Cognitive behaviour therapy in the context of indian culture

Cognitive-behavioral therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. 

It is most commonly used to treat anxiety and depression but can be useful for other mental and physical health problems. Shortly known as CBT, It is a form of psychotherapy that focuses on how your thoughts, beliefs, and attitudes affect your feelings and behavior. CBT aims to teach you effective coping strategies for dealing with different problems throughout life. It is based on the combination of the basic principles of behavioral and cognitive psychology.

Cognitive Behavioural Therapy (CBT) techniques:

1. Know your Negative Thoughts:

First of all, we have to recognize our negative thoughts about how they come to our mind, we can think positively and negatively even in a similar state. 

For example, Let's assume; "you went on a morning walk, after going for a walk, you thought that you have done a complete walk today and have done a lot of hard work, after thinking that you are satisfied and will feel happy. In the same way, you went on a morning walk, after a full walk, you think that you have not completed the excursion today, today’s walking was useless, after that you feel negative and you become unhappy."

2. Recognize Cognitive Distortions:

There are many different ways that you can distort your thoughts, which give rise to negative emotions or behaviors. Take a look at the way you think or talk about a problem, and how you can do one or more of the following:

• Discounting the positive thoughts.
• Overgeneralizing by making an overall negative conclusion beyond the current situation.
• Labeling something or someone without knowing more about it or them.
• Catastrophizing by predicting only negative outcomes in future

3. Challenge Negative Thoughts:

Create a record of thoughts by putting your thoughts in writing; you will be able to see your thoughts and feelings in a slightly different way. Your thoughts should help in answering these entire questions:

• What emotion did you feel? Rate the intensity using a scale.
• What actually happened? Include where, what, when, and how.
• What thought went through your mind? Create a rating scale of how much you believed it was truly such as form 1-10 or 1-100.
• What is another way to look at this situation?
• How would you rate your mood after reviewing all these questions? Use a scale.

4. Recognize Pleasant Activities:

Think of something that you enjoy or enjoyed in the past, or something you want to accomplish, but not yet. If you used to sing and want to be a professional singer, think about activities to start with, such as a singing practice or join the class.

5. Replace negative thoughts with positive ones:

Once you learn to identify triggers that come with negative thoughts and behaviors, then you will be more self-conscious about activating the brain. When you get a negative idea, and then use that moment to evaluate the truth behind that idea. Use positive affirmations about yourself, your life, and the world around you. Identify positive things, even if they are small, that can help to train your brain to think positively.

6. Make a list of the Pros and Cons of the options:

Think about each option available to you, Stick with the most logical options first, then create pros and cons for each. This list will help you to see other options in a more balanced way. Make sure to look at both the positives and negatives and not just one or the other.

7. Review the outcome of the plan: 

If the plan led to positive outcomes, enjoy that moment. Even if the problems are not fully solved, be thankful that you are headed in the right direction. If the plan still needs some motivation. Most negative thoughts, feelings, and situations don’t go away overnight, but that doesn’t mean they are impossible to work on.

How Cognitive Behavioral Therapy (CBT) works?

Cognitive Behavioural Therapy (CBT) is based on the concept that your thoughts, feelings, physical sensations, and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.  It aims to help you deal with overwhelming problems in a way by breaking them down into smaller parts. You are shown how to change these negative patterns to improve the way you feel.

Unlike some other talking treatments. Cognitive Behavioural Therapy (CBT) deals with your current problems, rather than focusing on issues from your past. It looks for a practical way to improve your state of mind daily.

Uses for Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy (CBT) is an effective way of treating several different mental health conditions. In addition to depression or anxiety disorder, CBT can also help people with:

• Obsessive-Compulsive Disorder (OCD)
• Panic Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Phobia
• Eating Disorder such as Anorexia and Bulimia
• Insomnia
• Problems related to Alcohol Misuse
• Anger Management
• Child and Adolescent Problems
• Mood Swings
• Sexual and Relationship

Cognitive Behavioural Therapy (CBT) is also sometimes used to treat people with long-term health conditions, such as:

• Irritable Bowel Syndrome (IBS)
• Chronic Fatigue Syndrome (CFS)

Cognitive Behavioural Therapy Treatment:

CBT is useful in many situations, so it is not possible to write, so we must include them all in this booklet and can consider more options for problems like sadness and panic. CBT is not for everyone, other negotiated treatment may be better for you.

• CBT is as effective as antidepressants in many types of depression problems. Antidepressants may be slightly more effective in treating panic.
• For the sharp category, antidepressants should be used along with CBT.
• When you feel very depressed, it is very difficult for you to change your mindset until you start feeling a bit better with antidepressants.
• Tranquilizers should not be used for prolonged treatment for panic. CBT is a good option.

Problems with Cognitive Behavioural Therapy:

If you are experiencing depression and there is a lack of focus, then it is difficult to understand CBT or any psychotherapy at first. This can make you frustrated and restless. A good therapist can speed up your session so that you can cope with the work you want to do. Sometimes it can be difficult to talk about experiences of sadness, panic, shame or anger.

What to do if the symptoms of CBT reoccur?

There is always the danger that sadness and panic may return. If this happens, it is easy to stop them with your CBT skills. So we must keep practicing CBT skills even despite feeling good. Some research suggests that CBT may be better than antidepressants in preventing depression from returning. If necessary, you can discuss it again.

CBT has an impact on our lives:

The sadness and panic do not feel good. They can severely affect our ability to work and enjoy life. CBT helps us prevent these symptoms. Apart from giving time to do this, your chances of negative effects are much less.

What if we can't do CBT?

You can discuss with your doctor more options. You can also read more about this treatment and its options:

If you want to know first if it is useful for you or not, then you can take the help of a self-help book or CD ROM.
If you have any kind of benefit ahead, you will change your mind, then later you can ask for CBT anytime.

Cognitive Behavioural Therapy in the Context of Indian Culture:

Thoughts and behaviors enable humans to navigate through life but when they become dysfunctional or maladaptive it interferes with an individual's functioning Cognitive behavior therapy (CBT) incorporates these in its approach by emphasizing the significance of cognition and behavior for emotional regulation. It also focuses on the case conceptualization and the specific structure for each therapy session Multicultural according to Ivey, Ivey & Zalaquett (2010) in their book is defined broadly to include race/ethnicity, gender, sexual orientation, language, spiritual orientation, age, physical ability/disability, socioeconomic status, geographical location, and other factors Several attempts have been made to adapt CBT in the eastern society of India which is one of the oldest economies with an ingrained system of beliefs and traditions.

While it is an emerging nation with all the advancements but still a majority of its population resides in the rural area and lacks even the basic amenities. Many of the beliefs related to mental health equate it with insanity in India because of a lack of awareness hence the problem is not brought in the knowledge of a medical professional but rather a faith healer. 

This gives birth to an important need for psychotherapists to include traditional practices such as cultural values, mythological texts for reference in their psychotherapy process to make it simpler for the local people The current paper focuses on appraising the CBT in light of its multicultural implications specific to Indian culture. India is home to diverse cultures which encompasses spiritual underpinnings to the beliefs and values that people hold and in turn, influences their personality and the world view is this that the Indians are highly influenced by their religious and cultural values that outward expression of their feelings and emotions is a sign of weakness and exploring it in the therapy is difficult as clients may engage in cultural defense.

The Indian society focuses on the relationship with others as important and defining elements of self, CBT formulation also focuses on the childhood events and the child's relationship with others which reinforces the client's own beliefs thus making the prognosis better. In Bhagwat Gita mythological text of one of the Indian cultures shows arjuna (mythological character) exhibiting cognitive distortions while under stress and Lord Krishna (God) helping him out which similarities the client-therapist relationship of CBT where the therapist makes the client aware of his cognitive distortion and help them through it talked about the hanuman complex where hanuman (client) forgot about his abilities because of a curse but jambavan (therapist) made him realize his abilities.

This concept resembles strength-based CBT where the therapist helps the client by incorporating the client's strength into the therapy. Such similarities between CBT and Indian mythology make it one of the preferred approaches to use with clients as they can easily understand and relate to it. Another prevalent belief of karma among the Indian masses states that an individual can change whatever is happening to them by awareness and an attempt to change themselves. 

This correlates with mindfulness approaches of Dialectical Behavior Therapy and Acceptance and Commitment Therapy which focus on bringing attention to the present and becoming aware of our surroundings (Balodhi, 1999). Indian clients often look up to their therapist as GURU meaning teachers who would enlighten them and help them in solving their problems.

The therapeutic relationship of CBT also resembles this idea where the therapist provides complete knowledge to the client about his problems with the process of psychoeducation. This helps in the initial rapport formation among the client and the therapist as it reinforces the GURU CHELA relationship.

Indian culture places importance on the relationships and individuals hold with others during their lifetime as their sense of self Is embedded among these relations. Similarly, CBT also emphasizes an individual's relationship with others to extract an individual's core beliefs and assumptions related to the self and the world. Thus, reinforcing their belief system.

Although the above-mentioned techniques of CBT serve as a perfect fit for Indian culture but still other few are not applicable. E.g. the technique of Socratic dialogue needs to be revised by adding more elements of support and direction rather than just self-help by including their significant others into the therapy. As CBT originated in the west it has its base in western thought whereas India is an eastern economy with almost everything different e.g.: western society operates on a cognitive model whereas eastern society specifically India operates in an emotional mode (Laungani,1997)

CBT approaches its clients with an individualistic framework while Indians believe in collectivism which is a major pitfall. Along with this CBT only focuses on the individual while ignoring the bigger problems manifesting in the family or the evolution of their culture which might lead to misinterpretation of the client’s experiences. The literacy rate among Indians is very low while CBT requires a higher level of intellectualization which could not be deciphered by the local people. Hence, the usage of more culturally appropriate language would drastically increase the adherence to the therapy.

Including excerpts from Indian mythology in the practice of psychotherapy could help the clients build initial trust with the therapist. The therapist should state examples from Indian culture in the therapy process so that the clients are better able to understand the concept. Even the themes of core beliefs e.g. I am unlovable, the world is cruel are all westernized patterns of thinking and could be replaced with eastern patterns of thinking like God is happy with me, I am fortunate, etc. Even a positive data log seemed to be a difficult technique for Indian clients to understand because of the difficulty of translation as English is neither their first nor preferred language.

Cognitive Behavioral Therapy is the most effective to make a person positive. CBT is really helpful for a person who is suffering from a mental disorder. Not only in foreign countries, but CBT is famous in India also As its results are found to be very good.

Case Report

A patient was a 27-years-old man suffering from social phobia, the youngest and his family, unmarried, graduate, having average socioeconomic status, and hailing from Haryana state, India. The patient came to RINPAS OPD with complaints of fearfulness in-crowd, sweating, low confidence, negative thoughts, decreased interaction, and inferiority complex. The duration of illness was 5-6 years. 

The patient had difficulty in carrying out his daily routine; consequently, he came for treatment. It was revealed from his history that he was fearful as compared to other persons of his age; from childhood, his mother was overprotective about him. His father was dominating and did not listen to anyone in the family; the patient was very scared of his father. Due to fearfulness, he remained dependent on others for the completion of his simple tasks. Gradually he started avoiding gatherings and crowds and did not go out of the home. 

He felt difficulty in interacting with unknown people and even in opening up with people with whom he was familiar. He was not able to talk with them in a crowd. He thought that he did not have a good pattern of behavior and could not behave like other people. Although he put in efforts to behave normally, yet he sweated a lot during public interaction. 

Whenever he went out in social gatherings, he thought people were avoiding him, and he felt inferior or disapproved. His self-esteem decreased gradually as he could not take initiative in any activity. Negative ideas also developed in his mind- that he would never flourish; he would not be successful; he would not be able to behave like other people in society. Behavioral analysis was done with regards to antecedent frequency, duration, intensity, and motivation of the patient to the target behavior. Assessment regarding family interaction system, available support system, and perceived of other significant persons towards the patients, was done systematically.

Assessment of the problem

At first, rapport was established with the patient, and then the clinical interview was conducted because the patient was suffering for the last 5-6 years. Due to fear in social gatherings, the patient was unable to interact with unknown people. He had lost his confidence and was unable to perform his work efficiently. Whenever he went to new places, he started sweating. He also suffered from an inferiority complex and had lost his interest in work. He was unable to maintain his daily routine as he was lethargic. 

Most of the time, he was worried about his problems and was unable to overcome this feeling of worry. This severely disturbed his social functioning, and he developed depressive features and poor self-esteem.

Result

The result of the present case study is in agreement with those earlier studies that indicate the significance of CBT in the treatment of patients suffering from social phobia. Psychoeducation proved to be very useful in understanding the dynamics of the patient's problems, as well as enable the patient to proceed in a positive direction with the help of emotional support. There was a decrease in anxiety and distress. Anxiety improves with the practice of Jacobson's progressive muscle relaxation technique. 

Cognitive Behavioural Therapy (CBT) helps him in modifying negative automatic thoughts, which in turn helped in improving the patient’s self-esteem and changed the patient’s perception and way of thinking about the world and him as well. The emphasis is on shifting the focus of attention, dropping safety behaviors, processing the situation, and evaluating what was predicted against what happened. This case report highlights the fact that a combination of cognitive, emotional, and behavioral approaches is effective and is the initial choice of treatment for social phobia.

Conclusion:

If you feel you are also suffering from such kinds of problems. Feel free to consult India's best therapists. Online Cognitive Behavioural Therapy (CBT) is also available on myfitbrain.in You can visit our clinic or can book an appointment online at myfitbrain.in