Isabel Clarke

, Southern Health NHS Foundation Trust, United Kingdom
Title : Introducing mindfulness into cultural adaptation; evaluation of a culture free manual


Culturally adapted CBT has produced good results with specified ethnic groups. This initiative evaluated the culturally adapted Comprehend, Cope and Connect (third wave CBT) approach on a varied cohort of ethnicities, ranging between Chinese, South Asian, Caribbean, mixed and others. The trans-diagnostic, trauma-informed formulation is co-produced around the individual’s lived experience however conceptualised, so does not depend on teaching a Western psychological model. Mindfulness, positive management of emotion and behavioural change are core interventions. The individualistic focus of Western therapies is modified through encouraging participation of partners and family in understanding the formulation and supporting the application of new coping skills. Faith and spirituality, where relevant to the individual, are incorporated. 

32 participants were recruited across local adult mental health services and offered between 8 and 12 sessions.  HADS, CORE, BSI, WHODAS all showed significant improvement across all three time-points. Feedback from the Patient Experience Questionnaire and the retention rate of 91% both evidence strong acceptability for this intervention. 
The manual was further refined through the experience of the therapists and the supervisor (the presenter), incorporating approaches to particular cultural mental health challenges; for instance, those arising from tension between the generations representing different levels of assimilation to the host culture and spiritual issues impacting mental health. 
A scientific paper on the project is in preparation (Phiri, Clarke, Baxter, Rathod, Soomro & Naeem), and a chapter, focusing on the trauma element of the intervention is published (Phiri, Clarke, Baxter, Elliot, Rathod & Naeem, 2021. Culture Free CBT for Diverse Groups. IntechOpen). Though not selected for trauma, the majority of the participants had experienced trauma or adversity that impacted their mental health. This was addressed as part of the intervention.


Isabel Clarke is a consultant clinical psychologist with over 25 years’ experience working as a therapist in the UK National Health Service with people with complex problems.  She has developed a trans-diagnostic, trauma-informed, formulation based approach, Comprehend, Cope and Connect (CCC), which has been applied in acute services and beyond, enabling individuals to be understood at an emotional, felt sense, level and teams to work psychologically.   Psychosis and spirituality, and the psychology of spirituality are further areas of specialism and publication.  For more information, see the website:   Recent and forthcoming publication: Clarke, I. & Nicholls, H. (2018) Third Wave CBT Integration for Individuals and Teams: Comprehend, Cope and Connect. Routledge. Clarke, I. (2022, forthcoming). Meeting mental breakdown mindfully – how to help the Comprehend, Cope and Connect way.   Routledge