Development of Southampton Adaptation Framework for CBT (SAF-CBT) : a framework for adaptation of CBT in non-western culture.

Abstract

Objective: To develop guidelines for adaptation of CBT in Pakistan. Design: Mixed methods ( both qualitative and quantitative). Place and Duration of Study: The studies were carried out in two cities in Pakistan, Rahim Yar Khan and Lahore, between October 2006 and March 2009. Subjects and Methods: We conducted in depth interviews with psychologists and with depressed patients and group discussions with University students. A thematic content analysis of information from these interviews and field and therapy notes was carried out to develop guidelines. Results: Themes and subthemes from different studies were compared with each other as well as with information gleaned from field and therapy notes. This information was organized in the form of an adaptation frame work. The framework consists of three themes; culture, capacity and cognitions, with each theme further divided into seven subthemes. This framework guided development of a culturally sensitive CBT manual which was later tested in a pilot project and adapted CBT was found to be effective in reducing symptoms of depression in Pakistan. Conclusion: Our work confirms some of the factors described for adaptation of therapy in previous guidelines which were developed in the West. However, we found that factors in addition to therapy itself need to be considered when adapting therapy in a given culture, for example the barriers posed by health system. In this paper we are describing the adaptation framework