The Cross-Cultural Validation of Neuropsychological Assessments and Their Clinical Applications in Cognitive Behavioral Therapy: A Scoping Analysis
Abstract
:1. Introduction
- (1)
- Studies involving the clinical assessment and diagnosis of cognitive functioning and cognitive change with respect to multiple languages and cultures, including both single and comparative case studies and more extensive sample size studies, for digital and non-digital neuropsychological assessments [14,15,16,24]. Theories related to cultural competence and neuropsychological assessments, such as those discussed in [25], support the need for culturally sensitive diagnostic practices. These models highlight how cultural factors influence cognitive assessment outcomes and stress the importance of adapting clinical practices to ensure validity across cultures.
- (2)
- Validation studies for adapting tools to language-specific or culture-specific assessments [13,14,19,20,25,26]. The need for cross-cultural validation is supported by theoretical models of test adaptation and equivalence, such as those proposed in [27]. These models provide a framework for understanding how psychological assessments need to be adapted and validated to maintain their reliability and validity across different cultural contexts.
- (3)
- Qualitative research on neuropsychological assessments, covering methods for cognitive function assessments, oral history or cultural memory for clinical condition evaluation, and intercultural research on the content and administration of cognitive tools in clinical research or everyday settings [11,15,16,17,28,29]. Theories from cultural psychology, such as those in [30,31], support the use of qualitative research to explore how culture shapes cognitive processes and behaviors, thus providing a theoretical basis for this category.
- (4)
- The development and design of cognitive function assessments and experimental procedures considering indigenous needs for medical resources [18,32]. The theoretical underpinnings of this category can be found in models of test construction and cultural adaptation, such as those discussed in [33] in the context of adapting educational and psychological tests. These models emphasize the importance of considering cultural differences in the development of assessment tools, ensuring that they are culturally relevant and valid for the populations being tested.
- (5)
- Theoretical papers and guidelines on the need to identify future directions and ethical considerations [21,34]. Theoretical discussions on ethics, such as those indicated in [35] on multicultural competence, provide a foundation for understanding the ethical challenges and considerations in applying neuropsychological assessments across different cultural groups.
- (6)
- Practice session papers, including studies reporting the development of digital app-based tools [22,36]. The integration of technology into neuropsychological assessments is supported by theoretical models of digital and remote assessments, such as those discussed in [37] that explored the implications of using digital tools in psychological testing. Theories related to the digital divide and accessibility, such as those presented in [38], also provide a framework for understanding the challenges and opportunities associated with implementing digital assessments in diverse cultural contexts.
2. Literature Review
2.1. Importance of Cross-Cultural Validation
2.2. Cross-Cultural Considerations in Neuropsychological Assessments
2.3. Cognitive Behavioral Therapy: Principles and Applications
2.4. Fundamentals of Cognitive Behavioral Therapy
2.5. Integration with Neuropsychological Assessments
2.6. Scope and Objectives
2.7. Research Questions
- [RQ1] What are the long-term effects of CA-CBT on mental health outcomes across different cultural groups?
- [RQ2] What factors contribute to the success of CA-CBT, and how effective, feasible, and scalable are digital and remote CA-CBT platforms in diverse populations?
- [RQ3] What specific cultural adaptations are necessary for the effective implementation of CA-CBT in various cultural contexts?
- [RQ4] How does the effectiveness of CA-CBT compare to standard CBT and other therapeutic interventions in diverse populations?
- [RQ5] What are the key considerations in validating neuropsychological assessment tools for use in diverse cultural settings?
- [RQ6] How can neuropsychological assessments be adapted to better align with the cultural contexts of diverse populations receiving CBT?
3. Materials and Methods
3.1. Search Strategy
- “Cognitive Behavioral Therapy” OR “CBT”;
- “Culturally Adapted” OR “Cultural Adaptation” OR “Culturally Sensitive”;
- “Depression” OR “Anxiety” OR “PTSD” OR “Psychosis”;
- “Chinese Americans” OR “Latino” OR “Syrian Refugees” OR “Jordanian” OR “Malaysian” OR “Afghan Refugees” OR “Iraqi Women” OR “Japanese Children” OR “Tanzanian” OR “Kenyan”;
- “Randomized Controlled Trial” OR “RCT” OR “Pilot Study”.
3.2. Inclusion and Exclusion Criteria
4. Results
4.1. Effectiveness of Culturally Adapted CBT
4.2. Feasibility and Acceptability
4.3. Digital and Remote Interventions
4.4. Specific Populations and Settings
5. Discussion
5.1. Limitations
5.2. Future Research
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Study Year | Country/Culture | Neuropsychological Assessment | Sample Size | Validation Methodology | Key Findings | Application in CBT | Gaps/Limitations |
---|---|---|---|---|---|---|---|
Hwang, 2015 [72] | USA/Chinese Americans | Hamilton Depression Rating Scale | 50 | RCT | CA-CBT led to greater overall decrease in depressive symptoms | Enhanced effectiveness of CBT through cultural adaptation | Small sample size, short follow-up period, high initial severity of depression |
Gonyea, 2016 [82] | USA/Latino | Neuropsychiatric Inventory, CES-D | 67 | RCT | Lower neuropsychiatric symptoms, less caregiver distress, greater self-efficacy | Culturally sensitive group CBT for caregivers | Limited to caregivers, short follow-up period |
Habib, 2014 [83] | Pakistan | PANSS, PSYRATS, Insight Scale | 42 | RCT | Significant improvement in positive, negative, and overall psychotic symptoms | CA-CBT effective for psychosis in low-income settings | Small sample size, short follow-up period |
Eskici, 2021 [73] | Turkish/Syrian Refugees | Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25 | 23 | RCT | Significant reduction in PTSD and anxious-depressive distress | CA-CBT effective for PTSD in refugee populations | Small sample size, short follow-up period |
Damra, 2014 [74] | Jordan | PTSD and Depression Symptomatology | 18 | RCT | Significant post-treatment improvements in PTSD and depression symptoms | Feasibility and acceptability of TF-CBT in Jordanian culture | Small sample size, short follow-up period |
Subhas, 2021 [77] | Malaysia/Muslim | Beck Anxiety Inventory | 1 | Single-case study | Significant reduction in anxiety and panic attack symptoms | Culturally and religiously adapted CBT for panic disorder | Single-case study, no control group |
Dwight-Johnson, 2011 [84] | USA/Latino | Hopkins Symptom Checklist, Patient Health Questionnaire-9 | 101 | RCT | Significant improvement in depression outcomes | Feasibility and acceptability of telephone-based CBT | Small sample size, potential selection bias |
Zemestani, 2022 [76] | Iraq | PTSD Symptom Severity, Depression, Anxiety, Stress | 48 | RCT | Significant reductions in PTSD, depression, anxiety, and stress symptoms | CA-TF-CBT effective for war-related PTSD | Short follow-up period |
Kananian, 2020 [75] | German/Afghan Refugees | General Health Questionnaire, PTSD Checklist, Patient Health Questionnaire | 24 | RCT | Large improvements in general psychopathological distress and quality of life | CA-CBT+ effective for refugees, low dropout rate | Small sample size, short follow-up period |
Hinton, 2011 [78] | USA/Latino | PTSD Symptom Scale, Anxiety Measures | 24 | RCT | Significant reduction in PTSD symptoms, large effect sizes | CA-CBT effective for treatment-resistant PTSD | Small sample size, short follow-up period |
Ishikawa, 2019 [85] | Japan | Diagnostic Interview, Self-Report Measures of Anxiety and Depression | 51 | RCT | Significant improvements in anxiety and depression symptoms | Bidirectional cultural adaptation of CBT for children and adolescents | Short follow-up period |
Salamanca-Sanabria, 2018 [79] | Colombia | Patient Health Questionnaire-9 | Not specified | RCT | Protocol for assessing efficacy of internet-delivered CBT | Methodology for culturally adapting internet-delivered interventions | No results reported, protocol study |
Paris, 2018 [80] | USA/Spanish-speaking | Substance Use Frequency | 92 | RCT | Significant improvement in substance use outcomes | Web-based CBT effective for substance use disorders | Short follow-up period |
Woods-Jaeger, 2017 [86] | Tanzania/Kenya | Qualitative Interviews | 12 | Qualitative Study | Importance of cultural responsiveness, value of TF-CBT for child mental health | Task-sharing approach for delivering TF-CBT | Small sample size, qualitative study |
Palic, 2009 [87] | Denmark/Refugees | Harvard Trauma Questionnaire, Trauma Symptom Checklist-23 | 26 | Observational Study | Small to medium effect sizes on most outcome measures | Multidisciplinary treatment including CBT for traumatized refugees | Small sample size, observational study |
Stange, 2017 [88] | USA | Symptom Checklist-90-Revised, Depression Anxiety Stress Scales | 39 | RCT | Greater brain-behavioral adaptability predicted better treatment response | Brain-behavioral adaptability as a predictor of CBT response | Small sample size, short follow-up period |
Husain, 2017 [89] | Pakistan | PANSS, PSYRATS, Schedule for Assessment of Insight | 36 | RCT | Significant improvements in positive and negative symptoms and overall psychotic symptoms | Feasibility and acceptability of CA-CBT for psychosis | Small sample size, short follow-up period |
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Gkintoni, E.; Nikolaou, G. The Cross-Cultural Validation of Neuropsychological Assessments and Their Clinical Applications in Cognitive Behavioral Therapy: A Scoping Analysis. Int. J. Environ. Res. Public Health 2024, 21, 1110. https://doi.org/10.3390/ijerph21081110
Gkintoni E, Nikolaou G. The Cross-Cultural Validation of Neuropsychological Assessments and Their Clinical Applications in Cognitive Behavioral Therapy: A Scoping Analysis. International Journal of Environmental Research and Public Health. 2024; 21(8):1110. https://doi.org/10.3390/ijerph21081110
Chicago/Turabian StyleGkintoni, Evgenia, and Georgios Nikolaou. 2024. "The Cross-Cultural Validation of Neuropsychological Assessments and Their Clinical Applications in Cognitive Behavioral Therapy: A Scoping Analysis" International Journal of Environmental Research and Public Health 21, no. 8: 1110. https://doi.org/10.3390/ijerph21081110