Culturally competent adaptation of cognitive-behavioural therapy for psychosis: cases of Orthodox Jewish patients with messianic delusions

Cognitive behavioural therapy (CBT) is an evidence-based treatment for various psychopathologies. CBT has also been used in psychosis, however relatively few articles deal with the culturally competent adaptation of CBT for psychosis, and none for the Orthodox Jewish population. We analysed cases of messianic delusion among Orthodox Jews, for whom we used a culturally competent adaptation of CBT. Our therapeutic work consisted of sorting out acceptable beliefs from delusions, and to acknowledge those acceptable beliefs. We recognised how patients themselves reframe their views when they become less delusional. We tried to accompany the patients in this reframing process. We advocate an approach in CBT where therapists can use a few culturally appropriate ideas taken from the patient's grossly delusional thinking, and help the patient reframe their frankly delusional thoughts into more culturally or socially accepted ideas.