Hogg Foundation for Mental Health

Cultural Adaptation Initiative: Therapists Learn New Treatment Strategies

June 1, 2007

As the Cultural Adaptation Initiative's first year winds down, the five grantee organizations have completed training in their selected mental health treatments and are gaining experience in using them with clients.

The first year of the initiative was focused on training grantees' psychotherapists in approaches to delivering evidence-based practices. Evidence-based practices are treatments that have been shown to yield positive client outcomes in numerous studies across researchers.

Once the therapists master the new treatments, they will begin adapting them to fit their patients' cultural backgrounds. These adaptations are the focus of the Hogg Foundation's initiative.

The grantees chose to focus on a range of evidence-based treatments for adults and children.

Family Service of El Paso, Tropical Texas Behavioral Health (formerly Tropical Texas Center for Mental Health and Mental Retardation) located in Edinburg, and Community Family Centers in Houston sought training in cognitive-behavioral therapy (CBT) to treat depression and anxiety in Latino child, adolescent, and adult clients.

Kevin Stark, Ph.D., professor of school psychology at The University of Texas at Austin, provided training on using CBT with depressed and anxious children and adolescents.

"Our goal is to teach therapists how to use the different treatment strategies found to be effective in recent research," said Dr. Stark who has been with UT-Austin for over 20 years.

"Much of the information is considered state of the art because it is very new," said Dr. Stark. "The therapists are learning new and different approaches to treatment."

Dr. Stark has provided CBT training to clinicians around the country. He recently worked with New Orleans' mental health organizations to train providers to treat Katrina survivors experiencing distress.

In addition to their child and adolescent CBT training with Dr. Stark, clinicians from Family Service of El Paso and Tropical Texas Behavioral Health trained in CBT to treat Latino adults with depression and anxiety.

Monica Basco, Ph.D., assistant professor of psychology at The University of Texas at Arlington, provided training to therapists in a CBT model for adults.

Dr. Basco has extensive CBT training experience and was hired by The State of Texas in February 2004 to provide CBT training to therapists in all community mental health centers. She continues to provide training and supervision to a range of groups.

Two Cultural Adaptation grantees have pursued training in other evidence-based treatments that have elements in common with CBT.

DePelchin Children's Center in Houston chose Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to treat their Latino child clients. TF-CBT is a variation of CBT that was developed for children who have experienced a traumatic event. The therapist teaches children and their parents skills for handling stress and intense emotions. The therapist also focuses on the traumatic event that the child experienced, helping the child process his or her thoughts and feelings about the event.

Lena Pope Home, Inc., in Fort Worth selected the Defiant Child model to serve African-American children and their families. Targeting Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder, the Defiant Child model includes individual and joint sessions with children and their parents and focuses on modifying children's problematic behaviors. Parent training in managing their child's behavior is a critical piece of the treatment.

In Year 2 of the Cultural Adaptation Initiative, grantees will use their experience with the evidence- based treatments they chose to determine how the treatments need to be modified to reflect the cultures of their client populations.

What is Cognitive-Behavioral Therapy?

Cognitive-Behavioral Therapy (CBT) is a psychotherapy approach that is grounded in the theory that problematic thought patterns cause the emotional distress that underlies disorders like depression and anxiety.

The treatment focuses on training people to become aware of their maladaptive thought patterns and develop healthier ways of thinking.

There are many types of maladaptive thinking patterns that can lead to distress. For example, in catastrophizing, a person will magnify small negative events into dire, global assessments of one's life. So, having gotten a "C" on a test, a college student may think to herself, "I fail at everything. I'm a loser and will never get anywhere in life," even though she is on the dean's list. This type of unhealthy thinking can lead to depression and other mental health problems.

The idea behind CBT is that people can learn to identify these patterns as they happen, make room to challenge them, and substitute healthier thoughts. With CBT training, the student who got a "C" on her test would catch herself making that harsh, unrealistic judgment and say to herself, "I did worse on this test than I would have liked, but in general I do very well in school. I'll talk to the professor and plan to study harder next time."

The "behavioral" part of CBT can take different forms. In depression, therapists may work with clients to increase their involvement in positive activities, such as exercise or going out with friends. Depression typically leads people to withdraw from pleasurable activities, so therapists use these positive activities to help "activate" depressed clients.

For anxiety, therapists may teach clients behavioral techniques for controlling the bodily cues of anxiety like rapid heart rate. For example, clients may learn relaxation and breathing techniques to regulate their breathing and slow their heart rate when they are feeling stressed.

Numerous studies have documented the effectiveness of CBT in treating depression and anxiety. However, most of those studies used client samples in which populations of color were poorly represented. While less is known about using CBT specifically with populations of color, the research that is available suggests that it is also effective with those groups.