Brief culturally adapted CBT for psychosis (CaCBTp): A randomized controlled trial from a low income country Farooq Naeem a, ⁎, Sofiya Saeed b , Muhammad Irfan c , Tayyeba Kiran d , Nasir Mehmood d , Mirrat Gul e , Tariq Munshi a , Sohail Ahmad f , Ajmal Kazmi g , Nusrat Husain h , Saeed Farooq i,j , Muhammad Ayub a , David Kingdon k,l a Department of Psychiatry, Queens University, Kingston, Canada b Pakistan Association of Cognitive Therapists, Karachi, Pakistan c Department of Psychiatry and Behavioural Sciences, Peshawar Medical College, Peshawar, Pakistan d Pakistan Institute of Living and Learning, Karachi, Pakistan e Sir Ganga Ram Hospital, Lahore, Pakistan f Department of Psychiatry, Abbasi Shaheed Hospital, Karachi, Pakistan g Department of Psychiatry, Karwan e Hayat Hospital, Karachi, Pakistan h Institute of Brain, Behaviour and Mental Health, University of Manchester, UK i Department of Psychiatry, PGMI Lady Reading Hospital Peshawar, Pakistan j Staffordshire University, UK k Mental Health Care Delivery, University of Southampton, UK l Southern Health NHS Trust, UK abstract article info Article history: Received 24 November 2014 Received in revised form 17 February 2015 Accepted 21 February 2015 Available online xxxx Keywords: Schizophrenia Positive and negative symptoms Psychopathology Insight Evidence for the effectiveness of Culturally adapted CBT for psychosis in Low And Middle Income Countries (LAMIC) is limited. Therefore, brief Culturally adapted CBT for psychosis (CaCBTp) targeted at symptoms of schizophrenia for outpatients plus treatment as usual (TAU) is compared with TAU. A total of 116 participants with schizophrenia were recruited from 2 hospitals in Karachi, Pakistan, and randomized into two groups with 1:1 allocation (CaCBTp plus TAU = 59, TAU = 57). A brief version of CaCBTp (6 individual sessions with the in- volvement of main carer, plus one session for the family) was provided over 4 months. Psychopathology was measured using Positive and Negative Syndrome Scale of Schizophrenia (PANSS), Psychotic Symptom Rating Scales (PSYRATS), and the Schedule for Assessment of Insight (SAI) at baseline and end of therapy. Participants in treatment group, showed statistically significant improvement in all measures of psychopathology at the end of the study compared with control group. Participants in treatment group showed statistically significant improvement in Positive Symptoms (PANSS, Positive Symptoms Subscale; p = 0.000), Negative Symptoms (PANSS, Negative Symptoms subscales; p = 0.000), Delusions (PSYRATS, Delusions Subscale; p = 0.000), Hallu- cinations (PSYRATS, Hallucination Subscale; p = 0.000) and Insight (SAI; p = 0.007). The results suggest that brief, Culturally adapted CBT for psychosis can be an effective treatment when provided in combination with TAU, for patients with schizophrenia in a LAMIC setting. This is the first trial of CBT for psychosis from outside the western world. These findings need replicating in other low and middle income countries. © 2015 Elsevier B.V. All rights reserved. 1. Introduction Cognitive Behavioural Therapy for psychosis (CBTp) is an evidence- based adjunct to medication in treating schizophrenia, and is recom- mended by National Treatment Guidelines in High Income Countries (APA, 2006; NICE, 2009). Cognitive Behaviour Therapy like other mod- ern therapies was developed in the West, and is therefore underpinned by the Western cultural values. The explanatory models of illness are often rooted in local cultural and religious beliefs and values, which need to be addressed in any psychosocial intervention as these play a very important role in help seeking and health-related behaviours (Joel et al., 2003; Kleinman, 1980; Lloyd et al., 1998). There is evidence to suggest that people in Pakistan can attribute spiritual causes to psy- chotic symptoms (Zafar et al., 2008), and are more likely to consider seeking help from faith healers, compared with their western counter- parts (Furnham et al., 2008). Therefore, it has been recommended that CBT needs cultural adaptation before its application in Non Western cul- ture (Hays, 2009; Rathod and Kingdon, 2009). Our work in Pakistan using mixed methods research to culturally adapt CBT for psychosis Schizophrenia Research xxx (2015) xxx–xxx ⁎ Corresponding author. E-mail address: farooqnaeem@yahoo.com (F. Naeem). SCHRES-06274; No of Pages 6 http://dx.doi.org/10.1016/j.schres.2015.02.015 0920-9964/© 2015 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres Please cite this article as: Naeem, F., et al., Brief culturally adapted CBT for psychosis (CaCBTp): A randomized controlled trial from a low income country, Schizophr. Res. (2015), http://dx.doi.org/10.1016/j.schres.2015.02.015