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Islamically modified cognitive behavioral therapy: Enhancing outcomes by

increasing the cultural congruence of cognitive behavioral therapy self-
statements

Article  in  International Social Work · May 2016

DOI: 10.1177/0020872816629193

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research-article2016
ISW0010.1177/0020872816629193International Social WorkHodge and Husain

Article i s w

International Social Work

2016, Vol. 59(3) 393­–405
Islamically modified cognitive © The Author(s) 2016
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DOI: 10.1177/0020872816629193
outcomes by increasing the cultural isw.sagepub.com

congruence of cognitive behavioral

therapy self-statements

Altaf Husain
Howard University, USA

David R Hodge
Arizona State University, USA

Abstract
Cognitive behavioral therapy (CBT) is one of the most widely used and effective therapeutic
modalities. When utilized with devout Muslims, however, outcomes may be enhanced by
modifying traditional CBT self-statements to reflect Islamic values. Toward this end, the values
that inform the Western counseling project are discussed. Areas of differing value emphasis
are noted between Islam and traditional CBT. The process of constructing Islamically modified
statements is illustrated, and it is proposed that this culturally congruent modality may engender
(1) faster recovery, (2) better treatment compliance, (3) lower rates of relapse, and (4) reduced
treatment disparities. The article concludes by providing suggestions to assist social workers
implement Islamically modified CBT statements in a manner that maximizes the potential to
achieve these salutary outcomes.

Keywords
CBT, Islam, Islamically, Muslims, social work

Cognitive behavioral therapy (CBT) is one of the most effective therapeutic modalities (Keith,
2013; Tolin, 2010). It has been used to successfully address a variety of problems (Chambless and
Ollendick, 2001). Due to its perceived utility in clinical settings, its importance is predicted to
increase in the future (Dobson, 2010).

Corresponding author:
Altaf Husain, School of Social Work, Howard University, 601 Howard Pl. NW, Washington, DC 20059, USA.
Email: altaf.husain@howard.edu
394 International Social Work 59(3)

Modifying CBT protocols so that they resonate with a given population’s cultural values can
enhance effectiveness (Rathod et al., 2010). As Western societies have become more culturally
diverse, it is increasingly recognized that therapeutic procedures should be adapted so they are
consistent with clients’ value systems (Sue and Sue, 2013). Modifying therapeutic strategies so
they are congruent with clients’ understandings of reality is an essential prerequisite for effective
service provision (Wolf, 1978).
Social workers serve individuals from diverse cultural backgrounds. Muslims may increasingly
come to the attention of social workers in light of the heightened climate of Islamophobia (Amri
and Bemak, 2012). Islamophobia refers to ‘either outright anti-Muslim bigotry due to religious
intolerance or racism and xenophobia toward people from the Middle East, North Africa, and
South Asia who are Muslim or who have a “Muslim-like” appearance’ (Husain, 2015: n.p.).
Muslims have become targets of physical and emotional violence following the 9/11 attacks (Peek,
2011). Muslims may increasingly find themselves in need of social work services to mitigate the
deleterious impact of Islamophobic victimization. To best serve this population, social workers
should deliver services in a manner that reflects the values, traditions, and belief systems of Islam.
Muslims represent one culturally distinct group that is rapidly increasing in size in many nations
around the world (Hedayat-Diba, 2014). Islam provides adherents with a unique value system
(Halstead, 2007). To be effective with Muslims, counselors must use therapeutic strategies that are
consistent with Islamic values (Graham et al., 2010). As is the case with other culturally distinct
populations, modifying Western therapeutic strategies can enhance their effectiveness with
Muslims (Abu Raiya and Pargament, 2010). Increasing the cultural congruence of CBT self-state-
ments with Islamic values can enhance therapeutic outcomes, a process that begins with under-
standing the values that inform CBT and other therapeutic modalities that comprise the Western
counseling project (Hodge and Nadir, 2008).

The Western counseling project

The Western counseling project – like other human constructions – is informed by a particular set
of values (Inayat, 2000; Kuhn, 1970). Certain anthropological assumptions regarding human func-
tioning are implicitly affirmed in Western therapeutic models (Smither and Khorsandi, 2009). As a
value-informed enterprise, the Western therapeutic project affirms certain norms regarding human
existence, relational dynamics, and healthy functioning.
It is important to acknowledge that many factors contributed to the emergence of the present-
day Western counseling project. Among these various factors, however, the European movement
commonly referred to as the ‘Enlightenment’ played an instrumental role (Gellner, 1992; Jafari,
1993). The Enlightenment posited a distinct set of assumptions about the nature of human exist-
ence. In turn, these values informed the construction of the Western therapeutic enterprise.
The period of enlightenment marked a rupture between the systems of thought in the ancient
world and modern thought (Sternhell, 2010). Enlightenment thinkers exchanged religious systems
of meaning-making for rationalism and faith in scientism (Park, 2003). Indeed, this attempt to
marginalize previously accepted beliefs in the supernatural influenced Freud’s essay on what he
referred to as the ‘uncanny’ (Park, 2003). In this essay, Freud attempted to reaffirm the existence
of the supernatural from a scientific perspective (Park, 2003). As such, his psychodynamic concept
of the uncanny represents a merger of pre-enlightenment mysticism and the new age empiricism
(Park, 2003). However, consistent with enlightenment philosophers, Freud rejected religion as a
‘mass delusion’ (Abu-Raya, 2014: 332). As such, he conceptualized his psychoanalytic theories,
from which modern psychology is based, within a secular framework (Abu-Raya, 2014) with
strong ties to enlightenment thought (Park, 2003).
Husain and Hodge 395

A central assumption of the Enlightenment narrative is the notion that humans are autonomous
individuals who are able to objectively discern material reality apart from any type of metaphysical
revelation (Lyotard, 1984 [1979]). In the Enlightenment story, authority stemming from transcend-
ent spiritual sources is largely displaced and relocated in the individual (Smith, 2003). In essence,
the individual human being is seen as an island of autonomous authority in a naturalistic world
(Skinner, 2010). The transcendent is de-centered and the individual is prioritized (Jafari, 1993).
In turn, the values of individualism and secularism have informed the Western counseling nar-
rative (Jafari, 1993). Individualistically based concepts animate Western therapeutic discourse.
Concepts such as independence, self-actualization, self-expression, and explicit communication
styles that clearly express individual opinion are widely privileged in Western therapeutic dis-
course (Al-Abdul-Jabbar and Al-Issa, 2000; Smither and Khorsandi, 2009).
Likewise, secularism is assumed to be normative and reflective of mental wellness. Secular
values and perspectives are privileged in Western therapeutic discourse, often at the expense of
spiritual alternatives (Woodhead, 2008). Leading theorists in the construction of the Western coun-
seling project – including Freud (1966), Fromm (1950), and Ellis (1980) – posited that devout
theistic spirituality was associated with psychopathology. In turn, this assumption was eventually
reflected in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised
(Larson et al., 1993), despite empirical evidence indicating that devout spirituality is associated
with mental health, rather than mental illness (Koenig et al., 2012). Literature in the helping profes-
sions frequently frames Islamic and other theistic perspectives negatively (Cnaan et al., 1999;
Hodge et al., 2006). For example, a content analysis of widely used Medline database revealed that
the surveyed literature implicitly indicated that being an observant Muslim poses health risks,
Muslims are adversely affected by tradition, and correspondingly, they should reject Islamic tradi-
tion and adopt the secular Enlightenment values of modernity (Laird et al., 2007).
In addition to pathologizing Islam, the biomedical basis in which practitioners make clinical
decisions may conflict with the metaphysical complaints of Muslim patients, leading to culturally
incongruent services. According to Islamic folklore, demonic spirits such as Jinn may possess an
individual and cause illness and misfortune (Lim et al., 2015). Jinn are believed to have greater
power than humans but less power than angels (Al-Krenawi and Graham, 1999). A review of the
literature found 47 documented cases of jinn complaints among patients, including a range of
somatic and psychiatric symptoms. In all, 66 percent of these cases led to a biomedical diagnosis,
ignoring the causal explanation reported by the patients and their family (Lim et al., 2015). Other
metaphysical causes of symptomatology among Islamic adherents may include ‘consequences for
past sins, being cursed by the evil eye (envious individuals who cast a hexing glance at the subject)
or separation from the divine’ (Keshavarzi and Haque, 2013: 233). Overlooking these cultural
expressions of distress at the least may lead to feelings of incongruence with services among
Islamic adherents or at the worst, the misdiagnosis of psychosis.
The inclusion of Albert Ellis in the above list of theorists who helped construct the Western
counseling project is particularly noteworthy. Ellis is perhaps the most influential founder of con-
temporary CBT (Beck, 1976; Ellis, 1962). Ellis (1980, 2000) is also a committed atheist. As noted
above, Ellis (1980) has posited that devout religious belief fosters psychopathology. Although Ellis
(1996, 2000) has subsequently modified his theoretical perspective in light of the empirical research
on spirituality and mental health, the self-statements central to the cognitive restructuring process
reflect Enlightenment-derived assumptions that are reflective of Ellis’ atheistic belief system.
The following self-statement is representative of those constructed by Ellis (2000).
Basic to CBT is the notion that harmful schema are replaced with salutary self-statements
(Hamdan, 2008). The goal of the subsequent self-statement is to enhance a client’s ability to toler-
ate frustration:
396 International Social Work 59(3)

Nothing is terrible or awful, only at worst highly inconvenient. I can stand serious frustrations and
adversity, even though I never have to like them. (Ellis, 2000: 32)

This self-statement reflects Enlightenment-based assumptions about human functioning. It is

both individualistic and secular in nature. As the use of the word ‘I’ suggests, the individual serves
as the change engine. The statement contains no reference to family, community, or the transcend-
ent. Ultimate authority is vested in an autonomous, individual self. While these suppositions may
be consistent with individuals who affirm Enlightenment values, they are often incongruent with
Muslims who derive their values from Islamic discourse (Hodge, 2008).

Islamic values
Familiarity with the Islamic teachings and beliefs that shape and inform Islamic values is impera-
tive for practitioners. Husain and Ross-Sheriff (2011) provide an overview of the Islamic world-
view, the tenets of Islam, and the core values and the implications for social work practice. Islam
is a way of life offering guidance for both the public and private domains of the lives of Muslims
and has perceived relevance for all times. Islam teaches that Allah created all of creation to worship
Him. This duty to worship Allah is central to the lives of Muslims. A part of worshipping Allah is
to exist on earth as the stewards of Allah and to ‘struggle in life to uphold righteous speech and
conduct’ (p. 14). Together, the teachings of Allah, the five pillars of Islam, and the six articles of
faith are the foundational principles of Islamic ontology, ‘which sustains and perpetuates their
belief in Allah’ (Husain and Ross-Sheriff, 2011: 16).
In the same way that certain values are embedded in the Enlightenment narrative, the Islamic
narrative also tends to affirm certain values (Hussain, 2009). Islam provides adherents with a dif-
ferent understanding of the human story, a different suppositional framework for understanding
reality (Husain and Ross-Sheriff, 2011). As such, it affirms different norms regarding human exist-
ence, relationships, and functioning (Weatherhead and Daiches, 2010).
In some cases, values widely affirmed within the Islamic narrative are also commonly affirmed
in the Enlightenment narrative. In other cases, they differ or even conflict. For example, instead of
individualism and secularism, Islam emphasizes community and spirituality (Husain and Ross-
Sheriff, 2011). Likewise, compared to values such as independence, self-actualization, self-expres-
sion, and explicit communication styles that express individual opinion, Islam tends to affirm
interdependence, community-actualization, self-control, and implicit communication styles that
safeguard others’ opinions (Williams, 2005).
Due to the difference in values, some practicing Muslims may be uncomfortable with the use of
traditional CBT self-statements (Rathod et al., 2010). For example, some clients might feel uncom-
fortable with the concept of the individual self as the locus of authority. As implied above, many
Muslims would look to their families, the Islamic community, and, especially, to Allah. Self-
actualization is not typically viewed as the pathway to mental health in Islam (Smither and
Khorsandi, 2009). Rather, surrender of the self to Allah is assumed to foster wellness (Husain and
Ross-Sheriff, 2011). A devout Muslim’s personal narrative is grounded in Allah rather than an
autonomous self (Hamdan, 2008).
It should be noted that the importance of salutary cognitive schema is not in question. Both
Enlightenment and Islamic narratives affirm the importance of the cognitive restructuring process.
Like most other faith traditions, Islam holds that healthy cogitation plays a critical role in mental
health (Richards and Bergin, 2014; Van Hook et al., 2001). Agreement exists that mental schema
play an important role in fostering wellness.
In short, it is not the cognitive restructuring process that conflicts with the Islamic narrative;
rather, it is the value system conveyed through the restructuring process (Hamdan, 2008). The key
Husain and Hodge 397

issue is the value system reflected in CBT self-statements (Rathod et al., 2010). Thus, it is possible
to enhance the cultural congruence of the modality by modifying the self-statements to reflect
Islamic values.

Constructing Islamically modified statements

The process of constructing Islamically modified CBT statements can be understood as a three-step
process (Hodge, 2008). This process can be summarized as (1) unpacking the European Enlightenment
values in CBT self-statements that are used to convey the underlying therapeutic concept, (2) evalu-
ating the basic concept to ensure its congruence with the Islamic values affirmed by the client, and
(3) repackaging the concept in Islamic values that resonates with the client’s value system. This
process is illustrated using the above-mentioned self-statement designed to enhance toleration of
frustration: ‘Nothing is terrible or awful, only at worst highly inconvenient. I can stand serious frus-
trations and adversity, even though I never have to like them’ (Ellis, 2000: 32).

Identify key therapeutic precepts

The first step is to separate the Enlightenment values from the underlying therapeutic concept that
is posited to promote wellness (Hodge and Nadir, 2008). In other words, the essential theoretical
precept (or precepts) that promotes mental health must be identified. This step entails identifying
the fundamental therapeutic ideas the vocabulary is designed to convey.
In terms of the present example, the underlying therapeutic concept might be understood as the
notion that frustrating events and circumstances are not horrendous but a normal part of existence.
While difficult situations may not be pleasant, they are not necessarily catastrophic. Such situa-
tions are not ‘the end of the world’.

Ensure value congruence

Once the underlying concept(s) has been identified, it is possible to proceed to the next step:
assessing the therapeutic concept’s degree of value congruence with Islam (Hodge and Nadir,
2008). Indicators of mental health and/or pathology are not universal (Gilligan, 1993; Richards and
Davison, 1992). As noted in the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (American Psychiatric Association, 2013), indicators can vary from culture to culture.
Concepts that promote wellness within secular Enlightenment cultures may not foster wellness in
Islamic cultures (Hussain, 2009).
In the case of the present example, the concept is congruent with the Islamic narrative (Hodge
and Nadir, 2008). The notion that difficult situations are neither pleasant nor overwhelming is
consistent with Islamic assumptions about human existence. Indeed, the Islamic narrative directly
affirms the notion that Muslims will encounter difficult situations, but promises adherents that their
circumstances can be overcome (Abu Raiya and Pargament, 2010).

Repackage the therapeutic concept

After identifying the therapeutic concept, and ensuring the concept is consistent with Islamic val-
ues, the concept must be formatted into an Islamically congruent CBT statement (Hodge and Nadir,
2008). In other words, the precept must be repacked in terminology drawn from the Muslim cli-
ent’s Islamic narrative so that the statement is, at a minimum, consistent with the client’s value
system. The following statement illustrates one way in which the therapeutic concept discussed
above might be articulated so as to increase its degree of cultural congruence with Islamic values:
398 International Social Work 59(3)

Misfortunes and blessings are from Allah. Misfortunes are not terrible or awful, but rather a test. Although
adversities may be unpleasant, we can withstand them. Allah tells us that He will not test us beyond what
we can bear. By reminding ourselves of Allah’s goodness, and engaging in regular dua (informal prayer),
we can cope with life’s challenges. (Hodge and Nadir, 2008: 37)

This infusion of Islamic concepts provides an important new rationale for dealing with frus-
trating situations. Specifically, the Islamic statement posits that the difficult circumstances rep-
resent a test divinely ordered by Allah. In addition, the statement incorporates a crucial Islamic
teaching – that the difficulty will not exceed a person’s ability to handle the situation. In other
words, the client has Allah’s promise that perseverance – although challenging – is possible and
that the faithful Muslim will prevail. This teaching can engender hope in the midst of adverse
circumstances. Finally, the statement reminds Muslims to utilize the Islamic practice of prayer as
a way to deal with life’s challenges, implicitly reminding clients that Allah in His goodness will
help them cope with difficulties.
When modified in this manner, a limited but growing body of research suggests that such
Islamic statements can help empower Muslims overcome a variety of problems.

Research on CBT modified with tenets from Islam and traditions

Although comparatively little research has been conducted with Muslims, a small body of research
exists on the effectiveness of Islamically modified CBT (Koenig and Shohaib, 2014). Five studies
have been conducted with relatively devout Muslims in Malaysia by two research teams. These
studies explored outcomes with clients wrestling with anxiety disorders (Azhar et al., 1994; Razali
et al., 2002), depression (Azhar and Varma, 1995b; Razali et al., 1998), and bereavement (Azhar
and Varma, 1995a). A sixth study was conducted with Muslims wrestling with schizophrenia in
Saudi Arabia (Wahass and Kent, 1997).
This general approach of adapting CBT self-statements to be congruent with clients’ spiritual
narratives has also been used with a number of other cultural groups (Hook et al., 2010). For exam-
ple, CBT modified with Taoistic precepts has been used with clients wrestling with neurosis (Xiao
et al., 1998). Beliefs drawn from the Latter Day Saint (LDS) tradition have been used to treat per-
fectionism (Richards et al., 1993). A generic spirituality has been used to help clients cope with
stress (Nohr, 2000), depression (D’Souza et al., 2002, 2003), and bipolar disorder (D’Souza et al.,
2003). CBT modified with Christian beliefs has been used to address compulsive disorder
(Gangdev, 1998) and, most notably, depression (Hawkins et al., 1999; Johnson et al., 1994; Pecheur
and Edwards, 1984; Propst et al., 1992).
In light of the limited research on CBT that has been modified to incorporate beliefs and prac-
tices drawn from clients’ spiritual narratives, it is difficult to draw definitive conclusions (Tan,
2013). The present research does, however, raise the possibility of improved outcomes (Hook
et al., 2010). More specifically, the research on CBT that has been modified with tenets from Islam
and other spiritual traditions suggests that this modality may enhance a number of outcomes.

Potentially enhanced outcomes

Islamically modified CBT may enhance four outcomes when used with Muslims who are spiritu-
ally motivated (Azhar and Varma, 2000; D’Souza and Rodrigo, 2004; Propst, 1996). These four
outcomes can be summarized as follows: faster recovery, enhanced treatment compliance, lower
levels of relapse, and reduced treatment disparities. Although interrelated in nature, each outcome
is discussed separately below.
Husain and Hodge 399

Faster recovery
Adapting interventions so that they resonate with clients’ Islamic belief system may enhance moti-
vation to change (Beitel et al., 2007; Margolin et al., 2006). Although decisions to seek assistance
are often multifaceted, help is often sought when problems become unmanageable (Cohen et al.,
2007). Thus, clients are often motivated to change by their inability to manage their lives in a satis-
factory manner. In addition to this motivation, the use of Islamic themes provides a further ‘motiva-
tional language’ that can be used to encourage the implementation of CBT self-statements (Propst,
1996: 400). Creating statements that incorporate Islamic precepts can tap devout Muslims’ spiritual
motivation, as illustrated by the above Islamic statement regarding frustration (Hamdan, 2008).
Since Islamically modified CBT taps two ‘motivational engines’, faster recovery may result
(Hodge, 2008; Koenig et al., 1996). Harnessing both secular and spiritual motivations may speed
recovery by heightening clients’ desire to address the problem (Azhar and Varma, 2000; D’Souza
and Rodrigo, 2004; Propst et al., 1992). Greater client ‘buy-in’ may result, in tandem with greater
buy-in among members of a client’s family and community (Al-Abdul-Jabbar and Al-Issa, 2000;
Al-Radi and Mahdy, 1994; Banawi and Stockton, 1993; Nadir and Dziegielewski, 2001).

Enhanced treatment compliance

Treatment adherence may be increased by adapting CBT statements so that they better reflect
Muslims’ spiritual values (Beitel et al., 2007; Margolin et al., 2006). For instance, framing treat-
ment as a form of spiritual practice can help mitigate the stigma often associated with seeking
therapeutic help and even elicit support from clients’ religious communities (Azhar and Varma,
2000; Weatherhead and Daiches, 2010). Support from one’s community can enhance one’s desire
to comply with the implementation of the therapeutic protocols. The family and community ‘buy-
in’ mentioned above support compliance with the treatment since therapeutic compliance is also
viewed as compliance with the community’s spiritual beliefs and practices.

Lower levels of relapse

As success is achieved in counseling, relapse is a common problem (Piderman et al., 2007). As the
problems that caused the original decision to seek treatment become more manageable over time,
the impetus to continue implementing traditional CBT self-statements can dissipate. Conversely, if
the statements are constructed in a manner that reflects Islamic precepts, spiritually motivated
Muslims are likely to continue to implement the protocols (D’Souza and Rodrigo, 2004; Hamdan,
2008). A felt spiritual rationale continues to exist when the felt secular rationale is no longer opera-
tive (Beitel et al., 2007; Margolin et al., 2006). In turn, the implementation of such spiritually based
interventions may result in lower levels of relapse (Elsheikh, 2008; Jarusiewicz, 2000; Lau and
Segal, 2007; Sterling et al., 2007; Taub et al., 1994).

Reduced treatment disparities

Finally, the use of Islamically modified CBT may engage Muslims who would otherwise fail to
receive help. Many Muslims are hesitant to access mental health professionals due to concerns that
their Islamic values will not be respected by Western-trained therapists who are often assumed to
be guided by Enlightenment values (Hedayat-Diba, 2014; Husain and Ross-Sheriff, 2011). By
constructing CBT statements that incorporate Islamic values, therapists implicitly communicate
respect for clients’ values. Treatment disparities can be reduced as previously un-served Muslims
receive counseling services (Azhar and Varma, 2000; Bowen et al., 2006).
400 International Social Work 59(3)

It is important to emphasize that all four of these outcomes will not necessarily be experienced
by every client. Rather, they represent potential outcomes that some spiritually engaged Muslims
may experience. The following suggestions are provided to assist helping professionals implement
Islamically modified CBT statements in a manner that maximizes the potential to achieve positive
outcomes.

Implementing Islamically modified CBT statements in practice

When interacting with clients, it is important to note the diversity that exists among self-identified
Muslims (Springer et al., 2009). In addition to a substantial number of native-born converts, the
Islamic community in North America alone comprises Muslims from over 80 nations (Husain and
Ross-Sheriff, 2011). Just as no single Enlightenment narrative exists, no single Islamic narrative
exists. Rather, many individual Islamic narratives exist, each shaped by an individual’s culture of
origin, race, ethnicity, spirituality, gender, and other contextual factors such as the degree of accul-
turation with the dominant secular culture (Ross-Sheriff, 2001; Smith, 1999).
Accordingly, it is critical to work within the parameters of the client’s value system (Hodge and
Bushfield, 2006). Since no two Muslims have exactly the same value system, it is important to
understand, and work within, the confines of each client’s personal Islamic narrative. Administering
a spiritual assessment can be helpful in mapping the unique terrain of an individual’s personal
value system (Canda and Furman, 2010). Given the variety of assessment models that exist, an
assessment approach can be selected that provides the best culture fit with each client’s needs,
desires, and values.
As is the case with traditional CBT self-statements, there is no single correct method of phrasing
Islamic statements (Hamdan, 2008). Therapeutic concepts that incorporate Islamic values may be
expressed in numerous phrasings. Statements that resonate with one Muslim may not resonate with
another or even be consistent with the values of another client.
Consequently, helping professionals should work with clients to co-construct interventions that
resonate with each client’s values (Azhar and Varma, 2000; Beck et al., 2004). Building upon the
knowledge obtained during the spiritual assessment, therapists might facilitate this process by ask-
ing questions designed to help clients articulate relevant aspects of their value system (Abu Raiya
and Pargament, 2010). As pertinent Islamic beliefs and practices are identified, helping profession-
als can interface their own understanding of therapeutically relevant concepts into the discussion
(Hodge and Nadir, 2008). Tentative hypotheses regarding Islamic statements can be suggested
based upon clients’ articulation. In turn, clients are encouraged to accept, reject, or modify the
tentative working statements.
Accordingly, the actual construction process is fluid and interactive. Although the construction of
the Islamic CBT statements was presented above as a sequential process for pedagogical purposes, in
practice the construction process is more circular than linear. The therapist and the client engage in a
dialectic conversation in which therapeutic hypotheses are offered, rejected, developed, and refined
until both parties eventually converge on mutually agreed statements (Azhar and Varma, 2000).
Toward this end, therapists might familiarize themselves with the basic tenets of Islam and
cultural norms among Muslims they commonly encounter in practice settings (Abu Raiya and
Pargament, 2010; Nadir and Dziegielewski, 2001). By developing a working understanding of
basic Islamic values, they are better positioned to construct potentially relevant interventions
(Hamdan, 2008). In other words, such knowledge helps therapists collaborate with clients by
enhancing their ability to suggest potentially relevant Islamic CBT statements.
Developing collaborative relationships with local religious and community leaders can also be
helpful (Husain and Ross-Sheriff, 2011). A local Imam may be able to assist therapists identify
therapeutic concepts that are consistent with Islam. In addition, they can also help therapists convey
such concepts in spiritually precise language that can help engage clients along with members of
Husain and Hodge 401

their families and communities. Similarly, when questions arise about the nature of clients’ Islamic
beliefs and practices, collaboration with an Imam can be helpful in distinguishing between healthy
and unhealthy beliefs and practices (Abu Raiya and Pargament, 2010). While religion is typically a
source of comfort, it can also be a source of distress (Abu Raiya and Pargament, 2010). In the latter,
an individual may express conflict and/or doubt in Allah, faith, or religious relationships (Abu Raiya
and Pargament, 2010; Khan et al., 2011). Because of the centrality of religion to the lives of Muslims,
negative religious coping may be more predictive of negative outcomes than among members of
other groups (Abu Raiya and Pargament, 2010). Furthermore, stigma and social isolation may medi-
ate the relationship as religious doubts in Islamic culture may be less socially acceptable than in
other cultures (Abu Raiya and Pargament, 2010: 186).
When problems arise that require additional information, Imams can be valuable partners in
constructing interventions that respect and reflect Muslims’ cultural values. Accordingly, practi-
tioners might seek to establish working relationships with Imams in their catchment areas.
Readers interested in further information on constructing Islamically modified CBT statements
may find the following sources helpful. Hamdan (2008) delineates a number of therapeutically
beneficial statements that reflect core Islamic beliefs. Hodge and Nadir (2008) illustrate the modi-
fication process by taking a number of statements drawn from Beck and Ellis’ work and adapting
them to incorporate Islamic values. Finally, Nielsen (2004) provides a well-documented case study
that illustrates a non-Muslim therapist – trained in Ellis’ perspective – co-constructing interven-
tions with a Muslim client.

Conclusion
Therapists are increasingly likely to encounter Muslims in practice settings as this population con-
tinues to grow in Western nations (Crabtree et al., 2008; Hedayat-Diba, 2014). To work effectively
with clients who adhere to an Islamic value system, it is necessary to ensure that the modalities
used in clinical settings reflect Islamic values (Weatherhead and Daiches, 2010). As Graham et al.
(2010) observe, therapists must reformate their interventions so that they reflect Islamic values to
be effective with Muslim clients.
CBT is particularly effective (Tolin, 2010), has been used with a wide array of problems
(Dobson, 2010), and can be readily adapted to incorporate Islamic values. As such, Islamically
modified CBT might be considered a first-line therapeutic option when working with spiritually
engaged Muslims. Islamically modified CBT may lead to faster recovery, better treatment compli-
ance, lower rates of relapse, and reduced treatment disparities. Accordingly, social work practition-
ers may wish to familiarize themselves with this modality.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Author biographies
David R Hodge is Professor at the School of Social Work, Arizona State University, and Senior Nonresident
Fellow, Program for Research on Religion and Urban Civil Society, University of Pennsylvania.
Altaf Husain is Associate Professor at the School of Social Work, Howard University.

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