Erschienen:
[Erscheinungsort nicht ermittelbar]: [Verlag nicht ermittelbar], 2016
Sprache:
Englisch
Identifikator:
Entstehung:
Hochschulschrift:
Dissertation, 2016
Anmerkungen:
Beschreibung:
This thesis carried out between January 2015 and July 2016, describes the process of adaptation of cognitive behaviour therapy (CBT) for common mental disorders (CMDs) and evaluation of its effectiveness through a pilot project in Pashto-speaking Khyber Pakhtunkhwa and FATA area of Pakistan and Afghanistan. This region has faced multiple traumas and difficulties including severe floods, earthquakes, Pak-Afghan-Russian war (1979-1989), the burden of Afghan refugees in Pakistan, civil war in Afghanistan, as well as terrorist attacks and bombing in the aftermath of 9/11. This brought destruction to the region and the rates of mental health problems, especially CMDs are considered to be fairly high in this region. Adapting a cost-effective intervention such as CBT, which is an effective treatment for the treatment of CMDs, might, therefore, be of enormous help in reducing CMDs in the region. However, CBT would need adapting for its use in non-western cultures. This thesis is divided into 12 chapters. The first chapter gives an overview of the problem, i.e. CMDs around the globe. This chapter includes Prevalence, Risk Factors, Presentation and Aetiology of CMDs and moves on to focusing on different treatment options. Chapter 2 describes CBT with the emphasis on its use in CMDs. Since CBT was developed in the west (as 2 highlighted in Chapter 2) and therefore might have been heavily influenced by the underlying cultural values, Chapter 3 discusses the link between culture and CBT. This chapter also encompasses discussion on Sufism (Islamic version of mindfulness). The next two chapters focus on mental health in the region under study in general but CMDs in specific. Chapter 4 describes health system of the region, the state of mental health as well as traditional healing practices in the region, while chapter 5 discusses current status of CMDs in the region. Chapter 6 is an introduction to the project which discusses the need for the project, methodology used, the reasons for choosing CBT, and a brief description of qualitative methods to be used. Chapter 7 describes the beginning of the qualitative research of the study. It describes exploration of the patients' views about their illness and its treatment and to see what they think about CBT. A similar approach is used in Chapter 8 to explore the views of the carers about the illness and treatment of their patients. Chapter 9 describes the interviews with the mental health professionals. It also highlights the methods adopted and the results of the qualitative analyses, similar to Chapter 7 and 8. It was also considered necessary to translate the terminologies used in CBT and for this, students were interviewed. This is described in Chapter 10. On the basis of all the qualitative work, we developed a study manual and Chapter 11 describes 3 the pilot project which was conducted to assess the effectiveness of the adapted therapy based on the manual prepared for patients with CMDs, using a Randomized Controlled Trial (RCT) design. The final chapter (chapter 12), summarizes the thesis and discusses some of the key findings. It also describes the lessons learnt from this project and elaborates the way forward for implementation of culturally adapted CBT in the region.