There is an urgent need to close the yearning gap between-western based psychotherapeutic interventions and African-based psychotherapeutic prophylactic measures. To achieve the treatment goals, each psychotherapeutic intervention needs to be sensitive to the culture which is been applied for the treatment of mental illness (Ebigbo, Elekwachi & Nweze, 2017). For the past three decades, the cultural adaptation of psychological treatment has been a major topic of debate among health care practitioners and academics in the mental health profession. Specifically, this debate has been focused on the role cultural dynamics play in a psychotherapeutic intervention (Bernal &Domenech-Rodriguez, 2012). Critiques have strongly voiced the relevance of contemporary psychology and the adaptation of cultural dynamics such as ethnicity, cultural background, and language in psychotherapeutic intervention. Cultural adaptation is described as the systematic modifications to evidenced-based intervention or treatment to suit the context, language, and culture, of a people in such a way that it becomes compatible with their cultural norms, values, and general, way of life (Sit, Ling, Lam, Chen, Latkin & Hall, 2020). Empirical evidence suggests that culturally adapting psychotherapeutic intervention has been one of the major ways to achieve effective treatment for mental health-related issues (Faregh, Lencucha, Ventevogel, Dubale & Kirmayer, 2019). Through the incorporation of cultural elements such as traditional beliefs system, social norms, and religious and spiritual beliefs, the selected psychotherapy can adequately take into account the local context for the psychological and mental health problem that is being treated, offer good evidence-based intervention for the target population (after rigorous modifications to suit cultural context), and improve the attitude of the locales towards the mental health intervention (Li, Zhang, Luo, Liu, Lin, et al. 2017).
The attitude of locales towards psychotherapy can be influenced positively when they perceive that psychotherapy is effective in relieving mental-health-related issues. Evidence-based treatment that is sensitive to culture, ethnicity, and language produces positive changes for the clients involved. Understanding the application of the Igbos culture to some selected psychotherapeutic techniques requires that we first understand and have a brief knowledge of the Igbos. The Igbos are the second largest ethnic group living in the Southern part of Nigeria. The Igbos are socially and culturally integrated, consisting of many subgroups. Although they live in densely populated groups of villages, they all speak a common linguistic “Igbo Language”. Traditional religious beliefs are shared by almost Igbo-speaking tribes. However, most of the Igbos’ cultural practices are locally organized with the most effective unit of religious worship within the extended families. The cultural dynamics of the Igbos need to be considered during Psychotherapeutic intervention in the region. Therefore, it has become pertinent to understand the cultural dynamics of the Igbos in the South Eastern region of Nigeria and how the dynamics can be applied to psychotherapeutic techniques for better treatments or interventions.
Empirical effort in understanding the adaptations of cultural dynamics to psychotherapeutic intervention is appreciable and has been largely focused on western countries with less attention given to low and middle-income countries globally. Although empirical literature on the cultural adaptations of Psychotherapeutic techniques exists in low and middle-income countries (e.g., Fendt-Newlin, Jagannathan & Webber, 2020; Zubieta, Lichtl, Trautman, Mentor, Cagliero, Mensa-Kawo, et al. 2020), but there exists a lacuna within the Nigeria context especially as it relates to the Igbo people of the South-East region of Nigeria. There is a paucity of empirical and theoretical studies about this context. Hence, it is vital to consider some salient and effective psychotherapeutic techniques and modify them to suit the cultural dynamics of the Igbo people. Consequently, two psychotherapeutic techniques will be adapted and modified based on their intended cultural adaptations that are being studied. The Psychotherapeutic techniques are Meseron therapy and cognitive behavioral therapy. The two psychotherapeutic techniques were adapted with consideration of the Igbo cultural dynamics and they are conceptualized below:
Meseron Therapy (MT)
Meseron therapy is a psychological treatment approach developed in Nigeria by Awaritefe, (1995). The term ‘Meseron’ is derived from the Urhobo language (the language of the Urhobo people of Delta State, Nigeria) which means “I reject/refuse it.” Its origin derives from the Nigerian belief in the power of spoken words. The power of spoken words is their potency, meanings, and consequences. Meseron therapy is seen as a form of cognitive therapy as its technique reflects a cognitive orientation and requires a mental restructuring for the client (Awaritefe & Ofovwe, 2007). Meseron therapy is a psychotherapeutic treatment approach of African descent that consists of a direct and holistic counter-attack on undesirable human situations. It was conceived from a Nigerian custom of rejecting the negativity of life while accepting the positive circumstances of life. It is also considered a motivational theory because it affirms the need for a man to strive for a desirable goal using his inherent potential and attributes. (Awaritefe & Ofovwe, 2007).
Cognitive Behavioural Therapy (CBT)
According to the American Psychological Association (2021), “cognitive behavioural therapy (CBT) is a type of psychological treatment that has been demonstrated to be potent for a range of psychological problems including depression, anxiety disorders, alcohol and, drug use problems, marital problems, eating disorders, and severe mental illness”. Several studies suggest that CBT leads to significant improvement in functioning and quality of life. In some other studies, CBT has been demonstrated to be as efficacious as other forms of psychological therapies or psychiatric medications (American Psychological Association, 2021).
Studies have shown that about 1in 10 mothers develop postnatal depression (Harding, 2017). It is very prominent and almost considered normal to have the disorder after childbirth. Symptoms include being weepy, irritability, and, feeling low. Baby blues usually occur around the third day but usually go by the 10th day after childbirth. It usually did not require any medical treatment. This is a rare but severe form of mental illness, it may occur with a low mood, but there are several visible features. It is not uncommon for the baby’s father to develop depression in the weeks after a baby is born. In postnatal depression (PND), symptoms are usually there on most days, most of the time, it may persist for two weeks or more (Harding, 2017). The symptoms are similar to those that occur with depression at any other time. They usually include one or many of the following: (i) decreased mood: It tends to be worse first thing in the morning hours, but not always; (ii) unable to enjoy anything: It usually leads to a lack of interest in self and your baby; (iii) lack of motivation to carry out any task; (iv) often having a weeping spell; (v) feeling irritable most of the time; (vi) feeling of guilt, rejection, or not being proactive in doing things.; (vii) Poor concentration (like forgetting or losing track of usual house chores) or being unable to make or contribute to decisions about family matters; and (viii) unadjusted feelings and unable to do anything at their disposal. In the treatment of postnatal depression, support and understanding from family, friends, and sometimes from professionals such as clinical psychologists and psychiatrists can help the client or the patient to recover. Other vital treatment options may include psychological treatment of administering therapies or other psychotherapeutic techniques that are adaptable to the patient’s culture. Antidepressant medications can also be a treatment option. Some of the cognitive therapeutic options are as follows: Cognitive behavioral therapy (CBT) which is a combination of cognitive therapy and behavioural therapy that gears towards restructuring individuals’ cognitive defects; the guided self-help related - CBT and during which patient or client will be offered some readings or computer-based information or video. He or she would go through the reading, watching or listening to it at his or her own pace. In the treatment method, the client would be able to talk to a therapist regularly, either face-to-face or by, -telephone, who would help the client regain insight into his or her problems and deal with them accordingly. In addition, interpersonal therapy can assist the patients or clients to identify problems in their relationships with family, friends, partners, and other people and see how these could relate to postnatal depression and other psychological problems. Lastly, other types of therapies include problem-solving therapies; such as assertive training and psychodynamic psychotherapy could also be adapted to treat postnatal depression.
Conceptual models of cultural adaptation of psychotherapy have been available for over 30 years. Early cultural adaptation models focused on some therapies’ that demand that demographics such as ethnicity and language need to match with a modifying therapy method that will be compatible with clients’ worldviews, such as incorporating indigenous healers, religious leaders, and family members into the psychotherapeutic measures. (Bernal, Bonilla & Belliodo (1995) provided an exclusive early model, identifying eight dimensions of interventions (language, persons, metaphors, content, concepts, goals, methods, and context) that could be adapted culturally. Several meta-analyses of empirical research generally have demonstrated that culturally adapted interventions produce better outcomes among ethnic minority clients than unadapted interventions (Hall & Yee, 2014; Hall, Ibaraki. et al., 2016; Smith & Trimble, 2016). The humanistic approach can be used to discuss the efficacy of adapting psychotherapeutic techniques to cultural dynamics. Humanistic therapy is a mental health approach that recognizes the importance of being your true self in order to have the most fulfilling life. The Humanistic theory also integrates a core belief that individuals are good at heart and capable of making the correct choices for themselves. The theory makes emphasis about individual values, belief system, and desire for self-actualization, and how it impacts an individual’s life. In application, Psychotherapeutic intervention that is sensitive to human values and a belief system will prove to be more efficacious because it targets very fundamental needs of people across specific societies and cultures.
There are existing literature that supports the efficacy of the adaptations of cultural dynamics to Psychotherapeutic techniques. For example, Binkley and Koslofsky (2017) studied the cultural adaptation of family-based therapy for bulimia in depressed Latina adolescents. The treatment was brief and incorporated components of family-based therapy and narrative therapy with overarching multicultural dimensions. The progress of the treatment was measured through self-report (Children’s Depression Inventory), parent-report, and concrete behavioral markers (e.g., reduced number of purging events). At the end of treatment, there was a quantum reduction of earlier depressive symptoms such as; elimination of suicidal ideation and cutting behaviors, reduction of fatigue, anhedonia, and low mood) as well as disrupted eating behaviours. By supporting the teenager and family to identify and leverage their individual and family strengths, the treatment also strengthened family communication, increased shared positive family experiences (e.g., over family meals), and supported the teenager in participating in community activities consistent with the family’s values and approval. The study further described the modified treatment used over the multiple domains to actualize culturally sensitive care, as well as by identifying the merits and demerits of the psychotherapeutic measures. Therefore, the adoption of the methods will strengthen the clinical outcome.
In a similar study by Cumba-Avilés (2017), they explored cognitive behavioural group therapy for Latino youth with type 1 diabetes and depression. The study which was a group case study described the course of a 14-session Cognitive-Behavioural Therapy (CBT) for Latino adolescents with type 1 diabetes mellitus (T1DM) and depressive symptoms. The prophylactic measure, known as Cognitive Behaviour Therapy- Diabetes Mellitus (CBT-DM), is an adaptation of an effective group intervention for adolescents’ depression. The treatment objectives and cultural adaption model are described, as well as procedures used to achieve sensitivity to the characteristics of the T1DM culture as experienced by Latino youth from Puerto Rico. Session-by-session protocol was evaluated, and treatment gains on the group as a whole and its members were presented, providing quantitative and qualitative information. Treatment feasibility, clients’ acceptance and satisfaction with treatment, and follow-up data up to 6 months post-treatment were also reviewed with due consideration of cognitive, behavioural, emotional, relational, medical, and functional outcomes. Complicating outcomes, barriers to care, and treatment implications are discussed in the context of treating clients with comorbid chronic physical illness and emotional problems that are embedded in a Latino culture. Translation of evidence-based treatments for depressive disorder into primary health care settings and adapting protocols in the treatment of youth populations with other medical illnesses were proposed by the author. As seen from the two empirical pieces of literature reviewed above, most studies are built on interventions occurring in the context of clinical trial research.
A study by Ebigbo et al. (2017) on the cross-cutting issues of the practice of psychotherapy in Nigeria observed that there is a need to bridge the gap between western psychotherapy by ensuring that these therapies are sensitive to the Nigerian context. Some salient factors were identified to help in bridging the gap. Some of these important relativities were adumbrated and they are comprised of frequent somatic complaints of psychological origin, beliefs in spirits including ancestral spirits, independent spirits, and the supreme spirit God to whom duties are owed to keep the moral order. Based on the aforementioned, the authors expressed uncertainty in the use of foreign diagnostic criteria for illnesses. Also, efforts were made to describe the traditional ways of treatment such as the popular prayer houses and traditional healers which some Nigerians have described as being very curative.
Zubieta et al. (2020) carried out a study on the perceived feasibility, acceptance, and cultural adaptation of mental health intervention for rural Haiti. Using a focus group discussion (FGD) consisting of 12 women, five intervention techniques were culturally adapted to the study of promoting mental health: individual counseling, income-generating skills training, peer support groups, reproductive health education, and couples’ communication training. The study revealed that individual counseling support groups and skills training components were generally expected to be effective, acceptable, and feasible by both genders of participants. Based on the outcome the participants expressed doubts regarding the acceptability of the couples’ communication training and reproductive health education due to: a perceived lack of male interest, traditional male and female gender roles, lack of female autonomy, and misconceptions about family planning. In addition, the feasibility, effectiveness, and acceptability of the components were described as dependent on cost, nearness to participants, and inclusion of female health promoters that are popular in the community.
Another study by Fendt-Newlin et al. (2020) investigated the cultural adaptation framework of social interventions in mental health: Evidence-based case studies from low- and middle-income countries. They adopted a case study approach to discuss the feasibility of developing and adapting psychosocial interventions which are entrenched in local knowledge, values, and practices. The study result indicated that the first case study introduces yoga as an alternative and/or complementary, and culturally relevant, approach for people experiencing mental health conditions in India. The second case study is a cross-cultural adaptation of a psychosocial intervention from the United Kingdom to fit the local idioms of distress and service context in Sierra Leone, as the West African country battled with the Ebola epidemic. The case studies were used to develop a Cultural Adaptation Framework, which takes cognizance that people and their mental health are products of their cultural heritage, and to inform the Clinicians and the general populace about the future development, adaptation, and evaluation of sociocultural interventions for people experiencing mental health conditions in low- and middle-income countries. Fendt-Newlin et al. (2020) concluded that a cultural adaptation framework can be utilized to ensure interventions that are culturally relevant, relative, and, effective to local conditions prior to evaluation in the clinical studies. Based on the foregoing, the following hypotheses were tested: (1) Meseron therapy will significantly be more effective in the treatment of Postnatal depression among nursing mothers attending post antenatal clinic in a teaching hospital in Awka Nigeria; and (2) Cognitive behaviour therapy will significantly be more effective in the treatment of postnatal depression among nursing mothers attending post antenatal clinic in a teaching hospital in Awka Nigeria.