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Ten Steps to Culturally Competent Evidence-Based Practice . Pamela A. Hays, Ph.D. www.drpamelahays.com. Agenda. 8-8:30am The Evidence-Based Practice of CBT: An Overview Cross-Cultural Strengths & Limitations of CBT 8:30-9:50am A New Framework For ADDRESSING Diversity Break 10-11:50am
Pamela A. Hays, Ph.D.
The Evidence-Based Practice of CBT: An Overview
Cross-Cultural Strengths & Limitations of CBT
A New Framework For ADDRESSING Diversity
10 Strategies for Culturally Competent CBT
Integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.
– APA Presidential Task Force on EBPP, 2006
--disturbing physical sensations
--involves changing unhelpful thoughts and images to more helpful ones, to manage overwhelming emotions & physical sensations, and change self-defeating behaviors.
Cultural InfluencesMinority Groups
Age/generational Children, adolescents, elders
Developmental disabilities People with developmental disabilities
Disabilities acquired People with disabilities acquired later in life
Religion & Spirituality Religious minority cultures
Ethnic & racial identity Ethnic & racial minority cultures
Socioeconomic status People of lower status by educ, income,
occup, rural habitat
Sexual orientation Gay, lesbian, & bisexual people
Indigenous heritage Indigenous/Aboriginal/Native people
National origin Refugees, immigrants, international students
Gender Women, transgender people
1. Bias is best thought of as a tendency to
think, act, or feel in a particular way.
& Biases Worldview
2. We’re all biased but we don’t all belong to dominant cultural groups.
3. Bias + Power = Systems of privilege (‘isms).
4. Nonprivileged members are socialized to be aware of the lines separating those who have privilege from those who do not.
5. Privileged members are socialized to ignore these lines and differences.
Disabilities acquired later In life
Religion & Spirituality
Ethnic & racial identity
1. Assess Needs w/emphasis on Respectful Behavior.
a. Explain what you do w/o jargon.
b. Slow down questioning process.
c. Use ADDRESSING to develop hypotheses.
d. Avoid questions that elicit negatives re: family or
e. Assess whether person wants change/what kind.
a. What do you consider your strengths & supports?
b. What would your mom/kids/friend say?
c. Do you have a connection to any religion or spiritual practice?
4. Clarify what part of the problem is primarily external & what part is primarily internal.
a. Validate experiences of oppression.
5. For External, consider Culture w/:
6. For Internal problem, use Cognitive Restructuring w/ emphasis on collaboratively exploring the helpfulness of a thought, belief, or image (rather than rationality or validity).
7. Be cautious about the Downward
(e.g. “So what if that were true?” “What is the
worst that could happen?”)
8. Do not challenge a core cultural belief unless client is open to this.
9. Use Culturally Related Strengths & Supports List to generate more helpful thoughts & images.
10. Develop culturally congruent
homework that emphasizes
Use ADDRESSING to generate Strengths and Supports List.
Define the 5 Components w/ Cultural considerations.
Clarify External & Internal parts of problem.
For External part, use Environmental Intervention w/Cultural considerations.
For Internal part, use Cognitive Restructuring that collaboratively considers helpfulness of thoughts.
Be cautious w/Downward Arrow Technique.
Don’t challenge core cultural beliefs.
Use Culturally Related Strengths & Supports List to generate helpful thoughts.
Culturally congruent Homework w/client direction.Culturally Responsive CBT
6. Question the need for this person's views to match your own.
7. Reframe irritations & annoyances as opportunities for growth.
8. Recognize your need for additional information and/or experience.
9. If appropriate, discuss the limitations of your knowledge and experience with the person.
10. If appropriate & possible, use humor.