Perceptions of Practitioners on Methods, Current Practice, and Barriers: A Descriptive Analysis of Cultural Adaptation of CBT in India

Background: Cognitive-behavior therapy (CBT) is noted as the gold standard first-line treatment for various psychopathologies. Nevertheless, the application and practice of CBT widely varies across countries and practitioners. There is little evidence surrounding scientific methods of culturally adapting CBT. This likely results in an overinclusive use of the term CBT and threatens ethical practice. Aim: To examine perspectives of Indian practitioners on CBT practices, beliefs, and attitudes towards cultural/language adaptation of CBT in India. Methods: Adopting an observational design, 83 (response rate of 46%) Indian CBT practitioners participated in an online survey. Information was collected across five-sections: current CBT practice, assessment, barriers, cultural adaption vs culture-focused, method of cultural/language adaptation.  Results: 93% of all CBT sessions were for adults (aged 19-59 years). 90% of practitioners adopted eclectic approaches, out of which 94% mixed techniques most regularly from other therapies. 71% made structural changes to their practice of CBT and 70% reported conducting CBT alongside family therapy. Majority did not use any standardized tools for session progress/therapy-outcome. More than 90% considered cultural adaptation over culture-focused CBT. 69% preferred integrating top-down and bottom-up approaches to cultural/language adaptation with field testing in each state and 93.6% viewed collaboration among Indian CBT practitioners as the method of validation. More than 70% highlighted the lack of CBT research in India. Conclusion: The findings highlighted the need for practice/ethical guidelines for CBT in India, a standardised Indian CBT with rigorous field testing (using robust cultural and language adaptation methods) and due emphasis on CBT supervised practice during education and training.