Cultural Considerations in Applying TIMBER Therapy

  • Basant Pradhan
  • Narsimha R. Pinninti
  • Shanaya Rathod


Culture influences every aspect of an individual’s experience including the trauma experience. Not only culture provides the language and the “matrix” to metabolize the trauma experience; it also influences an individual’s resilience and recovery: community support and a strong cultural identity are some of the important determinants of its outcomes. This chapter provides pointers to addressing cultural issues that may arise during the course of any therapy and how they may play out in TIMBER therapy as well.


Culture Cultural diversity Acculturation Buddhism Middle Way Therapy TIMBER therapy 


  1. 1.
    National Center for Cultural Competence (2004). Georgetown University Center for Child and Human Development.
  2. 2.
    Kirmayer LJ, Sartorius N. Cultural models and somatic syndromes. Psychosom Med. 2007;69:832–40.CrossRefGoogle Scholar
  3. 3.
    Analayo B. Satipatthana: the direct path to realization. Birmingham: Windhorse Publications; 2003.Google Scholar
  4. 4.
    Nyanamoli B. The path of purification (Visuddhimagga). Kandy: Buddhist Publication Society; 1975.Google Scholar
  5. 5.
    Pradhan BK. Yoga and mindfulness based cognitive therapy: a clinical guide. Berlin: Springer; 2014.Google Scholar
  6. 6.
    Pradhan BK, Pinninti NR, Rathod S. Brief interventions for psychosis: a clinical compendium. Switzerland: Springer Publishers; 2016.CrossRefGoogle Scholar
  7. 7.
    Pradhan BK, Gogineni RR, Sharma S. Mind, Mindfulness, and the Social Brain: Psychobiological Understandings and Implications. Ind J Soc Psychiatr. 2018;34(4):313–22.Google Scholar
  8. 8.
    Lama D. The middle way: faith grounded in reason (trans: Jinpa T). Boston: Wisdom Publications; 2009.Google Scholar
  9. 9.
    Garcia G, Zea C, (1997). Psychological interventions and research with Latino populations. Allyn & Bacon Boston.Google Scholar
  10. 10.
    Hinton DE, Lewis-Fernández R. The cross-cultural validity of post-traumatic stress disorder: implications for DSM-5. Depress Anxiety. 2011;28:1–19. Scholar
  11. 11.
    Caspi, Y., Ghafoori, B., Smith, S., and Contractor, A., on behalf of the Diversity and Cultural Competency SIG. (2013). On the Importance of Considering Culture When Defining Trauma. Stresspoints.Google Scholar
  12. 12.
    Marshall GN, Schell TL, Miles JN. Ethnic differences in post traumatic distress: Hispanics’ symptoms differ in kind and degree. J Consult Clin Psychol. 2009;77(6):1169–78.Google Scholar
  13. 13.
    Rajkumar AP, Premkumar TS, Tharyan P. Coping with the Asian tsunami: Perspectives from Tamil Nadu, India on the determinants of resilience in the face of adversity. Soc Sci Med. 2008;67:844–53.CrossRefGoogle Scholar
  14. 14.
    Charak R, Armour C, Elklit A, Angmo D, Elhai JD, Koot HM. Factor structure of PTSD, and relation with gender in trauma survivors from India. Eur J Psychotraumatol. 2014;5(1).CrossRefGoogle Scholar
  15. 15.
    Fodor KE, Unterhitzenberger J, Chou C, Kartal D, Leister S, Milosavljevic M, et al. Is traumatic stress research global? A bibliometric analysis. Eur J Psychotraumatol. 2014;5:23269. Scholar
  16. 16.
    Hinton DE, Lewis-Fernández R. The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-V. Depress Anxiety. 2010;0:1–19. Scholar
  17. 17.
    Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis. 1986;174:727–35.CrossRefGoogle Scholar
  18. 18.
    Elsass P. Individual and collective traumatic memories: A qualitative study of post-traumatic stress disorder symptoms in two Latin American localities. Transcult Psychiatry. 2001;38(3):306–16. Scholar
  19. 19.
    Kleinman A. Depression, somatization and the new cross-cultural psychiatry. Soc Sci Med. 1977;11(1):3–10.CrossRefGoogle Scholar
  20. 20.
    Kingdon DG, Turkington D. Cognitive-behavioral therapy of schizophrenia: Guilford Publications; 2005. p. 40–41 and 52-53.Google Scholar
  21. 21.
    Rathod S, Irfan M, Bhargava R, et al. Multinational comparative cross-sectional survey of views of medical students about acceptable terminology and subgroups in schizophrenia. BMJ Open. 2018;8:e021461. Scholar
  22. 22.
    Castillo RJ. Trance, functional psychosis, and culture. Psychiatry. 2003;66:9–21.CrossRefGoogle Scholar
  23. 23.
    Spiegel J. Transactions: the interplay between individual, family, and society. New York: Science House; 1971.Google Scholar
  24. 24.
    Shafe S, Hutchinson G. Child sexual abuse and continuous influence of cultural practices: a review. West Indian Med J. 2014;63(6):634–7.PubMedGoogle Scholar
  25. 25.
    Kisanga F, Nystrom L, Hogam N, Emmelin M. Child sexual abuse: common concern in urban Tanzania. J Child Sex Abuse. 2011;20:196–217.CrossRefGoogle Scholar
  26. 26.
    Lalor K. Child sexual abuse in Tanzania and Kenya. Child Abuse Negl. 2004;28(8):833–44.CrossRefGoogle Scholar
  27. 27.
    Fontes LA. Child abuse and culture: working with diverse families. New York: Guildford; 2005.Google Scholar
  28. 28.
    Roberts AL, Gilman SE, Breslau J, Breslau N, Koenen KC. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med. 2011;41:71–83. Scholar
  29. 29.
    Keller A, Lhewa D, Rosenfeld B, Sachs E, Aladjem A, Cohen I, Smith H, Porterfield K. Traumatic experiences and psychological distress in an urban refugee population seeking treatment services. J Nerv Ment Dis. 2006;194:188–94.CrossRefGoogle Scholar
  30. 30.
    Brown LS, Pantalone D. Lesbian, gay, bisexual and transgender issues in trauma psychology: a topic comes out of the closet. Traumatology. 2011;17:1–3.CrossRefGoogle Scholar
  31. 31.
    Brown LS. Sexuality, lies, and loss: lesbian, gay, and bisexual perspectives on trauma. J Trauma Prac. 2003;2:55–68.CrossRefGoogle Scholar
  32. 32.
    McClellan J, Adams J, Douglas D, McCurry C, Storck M. Clinical characteristics related to severity of sexual abuse: a study of seriously mentally ill youth. Child Abuse Negl. 1995;19(10):1245–54.CrossRefGoogle Scholar
  33. 33.
    Karim M, Ammar R. Female circumcision and sexual desire. Cairo: Ain Shams University Press; 1985.Google Scholar
  34. 34.
    Bhugra D. Migration and mental health. Acta Psychiat Scand. 2004;109(4):243–58.CrossRefGoogle Scholar
  35. 35.
    Rothe E, Tzuang D, Pumariega AJ. Acculturation, development, and adaptation. Child Adolesc Psychiatr Clin N Am. 2010;19(4):681–96.CrossRefGoogle Scholar
  36. 36.
    Mezzich JE, Carraci G, Fabrega H, Kir-mayer LJ. Cultural formulation guidelines. Transcult Psychiatry. 2009;46:383–405.CrossRefGoogle Scholar
  37. 37.
    Rathod S, Giga L, Degnan A, et al. The current status of culturally adapted mental health interventions: a practice-focused review of meta=analysis. Neuropsychiatr Dis Treat. 2017;13: 1–14.Google Scholar
  38. 38.
    Naeem F, Phiri P, Nasar A, Gerada A, Munshi T, Ayub M, Rathod S. An evidence-based framework for cultural adaptation of Cognitive Behaviour Therapy: Process, methodology and foci of adaptation. World Cult Psych Res Review. 2016;11(1/2):61–70.Google Scholar
  39. 39.
    Rathod S, Phiri P, Harris S, Underwood C, Thagadur M, Padmanabi U, Kingdon D. Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophr Res. 2013;143(2–3):319–26.CrossRefGoogle Scholar
  40. 40.
    Tseng WS, Chang SC, Nishizono M, editors. Asian culture and psychotherapy: implications for east and west. Honolulu: University of Hawaii Press; 2005.Google Scholar
  41. 41.
    Rathod, et al. Cultural Adaptation of CBT for Serious Mental illness: a guide for training and practice. Hoboken: Wiley – Blackwell; 2015.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Basant Pradhan
    • 1
  • Narsimha R. Pinninti
    • 2
  • Shanaya Rathod
    • 3
  1. 1.Department of PsychiatryCooper University HospitalCamdenUSA
  2. 2.Department of PsychiatryRowan University SOM Department of PsychiatryCherry HillUSA
  3. 3.Antelope HouseSouthern Health NHS Foundation TrustSouthamptonUK

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