top of page
Search

Adapting Cognitive Remediation for British South Asian experiencing a first episode

Jordan Bamford, General Adult Psychiatrist at Greater Manchester Mental Health NHS Foundation Trust, Honorary Academic Clinical Fellow at The University of Manchester


Man protectively holding his hands to his head

Our recent study, published in BJPsych Open, explored how to adapt a well-established cognitive remediation programme, CIRCuiTS™ (Computerised Interactive Remediation of Cognition and Thinking Skills), for British South Asian service users experiencing a first episode of psychosis. CIRCuiTS™ helps people practise skills such as attention, memory and problem-solving through structured computer tasks, supported by a therapist. It is adaptable in terms of difficulty, which tasks are done within a session, and the information provided in a task e.g. the ingredients for a recipe.


Why cultural adaptation matters


Standard cognitive remediation interventions are mostly developed and tested in largely Western populations. For South Asian groups, differing beliefs about illness and cognition, family roles and stigma can influence how treatments are received. Our team wanted to explore whether adapting CIRCuiTS™ could make it more engaging and acceptable for this community.


How we approached it


We began with qualitative interviews with British South Asian participants with first-episode psychosis, all of whom identified as Muslim. They discussed how cognitive difficulties affected daily life and what would help make CIRCuiTS™ more relevant. Suggestions included replacing culturally unfamiliar items (for instance, swapping non-Halal foods for South Asian dishes or references to churches for mosques), involving family members, and allowing flexible home-based sessions.

These insights guided a culturally adapted version of CIRCuiTS™ that we piloted with ten participants. The CIRCuiTS™ therapist also adapted the pace, language and examples to fit an individual needs. Family members were invited to an introductory session and were kept informed throughout treatment.

The adapted programme was highly acceptable, with strong engagement and satisfaction. Participants enjoyed the challenge of the tasks and the supportive contact with their therapist. Many noticed improvements in concentration, memory and confidence, and several reported using the strategies they learned in everyday life, such as making lists, planning journeys, or managing distractions. Although the sample was small, we saw signs of improvement in cognition and functioning. Importantly, families described the sessions as valuable and were often active in supporting participants’ progress, suggesting that this may reduce stigma.


Next steps


This was the first study to culturally adapt computerised cognitive remediation for British South Asians with psychosis. The positive feedback highlights that adapting established therapies to reflect people’s cultural and religious contexts can enhance both engagement and outcomes. What stood out most for me was how strongly participants valued the relationship with the therapist and the flexibility to work within their family environment. Cultural adaptation, it seems, is as much about how we deliver care as what we deliver.

We will test the adapted CIRCuiTS™ in larger studies, but our findings already suggest that culturally sensitive approaches like this can make evidence-based interventions more inclusive and, ultimately, more effective.

 


If you or your team are interested in joining the growing global community of Cognitive Remediation therapists and completing our online course, visit our Training page to find out more or Get in touch to book your place today.

Comments

bottom of page