{"id":{"repo_id":"exeter","oai_identifier":"oai:figshare.com:article/31846492"},"canonical_url":"https://search.dev.ndltd.org/etd/exeter/oai:figshare.com:article/31846492","repository":{"repo_id":"exeter","name":"University of Exeter","base_url":"https://api.figshare.com/v2/oai"},"display":{"title":"Developing a Culturally Adapted Low-Intensity Cognitive Behavioural Therapy Intervention for Saudi Adults with Multiple Sclerosis","abstract":"Background Multiple sclerosis (MS) is a chronic neurological condition associated with high levels of depression and anxiety, which substantially affect quality of life and illness adjustment. In Saudi Arabia, psychological difficulties among adults with MS remain insufficiently recognised and inadequately addressed within routine care. Barriers including cultural stigma, limited availability of psychological services, and the absence of culturally adapted therapeutic models restrict access to effective mental health support. Although Cognitive Behavioural Therapy (CBT) is well established for managing mood difficulties in chronic illness, standard CBT formats may be poorly aligned with the cultural, religious, and illness-related needs of Saudi adults with MS. Low-Intensity Cognitive Behavioural Therapy (LICBT) may represent a feasible and scalable solution; however, evidence regarding its cultural acceptability, adaptation requirements, and feasibility in this context remains limited. Methods Guided by the revised Medical Research Council (MRC) framework for developing and evaluating complex interventions, this PhD adopted a four-stage, multi-phase design. Stage I (Problem identification and evidence synthesis) involved a systematic review with thematic synthesis to examine the acceptability of CBT for adults with MS and to identify barriers and facilitators relevant to Muslim populations. Stage II (Understanding needs and context) comprised a qualitative study using semi-structured interviews with Saudi adults living with MS to explore experiences of CBT, cultural and religious influences, and systemic barriers to psychological care. Stage III (Intervention development and adaptation) integrated findings from the previous stages with cultural adaptation literature to develop a culturally and religiously congruent LICBT intervention, structured as two modular booklets and informed by the MRC and ORBIT (Obesity-Related Behavioural Intervention Trials) models. Stage IV (Early evaluation) employed a prospective case series to explore usability, engagement, and cultural acceptability of the adapted LICBT intervention in practice. Results Across the four stages, convergent findings were identified. Stage I revealed that CBT was perceived as potentially beneficial for emotional coping and self-management in MS, while acceptability was constrained by access barriers, illness-related fatigue, and limited cultural relevance. Stage II demonstrated that engagement with psychological therapy was shaped by alignment with Islamic values, family roles, language simplicity, and flexible delivery formats, alongside MS-related cognitive and physical constraints. Stage III resulted in a culturally adapted LICBT intervention incorporating a structured problem-solving technique and paced engagement without reliance on formal problem-solving. Stage IV indicated that participants engaged positively with the intervention, reporting improved organisation of daily challenges, enhanced emotional regulation, and reassurance derived from culturally familiar framing, despite symptom fluctuation. Conclusions This thesis demonstrates that culturally adapted LICBT is a feasible and acceptable psychological intervention for Saudi adults living with MS. By integrating cultural, religious, and illness-related considerations into intervention development, the research addresses a critical gap between recognised psychological need and contextually appropriate care. The findings provide a foundation for future feasibility trials, digital adaptation, and broader implementation within Saudi MS services.<p></p>","abstract_html":"Background Multiple sclerosis (MS) is a chronic neurological condition associated with high levels of depression and anxiety, which substantially affect quality of life and illness adjustment. In Saudi Arabia, psychological difficulties among adults with MS remain insufficiently recognised and inadequately addressed within routine care. Barriers including cultural stigma, limited availability of psychological services, and the absence of culturally adapted therapeutic models restrict access to effective mental health support. Although Cognitive Behavioural Therapy (CBT) is well established for managing mood difficulties in chronic illness, standard CBT formats may be poorly aligned with the cultural, religious, and illness-related needs of Saudi adults with MS. Low-Intensity Cognitive Behavioural Therapy (LICBT) may represent a feasible and scalable solution; however, evidence regarding its cultural acceptability, adaptation requirements, and feasibility in this context remains limited. Methods Guided by the revised Medical Research Council (MRC) framework for developing and evaluating complex interventions, this PhD adopted a four-stage, multi-phase design. Stage I (Problem identification and evidence synthesis) involved a systematic review with thematic synthesis to examine the acceptability of CBT for adults with MS and to identify barriers and facilitators relevant to Muslim populations. Stage II (Understanding needs and context) comprised a qualitative study using semi-structured interviews with Saudi adults living with MS to explore experiences of CBT, cultural and religious influences, and systemic barriers to psychological care. Stage III (Intervention development and adaptation) integrated findings from the previous stages with cultural adaptation literature to develop a culturally and religiously congruent LICBT intervention, structured as two modular booklets and informed by the MRC and ORBIT (Obesity-Related Behavioural Intervention Trials) models. Stage IV (Early evaluation) employed a prospective case series to explore usability, engagement, and cultural acceptability of the adapted LICBT intervention in practice. Results Across the four stages, convergent findings were identified. Stage I revealed that CBT was perceived as potentially beneficial for emotional coping and self-management in MS, while acceptability was constrained by access barriers, illness-related fatigue, and limited cultural relevance. Stage II demonstrated that engagement with psychological therapy was shaped by alignment with Islamic values, family roles, language simplicity, and flexible delivery formats, alongside MS-related cognitive and physical constraints. Stage III resulted in a culturally adapted LICBT intervention incorporating a structured problem-solving technique and paced engagement without reliance on formal problem-solving. Stage IV indicated that participants engaged positively with the intervention, reporting improved organisation of daily challenges, enhanced emotional regulation, and reassurance derived from culturally familiar framing, despite symptom fluctuation. Conclusions This thesis demonstrates that culturally adapted LICBT is a feasible and acceptable psychological intervention for Saudi adults living with MS. By integrating cultural, religious, and illness-related considerations into intervention development, the research addresses a critical gap between recognised psychological need and contextually appropriate care. The findings provide a foundation for future feasibility trials, digital adaptation, and broader implementation within Saudi MS services.&lt;p&gt;&lt;/p&gt;","abstract_has_math":false,"creators":["Samia Alharbi (21041573)"],"institution":null,"degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026-03-30T00:00:00Z","date_published":"2026-03-30T00:00:00Z","updated_at":"2026-07-27T19:33:48Z","subjects":["Multiple sclerosis","Low-Intensity Cognitive Behavioural Therapy (LICBT)"],"languages":[],"rights":["All rights reserved"],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["10779/exe.31846492.v1"],"render_values":[{"text":"10779/exe.31846492.v1","href":null,"code":true}]}]},"links":{"outbound_url":null,"outbound_label":null,"outbound_source":null},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Samia Alharbi (21041573)"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2026-03-30T00:00:00Z"]},{"key":"dc:relation","label":"Dc Relation","values":["https://figshare.com/articles/thesis/Developing_a_Culturally_Adapted_Low-Intensity_Cognitive_Behavioural_Therapy_Intervention_for_Saudi_Adults_with_Multiple_Sclerosis/31846492"]},{"key":"dc:type","label":"Dc Type","values":["Text","Thesis"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Multiple sclerosis","Low-Intensity Cognitive Behavioural Therapy (LICBT)"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:rights","label":"Dc Rights","values":["All rights reserved"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["10779/exe.31846492.v1"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Background Multiple sclerosis (MS) is a chronic neurological condition associated with high levels of depression and anxiety, which substantially affect quality of life and illness adjustment. In Saudi Arabia, psychological difficulties among adults with MS remain insufficiently recognised and inadequately addressed within routine care. Barriers including cultural stigma, limited availability of psychological services, and the absence of culturally adapted therapeutic models restrict access to effective mental health support. Although Cognitive Behavioural Therapy (CBT) is well established for managing mood difficulties in chronic illness, standard CBT formats may be poorly aligned with the cultural, religious, and illness-related needs of Saudi adults with MS. Low-Intensity Cognitive Behavioural Therapy (LICBT) may represent a feasible and scalable solution; however, evidence regarding its cultural acceptability, adaptation requirements, and feasibility in this context remains limited. Methods Guided by the revised Medical Research Council (MRC) framework for developing and evaluating complex interventions, this PhD adopted a four-stage, multi-phase design. Stage I (Problem identification and evidence synthesis) involved a systematic review with thematic synthesis to examine the acceptability of CBT for adults with MS and to identify barriers and facilitators relevant to Muslim populations. Stage II (Understanding needs and context) comprised a qualitative study using semi-structured interviews with Saudi adults living with MS to explore experiences of CBT, cultural and religious influences, and systemic barriers to psychological care. Stage III (Intervention development and adaptation) integrated findings from the previous stages with cultural adaptation literature to develop a culturally and religiously congruent LICBT intervention, structured as two modular booklets and informed by the MRC and ORBIT (Obesity-Related Behavioural Intervention Trials) models. Stage IV (Early evaluation) employed a prospective case series to explore usability, engagement, and cultural acceptability of the adapted LICBT intervention in practice. Results Across the four stages, convergent findings were identified. Stage I revealed that CBT was perceived as potentially beneficial for emotional coping and self-management in MS, while acceptability was constrained by access barriers, illness-related fatigue, and limited cultural relevance. Stage II demonstrated that engagement with psychological therapy was shaped by alignment with Islamic values, family roles, language simplicity, and flexible delivery formats, alongside MS-related cognitive and physical constraints. Stage III resulted in a culturally adapted LICBT intervention incorporating a structured problem-solving technique and paced engagement without reliance on formal problem-solving. Stage IV indicated that participants engaged positively with the intervention, reporting improved organisation of daily challenges, enhanced emotional regulation, and reassurance derived from culturally familiar framing, despite symptom fluctuation. Conclusions This thesis demonstrates that culturally adapted LICBT is a feasible and acceptable psychological intervention for Saudi adults living with MS. By integrating cultural, religious, and illness-related considerations into intervention development, the research addresses a critical gap between recognised psychological need and contextually appropriate care. The findings provide a foundation for future feasibility trials, digital adaptation, and broader implementation within Saudi MS services.<p></p>"]},{"key":"dc:title","label":"Title","values":["Developing a Culturally Adapted Low-Intensity Cognitive Behavioural Therapy Intervention for Saudi Adults with Multiple Sclerosis"]}]}],"canonical_facts":{"dc:creator":["Samia Alharbi (21041573)"],"dc:date":["2026-03-30T00:00:00Z"],"dc:description":["Background Multiple sclerosis (MS) is a chronic neurological condition associated with high levels of depression and anxiety, which substantially affect quality of life and illness adjustment. In Saudi Arabia, psychological difficulties among adults with MS remain insufficiently recognised and inadequately addressed within routine care. Barriers including cultural stigma, limited availability of psychological services, and the absence of culturally adapted therapeutic models restrict access to effective mental health support. Although Cognitive Behavioural Therapy (CBT) is well established for managing mood difficulties in chronic illness, standard CBT formats may be poorly aligned with the cultural, religious, and illness-related needs of Saudi adults with MS. Low-Intensity Cognitive Behavioural Therapy (LICBT) may represent a feasible and scalable solution; however, evidence regarding its cultural acceptability, adaptation requirements, and feasibility in this context remains limited. Methods Guided by the revised Medical Research Council (MRC) framework for developing and evaluating complex interventions, this PhD adopted a four-stage, multi-phase design. Stage I (Problem identification and evidence synthesis) involved a systematic review with thematic synthesis to examine the acceptability of CBT for adults with MS and to identify barriers and facilitators relevant to Muslim populations. Stage II (Understanding needs and context) comprised a qualitative study using semi-structured interviews with Saudi adults living with MS to explore experiences of CBT, cultural and religious influences, and systemic barriers to psychological care. Stage III (Intervention development and adaptation) integrated findings from the previous stages with cultural adaptation literature to develop a culturally and religiously congruent LICBT intervention, structured as two modular booklets and informed by the MRC and ORBIT (Obesity-Related Behavioural Intervention Trials) models. Stage IV (Early evaluation) employed a prospective case series to explore usability, engagement, and cultural acceptability of the adapted LICBT intervention in practice. Results Across the four stages, convergent findings were identified. Stage I revealed that CBT was perceived as potentially beneficial for emotional coping and self-management in MS, while acceptability was constrained by access barriers, illness-related fatigue, and limited cultural relevance. Stage II demonstrated that engagement with psychological therapy was shaped by alignment with Islamic values, family roles, language simplicity, and flexible delivery formats, alongside MS-related cognitive and physical constraints. Stage III resulted in a culturally adapted LICBT intervention incorporating a structured problem-solving technique and paced engagement without reliance on formal problem-solving. Stage IV indicated that participants engaged positively with the intervention, reporting improved organisation of daily challenges, enhanced emotional regulation, and reassurance derived from culturally familiar framing, despite symptom fluctuation. Conclusions This thesis demonstrates that culturally adapted LICBT is a feasible and acceptable psychological intervention for Saudi adults living with MS. By integrating cultural, religious, and illness-related considerations into intervention development, the research addresses a critical gap between recognised psychological need and contextually appropriate care. The findings provide a foundation for future feasibility trials, digital adaptation, and broader implementation within Saudi MS services.<p></p>"],"dc:identifier":["10779/exe.31846492.v1"],"dc:relation":["https://figshare.com/articles/thesis/Developing_a_Culturally_Adapted_Low-Intensity_Cognitive_Behavioural_Therapy_Intervention_for_Saudi_Adults_with_Multiple_Sclerosis/31846492"],"dc:rights":["All rights reserved"],"dc:subject":["Multiple sclerosis","Low-Intensity Cognitive Behavioural Therapy (LICBT)"],"dc:title":["Developing a Culturally Adapted Low-Intensity Cognitive Behavioural Therapy Intervention for Saudi Adults with Multiple Sclerosis"],"dc:type":["Text","Thesis"]},"updated_at":"2026-07-27T19:33:48Z"}