Date Modified

2020-08-17

Period

6/months

Report Summary

Title: Effectiveness of Culturally Modified Cognitive Behavioral Therapy (CBT) for Patients with Tinnitus in Sri Lanka, a randomized control trial. Study Phase: 1 - Refinement of the CBT Manual General Objective: 1. To make culturally specific adaptations to the existing CBT manual for tinnitus. Specific Objectives: 1. To use information gathered during literature search to make culturally specific adaptations to the existing CBT manual for tinnitus 2. To review this preliminary culturally adapted CBT manual with the stakeholders and revise accordingly Detailed description of the research carried out during the above period: Ethical clearance of this was granted from the Ethics Review Committee of the Faculty of Medicine, University of Kelaniya, Ragama. We also informed about the modifications of the study to the Sri Lanka Clinical Trial Registry. The phase of the refinement of the CBT manual was adopted a mixed methodology with a view to further improving the developed CBT manual for tinnitus to make it more culturally appropriate for Sri Lanka. In this phase we have done a comprehensive literature search of modifying psychotherapy to suit cultural context. The modifications were supervised by Dr Asiri Rodrigo, consultant psychiatrist with special expertise in psychotherapy. In doing so we considered all 8 different dimensions, namely language, persons, metaphors, content, concepts, goals, methods and context when modifying the manual.1 we also considered following areas in adapting the manual.2 • Awareness of relevant issues and preparation for therapy • Assessment and engagement • Modifications in therapy techniques • Adjustments in process of psychotherapy including changes in health care system • Awareness of relevant cultural issues, including areas related to culture, religion and spirituality Once the preliminary modified CBT manual for Tinnitus was completed it was discussed with eight selected stake holders comprising of a consultant psychiatrist who are experienced in providing psychotherapy, two clinical psychologists with adequate working experience, two audiologists who is experienced in managing tinnitus and three ENT specialists. We selected them into this stake holder group as we believed this professional group was truly representing the actual or potential treatment providers for patients with tinnitus. Above mentioned professionals were identified by the student researcher depending on their expertise in the field of psychotherapy and / or tinnitus. They were contacted by the student researcher to explain the study to them and invite them to participate in the same. The number of participants required for the stakeholder group was decided after reviewing similar studies. The studies found 8-12 participants from a stakeholder group adequate to gather the necessary information. It was observed that all areas were covered with sufficient depth with 8-12 participants from a group3, 4 Professionals, who were agreed to take part, were provided with the CBT manual and written summary of the main points. The components of CBT manual was verbally explained to them by the student researcher. They were contacted after 1-2 weeks to arrange a time for the semi structured interview. They were interviewed regarding their experiences and attitudes towards providing similar treatment. Information was gathered on how to improve the manual further. Questions were asked about further improvement of main components and sessions. All individual interviews were audio-recorded and transcribed. References: 1. Bernal G, Bonilla J, Bellido C. Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychological treatments with Hispanics.Journal of Abnormal Child Psychology.1995;23:67-82 2. Naeem F, Ayub M, McGuire N, Kingdon D. Culturally Adapted CBT (CaCBT) for depression. Therapy Manual for use with South Asian Muslims: PACT;2013 3. Naeem F, Ayub M, Gobbi M, Kingdon D. Development of Southampton Adaptation Framework for CBT (SAF-CBT): a framework for adaptation of CBT in non-western culture. Journal of Pakistan Psychiatric Society. 2009; 6 (2):79-84. Rathod S, Kingdon D, Phiri P, Gobbi M. Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users' and health professionals' views and opinions. Behav Cogn Psychother. 2010 Oct; 38(5):511-33. doi:10.1017/S1352465810000378

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