Diddeniya, Prashan (2025) An exploration of the cultural applicability of Cognitive Behaviour Therapy and the Three Flows of Compassion in the South Asian population. University of Southampton, Doctoral Thesis, 158pp.
Abstract
Psychological interventions such as Cognitive Behaviour Therapy (CBT) and Compassion Focused Therapy (CFT), have a growing literature base that suggest their potential effectiveness in a range of mental health presentations across cultures (individualistic and collectivistic cultures). However, South Asian populations, for example, are often under studied in psychological intervention research, specifically Sri Lankan populations.
With this in mind, the first chapter of this thesis comprises a narrative systematic review and a meta-analysis of the effectiveness of CBT for depression in South Asian populations. The review identified 20 randomised controlled trials (RCTs) that met the study’s inclusion criteria, with a total of 4758 participants. The findings suggested CBT to be effective as an intervention for depression in South Asian populations.
The second chapter is a reflexive account of the researcher’s experience in conducting their empirical research. As the researcher is from the same cultural identity as the target population in the empirical study, the researcher provides an insight about their cultural influences, their motivations for the research, conducting the research, and their hopes for the future.
The empirical paper looks at the experiences of shame and the cultural applicability within the context of Gilbert’s(2010) three flows of compassion in second-generation Sri Lankan men living in the UK. The study implemented a qualitative design and conducted semi-structured interviews with twelve participants who were met the eligibility criteria. A reflexive thematic analysis identified four themes: ‘shame driven by expectation’, ‘living between worlds’, ‘when the three flows of compassion feels safe’, and ‘the emerging self’. Clinical implications recommend for culturally-adapted interventions to be delivered, and/or delivered by clinicians who identify as South Asian or speak their preferred language. Future research should explore the effectiveness of CBT for depression in men and other South Asian communities. Additionally, for second-generation Sri Lankan me, clinicians are recommended to explore mental health presentations linked to experiences of shame, connected to their cultural heritage and community, their masculinity, pressures to succeed, and providing a space to experience the three flows of compassion. Future research in this area should explore the quantitative measures of the three flows of compassion in this population using standardised measures and explore whether second-generation Sri Lankan women also experience three flows of compassion, in the context of shame.
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