Academic journal article International Journal of Psychology and Psychological Therapy

Is Culturally Sensitive Cognitive Behavioral Therapy an Empirically Supported Treatment?: The Case for Hispanics

Academic journal article International Journal of Psychology and Psychological Therapy

Is Culturally Sensitive Cognitive Behavioral Therapy an Empirically Supported Treatment?: The Case for Hispanics

Article excerpt

The field of clinical psychology experienced an important shift in recent decades and is increasingly influenced by an orientation toward evidence-based practice (Chambless & Ollendick, 2001; Lilienfeld & O'Donohue, 2007; Ollendick, 2012). A large focus of this movement has been on changing service delivery so that empirically supported treatments (ESTs) are delivered to clients and treatments without outcome research demonstrating their effectiveness and safety are not (Chambless & Ollendick, 2001). The focus on ESTs is consistent with recent health reform legislation such as the Affordable Care Act, winch emphasizes efficient, effective health care interventions in an attempt to improve safety, costs, and outcomes (Wendell, O'Donohue, & Serratt, 2014). At the heart of ESTs is the randomized controlled trial (RCT). Indeed for an intervention to achieve EST status there must be evidence that it is superior to a placebo (or other treatment) or equal to an already established EST (via at least two RCTs or a series of single-case design experiments conducted by different investigators: Task Force, 1995; Dobson & Dobson, 2006). Cognitive behavioral therapy (CBT) is at the core of the EST movement as there is substantial evidence that CBT is effective for treating a number of mental health conditions (Chambless & Ollendick, 2001).

The EST movement is not without critiques. Indeed there have been numerous debates regarding the overall value of the EST movement (e.g., Beutler, 1998; Goldfried & Wolfe, 1998); what exactly constitutes "empirically supported" (Borkovec & Costonguay, 1998; Herbert, 2003); how therapies that have achieved this status should be labeled (e.g., "empirically validated", "evidenced based" etc.: Duncan & Reese, 2013); and to what extent ESTs generalize to ethnic minority individuals due to the alleged underrepresentation of such individuals in the original outcome research (Bemal & Scharró del Río, 2001). In fact, some have asserted generalizability of ESTs to cultural minorities may be limited because of the majority culture values and assumptions represented in these therapies (Benish, Quintana, & Wampold, 2011) and the dependent measures used to assess the outcomes of these therapies may not be appropriate -and perhaps even detrimental- when used with cultural minorities (Cardemil, 2010).

One means of addressing these concerns has been to focus on treatments that have undergone some modification with the goal of improving the cultural sensitivity of the intervention. Several authors (e.g., Bernal, Jiménez Chafey, & Domenech Rodriguez, 2009; Falicov, 2009; Kreuter & Skinner, 2000; Barrera et al., 2013) have attempted to explicate how treatments should be adapted and modified based on putative cultural values (see Table 1 for a list of associated definitions). As illustrated in Table 1 there are several terms (e.g., tailored, adapted etc.) that are used to refer to a treatment that has been modified based on cultural values and under each of these terms there is some variation in how the treatment is modified. Our review of the literature revealed that works on culturally modified treatments are largely theoretical and speculative and data that actually show that these recommendations resulted in improved outcomes for Hispanics are much less prevalent (Huey, 2013). Thus in this paper we reviewed the literature to determine what "culturally sensitive" interventions (whereby "culturally sensitive" was defined as any study that included a specific focus on the cultural group of interest) can be considered well-established, beneficial treatments for use with Hispanic populations. Because the literature on cultural sensitivity is vast, we limited the scope of our review to Hispanics as this group constitutes one of the largest minorities in the United States (the latest census Hispanics account for more than half of the total United States population growth in the past decade and constitute the largest and fastest growing minority group in the country: U. …

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