1. Dr. Priscila Chacon, Departamento de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo
2. Dr. Alice de Mathis, Departamento de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo
3. Dr. Juliana Negreiros, R. Psych., Postdoctoral Fellow, Department of Psychiatry, University of British Columbia, Provincial OCD Program, B.C. Children's Hospital
Obsessive-Compulsive Disorder (OCD) is a psychiatric illness that affects people worldwide. Despite some research showing that the manifestation of OCD across cultures may be different in terms of symptom expression, obsessive cognitions, and other issues (Williams & Steever, 2015), cognitive-behavioral therapy (CBT) is a universally used evidence-based approach to treating OCD. Although using such protocol may increase the likelihood of achieving positive treatment outcomes, cultural differences may also present as barriers to reach treatment success. Based on the authors’ clinical experience, this text highlights a potential cultural challenge to treating OCD in Brazilian patients.
Sadly, both in North America and Brazil, individuals with OCD have limited access to OCD-trained treatment providers. Among those OCD-affected Brazilians who are able to access evidence-based treatment, not all experience a significant decrease in their OCD symptoms. Anecdotally, a common (and interesting) factor that seems to interfere in the treatment stems from the unique way that Brazilians interact with high cost of responses and the delay of reinforcement of contingencies (Fernandes, Perallis and Pezzato., 2015), known as the “jeitinho brasileiro” (or “the Brazilian way of doing things”). Generally, Brazilians are inclined to solve difficult problems that may result in unpredicted and adverse events in a special, efficient, and fast way (“jeitinho brasileiro”). The aim is to reach short-term goals regardless if the solution is “final, provisional, ideal, legal, or illegal.” (Barbosa, 2006, p. 41). While this specific cultural behavior pattern can be an immediate, useful and often advantageous solution to a problem, especially for those who have their behavior reinforced, in the long run, it may also be harmful for the group as a whole (e.g., corruption) and, in our opinion, negatively influence treatment outcomes.
In CBT protocols, practicing exposures outside the therapy session is a key component of the treatment. However, we often observe Brazilian families having a very hard time following through homework assignments. It is possible that Brazilian patients may be resistant to completing homework due to their difficulty foreseeing the long-term benefit of experiencing momentary discomfort that does not lead to immediate improvements of their OCD symptoms. As psychologists, our strategy to address the “jeitinho brasileiro” in therapy is to develop a good rapport and work on patient’s ability to accomplish homework in order to generalize the gains they make at the clinic across settings, people, and/or situations. Indeed, homework completion can be a challenge faced by any individual regardless of his or her cultural background. However, we would like to bring light to this cultural phenomenon that seems to be an additional barrier to effectively treating OCD-affected individuals in Brazil.