Table 2 Conceptual model for culturally adapted CBT for people with substance use disorders in Pakistan

Conceptual model of CBT intervention for people with substance use disorders in Pakistan

Therapeutic materials

• Translated CBT manuals for substance use disorders in national language Urdu

• Translated CBT homework sheets and forms in national language Urdu

• Cards, sheets, and charts with illustrative images to make basic therapeutic concepts and patients’ thought processes understandable for them

Therapeutic processes

• Before formal start of the therapy 1–2 educational sessions should be conducted with patients and their family members to educate them about nature and effectiveness of CBT for substance use disorders. Psychiatrists should also participate in these sessions to increase awareness

• Initial few sessions should be short (20–25 min long) until acceptance of long sessions of standard duration, i.e., 40–45 min

• Group sessions, and role play may be used in initial sessions to encourage people to open up and develop rapport

• Remaining sessions should be of standard duration 40–45

• When collaborative approach does not work it should be alternated with instructional/directional approach

Therapeutic techniques

• To motivate patients and their families to engage in and comply with the therapy success stories of similar patients should be shared with them during educational sessions before the start of therapy

• Progressive Muscular Relaxation techniques should be taught to patients to deal with cravings

• Psychoeducation should be continued during the sessions to make therapeutic processes and techniques understandable for patients

Cultural facilitators

• To counter superstitious beliefs renowned religious scholars’ speeches in favour of medical and psychiatric treatment and negation of superstitious beliefs should be shared with the patient and their families during educational sessions before starting psychotherapy

• Families of patients should be engaged in therapy as families play vital role in treatment decisions and processes