Enhancing social inclusion through a culturally adapted ACT manual for substance use stigma and shame

Purpose Cultural disparities in mental health services may restrict accessibility and efficacy for ethnic minority populations. This study aims to examine the cultural adaptation of Acceptance and Commitment Therapy (ACT) to mitigate stigma and shame associated with substance use disorders (SUDs) within an Urdu-speaking Pakistani culture. Design/methodology/approach The study used the ecological validity model (EVM) and conducted semi-structured interviews with 40 participants, comprising clinical psychologists, individuals with SUDs and caretakers. Participants were chosen based on their experience with or direct engagement in substance use disorder treatment. Thematic analysis, adhering to Braun and Clarke’s six-step methodology, was used to discern significant cultural influences. Findings Findings indicate that cultural elements such as language, religious convictions, stigma and therapeutic anticipations influence therapy outcomes. The findings emphasized the necessity for streamlined psychological language, culturally pertinent metaphors and the integration of religious activities. Therapists underscored the significance of behavioral activation and metaphorical approaches adapted to regional narratives. Originality/value This research introduces the inaugural cultural adaptation of ACT (CA-ACT) for Pakistani adults with SUDs. The CA-ACT methodology enhances therapeutic significance, client involvement and therapy efficacy. The research highlights the significance of cultural competence in psychotherapy and calls for additional investigations, including randomized controlled trials, to assess the efficacy of CA-ACT. This adaptation provides a basis for future clinical implementation and training in various scenarios.