The academic article "Asian culture and psychotherapy: Implications for East and West " (Tseng et al. 2005) presents a framework with the following levels of adjustment for culturally adapting CBT, allowing flexibility for cultural beliefs while preserving validity to the original treatment principles of CBT :
1. Philosophical orientation;
2. Practical considerations of societal and health system-related factors;
3. Technical adjustments of methods and skills; and
4. Theoretical adaptations of concepts.
In "Cultural Adaptation of CBT for Serious Mental Illness : A Guide for Training and Practice", Shanaya Rathod emphasizes that the key principle of this framework is "that every individual has a unique culture that is influenced by their wider culture, sub-culture and further developed through unique life experiences. There must be flexibility in applying the culturally adapted therapy, and clinicians should be aware of their own biases, and propensity to stereotype when working with people from minority groups. " (Rathod, et. al 2019).
The first component, Philosophical Orientation refers to an individuals fundamental beliefs as informed by their culture , including the following:
Acculturation
Beliefs about illness (e.g., supernatural vs. medical explanations)
Help-seeking behaviors
Expectations of therapy
Together, these beliefs influence therapy goals and must be understood by therapists for culturally competent care
The second component, Practical considerations of societal and health system-related factors includes external factors that impact a client’s engagement with therapy, such as:
Economic conditions
Immigration status and policies
Health system accessibility
Stigma, racism, and systemic discrimination
These factors affect trust in the healthcare system and therapy participation.
The next component Technical adjustments of methods and skills, provides modifications to how therapy is delivered, considering:
Setting and environment of sessions
Therapist-client relationship styles (e.g., hierarchical vs. collaborative)
Preferred therapeutic models (e.g., cognitive vs. experiential)
Family involvement, religion, and cultural communication styles
These ensure therapy methods resonate with the client’s cultural expectations and context
Finally, Theoretical adaptations of concepts involve modifying core therapy ideas to align with cultural beliefs and values. Examples include:
Concepts of self and boundaries (individual vs. collective identity)
Body-mind relationships and holistic health views
Personality development across cultures
Cultural interpretations of defense mechanisms and coping
These adaptations ensure conceptual relevance of CBT while maintaining fidelity to its core structure