The cultural adaptation of mindfulness-based cognitive therapy for older adults with depression in Indonesia
DOI:
https://doi.org/10.33736/jcshd.8830.2025Keywords:
depression, older adults, mindfulness-based cognitive therapy, IndonesiaAbstract
Despite its global recognition, Mindfulness Based Cognitive Therapy (MBCT) remains under-explored in terms of cultural adaptation and effectiveness among older adults in non-Western contexts such as Indonesia, where depression is both prevalent and shaped by cultural perceptions. This study presents a culturally adapted MBCT approach for older Indonesians with depression to enhance its relevance, acceptability, and therapeutic efficacy. The adaptation process utilised a systematic methodology grounded in the FMAP (Formative Method of Adapting Psychotherapy) as a multistep therapeutic adaptation procedure, and the PAMF (Psychotherapy Adaptation and Modification Framework) facilitated the identification of places suitable for adaptation to enhance the legitimacy of these alterations. The modified intervention was tested with a cohort of eight older adults, and qualitative feedback was gathered to evaluate its acceptability and efficacy. Initial findings indicate that the culturally adapted MBCT programme was well received, as demonstrated by high attendance rates and low attrition, highlighting its practicality and acceptance within this community. The study emphasises the importance of cultural sensitivity in mental health interventions. It also provides recommendations for future research, advocating for larger randomised controlled trials to validate the findings and further refine the cultural adaptation and implementation of MBCT for older population.
References
Adebayo, Y. O., Adesiyan, R. E., Amadi, C. S., Ipede, O., Karakitie, L. O., & Adebayo, K. T. (2024). Cross-cultural perspectives on mental health: Understanding variations and promoting cultural competence. World Journal of Advanced Research and Reviews, 23(1), 432–439. https://doi.org/10.30574/wjarr.2024.23.1.2040
Anik, E., West, R. M., Cardno, A. G., & Mir, G. (2021). Culturally adapted psychotherapies for depressed adults: A systematic review and meta-analysis. Journal of Affective Disorders, 278, 296–310. https://doi.org/10.1016/j.jad.2020.09.051
Arjadi, R., Nauta, M. H., Suryani, A. O., & Bockting, C. L. H. (2018). Guided act and feel Indonesia – Internet-based behavioral activation intervention for depression in Indonesia: A systematic cultural adaptation. Makara Human Behavior Studies in Asia, 22(1), 3–11. https://doi.org/10.7454/hubs.asia.2050418
Blignault, I., Saab, H., Woodland, L., & O’Callaghan, C. (2023). Cultivating mindfulness: Evaluation of a community-based mindfulness program for Arabic-speaking women in Australia. Current Psychology, 42, 8232–8243. https://doi.org/10.1007/s12144-021-02146-z
Chu, J., & Leino, A. (2017). Advancement in the maturing science of cultural adaptations of evidence-based interventions. Journal of Consulting and Clinical Psychology, 85(1), 45–57. https://doi.org/10.1037/ccp0000145
Cucchi, A. (2022). Integrating cognitive behavioural and Islamic principles in psychology and psychotherapy: A narrative review. Journal of Religion and Health, 61, 4849–4870. https://doi.org/10.1007/s10943-022-01576-8
DeLuca, S. M., Kelman, A. R., & Waelde, L. C. (2018). A systematic review of ethnoracial representation and cultural adaptation of mindfulness- and meditation-based interventions. Psychological Studies, 63(2), 117–129. https://doi.org/10.1007/s12646-018-0452-z
Ebrahimi, Z., Patel, H., Wijk, H., Ekman, I., & Olaya-Contreras, P. (2021). A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatric Nursing, 42(1), 213–224. https://doi.org/10.1016/j.gerinurse.2020.08.004
Ernawati, A. H., & Wilodati. (2021). Minangkabau cultural values cultivating strategy in the Minang Perantau family in Bandung City. International Journal of Educational Dynamics, 3(2), 16–22.
Fountoulakis, K. N. (2022). Psychiatry: The state of the art. In K. N. Fountoulakis (Eds.), Psychiatry: From its historical and philosophical roots to the modern face (pp. 445–467). Springer Cham. https://doi.org/10.1007/978-3-030-86541-2_18
Hwang, W. C., Myers, H. F., Chiu, E., Mak, E., Butner, J. E., Fujimoto, K., Wood, J. J., & Miranda, J. (2015). Culturally adapted cognitive-behavioral therapy for Chinese Americans with depression: A randomized controlled trial. Psychiatric Services, 66(10), 1035–1042. https://doi.org/10.1176/appi.ps.201400358
Khan, S., Lovell, K., Lunat, F., Masood, Y., Shah, S., Tomenson, B., & Husain, N. (2019). Culturally-adapted cognitive behavioural therapy based intervention for maternal depression: A mixed-methods feasibility study. BMC Women’s Health, 19, 21. https://doi.org/10.1186/s12905-019-0712-7
Koç, V., & Kafa, G. (2019). Cross-cultural research on psychotherapy: The need for a change. Journal of Cross-Cultural Psychology, 50(1), 100–115. https://doi.org/10.1177/0022022118806577
Llave, K., Cheng, K. K., Ko, A., Pham, A., Ericson, M., Campos, B., Perez-Gilbe, H. R., & Kim, J. H. J. (2024). Promising directions: A systematic review of psychosocial and behavioral interventions with cultural incorporation for advanced and metastatic cancer. International Journal of Behavioral Medicine, 31, 848–870. https://doi.org/10.1007/s12529-024-10264-8
Musa, Z. A., Soh, K. L., Mukhtar, F. B. M., Soh, K. Y., Olalekan, O. T., & Soh, K. G. (2020). Effectiveness of mindfulness-based cognitive therapy on the management of depressive disorder: Systematic review. International Journal of Africa Nursing Sciences, 12, 100200. https://doi.org/10.1016/j.ijans.2020.100200
Opland, C., & Torrico, T. J. (2024). Psychotherapy and therapeutic relationship. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK608012/
Pinho, L. G., Fonseca, C., Gawęda, Ł., Lopes, M., & Schneider, B. C. (2024). Editorial: Non-pharmacological interventions for mental disorders. Frontiers in Psychology, 15, 1363348. https://doi.org/10.3389/fpsyg.2024.1363348
Praptomojati, A., Icanervilia, A. V., Nauta, M. H., & Bouman, T. K. (2024). A systematic review of Culturally Adapted Cognitive Behavioral Therapy (CA-CBT) for anxiety disorders in Southeast Asia. Asian Journal of Psychiatry, 92, 103896. https://doi.org/10.1016/j.ajp.2023.103896
Primasari, I., Hoeboer, C. M., Sijbrandij, M., & Olff, M. (2024). Trauma web-based psychoeducational programme: Systematic cultural adaptation and protocol for a feasibility-acceptability study. European Journal of Psychotraumatology, 15(1). https://doi.org/10.1080/20008066.2024.2426338
Rathod, S., Phiri, P., Naeem, F., Halvorsrud, K., & Bhui, K. (2020). The importance of cultural adaptation of psychological interventions: Learning from UK experiences of IAPT and CBT services. Synergi Collaborative Centre. https://legacy.synergicollaborativecentre.co.uk/wp-content/uploads/2020/12/The-importance-of-cultural-adaptation-IAPT-and-CBT.pdf
Rochelle, N. S., & Hoyer, J. (2024). A cross-cultural conceptual comparison of behavioral activation and ikigai. Journal of Contemporary Psychotherapy, 54, 37–46. https://doi.org/10.1007/s10879-023-09592-9
Segal, Z. V., Teasdale, J. D., Williams, J. M., & Gemar, M. C. (2002). The mindfulness-based cognitive therapy adherence scale: Inter-rater reliability, adherence to protocol and treatment distinctiveness. Clinical Psychology & Psychotherapy, 9(2), 131–138. https://doi.org/10.1002/cpp.320
Sekhon, S., Patel, J., & Sapra, A. (2023). Late-life depression. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK551507/
Sit, H. F., Ling, R., Lam, A. I. F., Chen, W., Latkin, C. A., & Hall, B. J. (2020). The cultural adaptation of step-by-step: An intervention to address depression among Chinese young adults. Frontiers in Psychiatry, 11, 650. https://doi.org/10.3389/fpsyt.2020.00650
Skewes, M. C., Gonzalez, V. M., Gameon, J. A., Ricker, A., Martell, S., Reum, M., & Holder, S. (2024). Development and feasibility pilot study of indigenous recovery planning: A community-engaged approach to addressing substance use in a native community. Clinical Psychological Science. 12(2), 253–269. https://doi.org/10.1177/21677026221141662
Thomas, J., Raynor, M., & Bakker, M. C. (2016). Mindfulness-based stress reduction among Emirati Muslim women. Mental Health, Religion and Culture, 19(3), 295–304. https://doi.org/10.1080/13674676.2016.1168389
Walaszek, A. (2024). Optimizing the treatment of late-life depression. American Journal of Psychiatry, 181(1), 7–10. https://doi.org/10.1176/appi.ajp.20230919
Werheid, K., Schaubs, B., Aguirre, E., & Spector, A. (2021). Cognitive stimulation therapy: Model-based cultural adaptation and manual translation of an evidence-based psychosocial group therapy for people with dementia. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 34(3), 117–124. https://doi.org/10.1024/1662-9647/a000244
Williams, K., Hartley, S., Langer, S., Manandhar-Richardson, M., Sinha, M., & Taylor, P. (2022). A systematic review and meta-ethnographic synthesis of Mindfulness-based Cognitive Therapy for people with major depression. Clinical Psychology & Psychotherapy, 29(5), 1494–1514. https://doi.org/10.1002/cpp.2773
Wong, K. L. Y., & Hung, L. (2023). Cultural adaptation in television technology for older adults with dementia in care settings. Frontiers in Dementia, 1, 1098446. https://doi.org/10.3389/frdem.2022.1098446
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