3 Jun 2022


Role-Playing Practice: Using the CFI to Individualize Anxiety Care

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Following the revision of the Outline for Cultural Formulation from the DSM-IV, it is now possible to conduct Cultural Formulation Interview (CFI). In engaging my partner during the CFI, the essential skills I used was following the established protocols and being culturally sensitive. Interview skills are also critical as CFI depends on the personalized interview skills to address preconceived notions about race, ethnicity, and “other” people (Diáz et al. 2017). Therefore, when conducting those interviews, it is crucial to engage the person in an objective and non-judgment approach. I tried to engage my partner objectively and did not try to judge her actions but focused on the outcome of the interview. 

The essential aspects of CFI are the focus on problem-solving, and the personal assessment of the problem one is facing. Traditional methods sought to have the assessor identify possible issues based on the judgment of the interviewer. However, with CFI, it is about self-definition and personal understanding of the problems at hand (Blevins et al. 2015). It focused on the background, identity, relationship with others, and especially the significant others, and other aspects. Documenting the answers to those questions leads to a holistic view of the interviewee. Instead of trying to understand how they are coping, the respondents provide the information. I found the approach by CFI helpful as it eliminates chances of the stereotyping others. It provides a window to understand others, how they perceive life, and the challenges they have to confront. 

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Culture is an essential component of mental health. In more egalitarian societies, such as tribal societies where responsibilities are shared, cases of mental illnesses such as depression and anxiety are low. However, in highly competitive societies, depression starts to become an issue due to the pressure of modern living, lack of jobs, the high cost of living, etc. Race and socioeconomic status play a role. Among the Latino with strong social and family bonds, people have better mental health as the group provides social insurance. Religion also plays an important role. Most religions preach the value of forgiveness and living in harmony with others. Poor mental health is sometimes the inability to forgive and integrate with the community. Religion provides an avenue for integration into the social structure, even when the family is not around. Members of the church become the family, and that positively improves mental health. 

The components described in the preceding paragraph influence mental wellbeing in many ways. Access to a large pool of friends allows the person to share their negative experiences, and that fact is cathartic. The friends offer moral support, and they advance social capital. A new person might get a job due to the networks of his or her friends within the community. However, growing in a community that is communal and where things are shared might make it harder to thrive in highly capitalistic and individualistic communities (Price & Stolk-Cooke, 2015). Such persons might suffer from poor mental health as a consequence. After reviewing my partner using CFI, I found those components influential in shaping their mental health experience. For instance, she placed great emphasis on relationships with the members of her family and certain community members. However, church attendance compensated for the social isolation she felt without a family near her. 

I used all the sections of the CFI, but I found some sections more important than others are during the engagement with my partner. The most important one was the self-assessment of their problem. In this manner, a person can describe his or her problem as they see it. Although the description of the problem can be subjective, it communicates how a person experiences the world. That experience influences their mental health status and therefore, cannot be ignored. Another aspect of the CFI is asking the person to identify what is happening to them. The question prompts the interviewee to review his life in the context of ongoing experiences to identify where the problem lies (Price & Stolk-Cooke, 2015). Most honest people can identify the genesis of their current challenges, and that provides an avenue to understand the issues troubling them. For a mental health expert, the information is invaluable when developing a program for assisting them to cope. 

CFI analyzes various aspects of the life of a person. However, it is evident that in some cases, certain elements have more influence. For instance, a person might identify the broken relationship with others as the source of the problem. In such a case, an intervention can be adjusted to suit the circumstances of the person. The questions can delve deeper into the nature of those relationships, how they have evolved over the years, possible pressures that undermined them, and similar questions to delve deeper into the problem (Anagnostopoulos & Botse, 2016). I can also customize the questions to learn more about the culture of origin so that I can place the role of family relationships in a cultural context. In cultures where strong family relationships are valued, perceived failure to maintain those relationships might negatively influence the mental health of a person. 

After gaining a deeper understanding of the person based on their circumstances, the next step is implementing interventions. The interventions differ but in the case of the broken family relationship, seeking to mend them is part of the healing process. However, if the family is not around, alternative relationships with friends and members of the church can help. On the other hand, if the problem is cultural disconnect due to differences in values, an intervention that seeks to integrate a person into a new culture can help as well (Aggarwal et al. 2014). Overall, CFI is an essential tool for identifying a specific problem and recommending the right intervention given the circumstances surrounding the person. 

DSM-5 (SCID-5) is a validation tool for persons suffering from various mental health conditions, including PSTD. Therefore, the responses collected using CFI can be validated using the tool to make sure they are standardized and reliable before treatment can commence. During treatment, the cultural considerations I made included the ethnic or racial background. Of reasons mentioned earlier, culture, race, or ethnic matters because the nature of relationships affects the mental health of the lived experience (Aggarwal et al. 2013). In such a situation, treatment has to consider mending those broken relationships. Also, if the problem is lack of integration, appropriate treatment must consider the issue as part of the treatment to improve outcomes. The patient has to feel part of the community to remain whole, and the psychologist has to assist the person in attaining wholeness. The instrument emerged due to the weaknesses of existing ones when applied to diverse populations. Thus, the instrument is validated with diverse populations and captures important elements of other instruments could not measure or identify due to their inherent weakness for a diverse population. 


Aggarwal, N. K., Nicasio, A. V., Desilva, R., Boiler, M., & Lewis-Fernández, R. (2013). Barriers to Implementing the DSM-5 Cultural Formulation Interview: A Qualitative Study. Culture, Medicine, and Psychiatry , 37 (3), 505–533. doi: 10.1007/s11013-013-9325-z 

Aggarwal, N. K., Glass, A., Tirado, A., Boiler, M., Nicasio, A., Alegría, M., … Lewis-Fernández, R. (2014). The Development of the DSM-5 Cultural Formulation Interview-Fidelity Instrument (CFI-FI): A Pilot Study. Journal of Health Care for the Poor and Underserved , 25 (3), 1397–1417. doi: 10.1353/hpu.2014.0132 

Anagnostopoulos, F., & Botse, T. (2016). Exploring the Role of Neuroticism and Insecure Attachment in Health Anxiety, Safety-Seeking Behavior Engagement, and Medical Services Utilization. SAGE Open , 6 (2), 215824401665364. doi: 10.1177/2158244016653641 

Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. Journal of Traumatic Stress , 28 (6), 489–498. doi: 10.1002/jts.22059 

Diáz, E., Añez, L. M., Silva, M., Paris, M., & Davidson, L. (2017). Using the cultural formulation interview to build culturally sensitive services. Psychiatric Services, 68 (2), 112–114. doi:10.1176/appi.ps.201600440 

Price, M., & Stolk-Cooke, K. V. (2015). Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria. Journal of Affective Disorders , 186 , 149–155. doi: 10.1016/j.jad.2015.06.012 

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