A Cultural Adaptation of Dialectical Behavior Therapy in Nepal

Area of Science:

• Global Mental Health
• Psychotherapy Adaptation
• Cultural Psychiatry

Background:

• Evidence-based interventions show potential for adaptation in low- and middle-income countries (LMICs).
• Psychotherapies from high-income countries (HICs) require cultural adaptation for LMIC contexts.
• Dialectical Behavior Therapy (DBT) has potential for South Asian settings with high suicide rates.

Purpose of the Study:

• To describe a tri-phasic approach for adapting Dialectical Behavior Therapy (DBT) in Nepal.
• To identify necessary adaptations for DBT in a South Asian cultural context.
• To assess initial feasibility and utility of culturally adapted DBT.

Main Methods:

• Qualitative interviews with Nepali mental health stakeholders.
• An adaptation workshop with 15 Nepali counselors.
• A small-scale pilot treatment with eligible clients in a rural district.

Main Results:

• Significant adaptations were required due to low literacy, distinct mind-body conceptualizations, and adherence barriers.
• DBT concepts linked to Asian belief systems were least comprehensible to clients.
• An 82% program completion rate suggests utility of the structured, skills-based treatment.

Conclusions:

• Culturally adapting DBT in Nepal required addressing contextual factors like literacy and cultural beliefs.
• The high completion rate indicates the potential effectiveness of skills-based, adapted DBT in South Asia.
• This adaptation process provides a model for future research on culturally adapted DBT in similar settings.