TORONTO, March 7, 2023 – Culturally adapted cognitive behavioural therapy (CaCBT) is a more effective treatment for people of South Asian origin experiencing depression and anxiety, and should be implemented countrywide.
This is a key conclusion from new research entitled Culturally Adapted Cognitive Behavioural Therapy for Canadians of South Asian Origins released today by the Centre for Addiction and Mental Health (CAMH) alongside the Mental Health Commission of Canada (MHCC) and community partner organizations nationwide. Offered with the research report are training resources for mental health professionals of all backgrounds on how to implement the newly developed culturally adapted mental health treatment for South Asian people, as well as supplementary information for patients and mental health professionals.
There are 2.6 million people of South Asian origin in Canada, representing seven percent of the population and the country’s largest racialized group. This population has a higher rate of anxiety and mood disorders, but is also 85 per cent less likely to seek treatment due to many factors, including socioeconomic disparities, cultural differences and stigma.
When treating depression and anxiety, many therapists will turn to cognitive behavioural therapy (CBT), an evidence-based psychological treatment that focuses on changing people’s negative thoughts and beliefs. However, CBT was developed in a Western context, and has proven to be not as effective with those of different backgrounds. In 2019, CAMH received funding from the Health Canada Health Care Policy Contribution Program to develop, test and evaluate new mental health supports for South Asian populations in Canada. CAMH also worked closely with partners MHCC, Moving Forward Family Services (Vancouver), Ottawa Newcomer Health Centre (Ottawa) and Punjabi Community Health Services (Greater Toronto Area) as part of this initiative.
“CBT is the most popular form of evidence-based therapy that exists,” Principal Investigator Dr. Farooq Naeem, CAMH Clinician Scientist at the Campbell Family Mental Health Research Institute. “This new culturally adapted CBT also takes into account a person's cultural background and is modified to better fit the patient's beliefs, language, and cultural context. This study found that in terms of acceptance and effectiveness, culturally adapted CBT works even better for this population.”
As part of the study, researchers first met with various members of the South Asian community (including those diagnosed with depression and anxiety, their families/caregivers, community leaders and more) to better understand beliefs, experiences and opinions about mental health, illness and treatment within that population. All the data was then used to create a new culturally adapted CBT protocol and training manual for therapists. In order to test the new approach, 146 participants of South Asian origin were randomly assigned to receive 8-12 sessions of standard or the specialized CaCBT. Finally, 29 therapists of various racial and ethnic backgrounds received the training and provided feedback on their experiences.
Participants who received CaCBT reported lower levels of mental illness symptoms and higher self-reported overall health than those receiving standard CBT. The number of mental health visits to a psychiatrist, psychologist and other medical doctors was also significantly lower in the CaCBT group, indicating that expanding this therapy more widely in Canada could reduce strain on the healthcare system. The research team is currently seeking government funding for a national training program of clinicians in CaCBT based on the training created for this study.
“One of the important things about this work and the training available in CaCBT for the South Asian population—or indeed the Caribbean origin population through the CAMH Health Equity Department—is it signals to therapists that we cannot use simple one-size-fits-all treatments in a diverse country like Canada,” said Co-Principal Investigator Dr. Kwame McKenzie, Director of Health Equity at CAMH. “We sometimes need different interventions for different groups of people. Equity requires therapeutic flexibility.”
The researchers stress that CaCBT does not have to be administered by a therapist with the same cultural background as the patient to be effective. One participant in the study who had tried therapy in her native Pakistan without success found the CaCBT treatment she received from a non-South Asian therapist so beneficial that she continued to seek treatment from that therapist after the study period ended.
“CAMH was a pioneer in this work and now leads nationally and internationally in the study and implementation of CaCBT among several populations,” added Dr. Naeem. “As a diverse country with an ongoing mental health crisis, we need options for care that honour people’s cultural values, beliefs and life experiences. We are proud to offer today proven, effective mental health care resources that can make a real impact for millions of people Canada-wide.”
“When I started I did not even know if I needed this type of therapy. Now that I have gone through this program I know that this works way better than any other therapy I have tried. It’s a process and the journey continues, but I definitely feel more like myself than before I started this therapy.”
- Sidra Mobin, Study Participant
“As a child of refugee parents, I always saw that there were huge gaps in treatment for racialized populations in Canada. This training made me a better therapist and opens me up to a wider range of clients. Now that more people are opening themselves up to therapy, we have to be prepared to see everybody and not just one type of client.”
- Helen Yohannes, Registered Psychotherapist
“The results from this study highlight the value of culturally-competent mental health supports in reducing the stigma around mental illness and barriers to care in South Asian and other equity-deserving communities. As we work with provinces and territories to enhance our universal health care system, our government will continue doing whatever it takes to ensure that all people in Canada have the mental health and substance use supports they need to sustain their well-being.”
- The Honourable Carolyn Bennett, P.C., M.P., Minister of Mental Health and Addictions, and Associate Minister of Health
- Michel Rodrigue, President and CEO, Mental Health Commission of Canada
“Punjabi Community Health Services (PCHS) is pleased to be a part of this project. This project engaged the South Asian community to look at the applicability of cognitive behavioural therapy as a modality for intervention to support mental health. I am pleased that we are able to adapt the CBT model to make it more acceptable to the nuances of the South Asian community. We look forward to its application within our agency.”
- Baldev Mutta, Chief Executive Officer, PCHS
Watch a video featuring our partners Moving Forward Family Services, Ottawa Newcomer Health Centre and Punjabi Community Health Services on the value of these CaCBT resources for South Asian communities.