this shortfall and provide effective, culturally adapted CBT interventions. Aim: To develop a culturally adapted, feasible and acceptable cognitive behaviour therapy (CBT) intervention for people with schizophrenia, to be delivered by mental health nurses in Saudi Arabia Methodology: The Medical Research Council (MRC) guideline for developing and evaluating complex interventions with an emphasis on the development phase was followed in four interrelated studies. Study one: a review of systematic reviews to identify the recent systematic review of CBT interventions being culturally adapted in order to identity the key components of CBT interventions and the cultural adaptation process. Study two: Qualitative semi-structured interviews with 15 people with schizophrenia to explore their beliefs and attitudes concerning the proposed CBT intervention. Study Three: Qualitative semi-structured interviews with family members of people with schizophrenia to explore the beliefs and attitudes concerning the proposed CBT intervention. Study Four: Focus groups with mental health nurses to explore their beliefs and attitudes concerning the proposed CBT intervention and perceived barriers to and facilitators of delivering the CBT intervention. Results: Study one: The most common components of culturally adapted CBT were engagement, psychoeducation, working with psychotic symptoms, medication management and relapse prevention. The processes of cultural adaptation were language, concepts and illness models, family, communication, content, cultural norms and practices, context and delivery and therapeutic alliances. Study two: The findings revealed that the proposed CBT intervention was accepted by the majority of people with schizophrenia and there were some factors that could potentially influence their engagement and motivation in the CBT intervention, such as therapist quality (gender, empathy, and competence), family involvement, a religious component, and the number and format of the CBT intervention. Study three: The findings revealed that family members confirmed the importance of having this CBT intervention available in mental health services for people with schizophrenia. They also recommended that the CBT intervention should include home visits and family sessions. The most common need identified by family members was to be offered information about the nature of schizophrenia, antipsychotic medications, coping skills, and early signs of relapse. Also, the results revealed that some factors could potentially influence family members engagement and motivation in the CBT intervention, such as therapist quality (gender, empathy, and competen
Date of Award1 Aug 2023
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKarina Lovell (Supervisor) & Owen Price (Supervisor)

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