Adapting cognitive-behavioral therapy for a Malaysian muslim

Natasha Subhas; Firdaus Mukhtar; Khadeeja Munawar

doi:10.47176/mjiri.35.28

Adapting cognitive-behavioral therapy for a Malaysian muslim

Med J Islam Repub Iran. 2021 Feb 25:35:28. doi: 10.47176/mjiri.35.28. eCollection 2021.

Authors

Natasha Subhas^{1

2}, Firdaus Mukhtar², Khadeeja Munawar^{3

4}

Affiliations

¹ Department of Psychiatry and Mental Health, Hospital Tengku Ampuan Rahimah, Ministry of Health, Malaysia.
² Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
³ Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia.
⁴ Department of Psychology, Faculty of Social Sciences & Liberal Arts, UCSI University Malaysia, UCSI Heights 1, Jalan Puncak Menara Gading, Taman Connaught, 56000, Cheras, Kuala Lumpur, Malaysia.

Abstract

Background: Over the years, cognitive-behavioural therapy (CBT) has gained momentum because of its robust evidence in the treatment of several disorders. However, there is an issue of religious and cultural appropriateness as CBT principles are based on Western conceptualization. This single-case study (N = 1) implements a culturally and religiously adapted CBT on a 34-year-old male with panic disorder with agoraphobia in Malaysia. The client had symptoms comprising various episodes of sudden onset of breathlessness, accelerated heart rate, and fear of dying for the last 14 years. The CBT was culturally and religiously adapted based on (1) A CBT manual in Bahasa Malaysia that was previously modified and adjusted according to the norms of the Malaysian society and (2) General guidelines in "Religious-Cultural Psychotherapy in the Management of Anxiety Patients" by Razali et al in 2002. The present modified CBT had 3 assessments formulation sessions and 12 intervention sessions. Methods: The first 6 sessions were based on the behaviour component of CBT (ie, a relaxation technique using Islamic prayer, reciting verses from the Holy Quran, slow breathing exercise, body scan, and progressive muscular relaxation). However, sessions 7 to 12 were focused on cognitive restructuring and exercises, such as identification of negative automatic thoughts, cognitive distortions, dysfunctional thought records, vertical arrow technique, and the coping statement was practised through collaborative empiricism, while implementing Islamic and cultural elements. The focus of termination sessions was on interoceptive exposure, cognitive rehearsal, and in vivo situational exposure. Results: Beck Anxiety Inventory (BAI) was administered at regular intervals. BAI scores revealed the effectiveness of adapting the intervention. Conclusion: Panic attacks, worry about panic attacks, and anxiety scores reduced remarkably and the client was able to go out of the house, travel independently, and pursue religious/social activities.

Keywords: Cognitive-Behavioural Therapy; Culturally Adapted Treatment; Psychotherapy; Religion.