Protocol for a multi-phase, mixed methods study to develop and evaluate culturally adapted CBT to improve community mental health services for Canadians of south Asian origin

Abstract Background Canadians of South Asian (SA) origin comprise the largest racialized group in Canada, representing 25.6% of what Statistics Canada terms “visible minority populations”. South Asian Canadians are disproportionately impacted by the social determinants of health, and this can result in high rates of mood and anxiety disorders. These factors can negatively impact mental health and decrease access to care, thereby increasing mental health inequities. Cognitive Behavioural Therapy (CBT) in its current form is not suitable for persons from the non-western cultural backgrounds. Culturally adapted Cognitive Behavioural Therapy (CaCBT) is an evidence-based practice. CaCBT is more effective than standard CBT and can reduce dropouts from therapy compared with standard CBT. Thus, CaCBT can increase access to mental health services and improve outcomes for immigrant, refugee and ethno-cultural and racialized populations. Adapting CBT for growing SA populations in Canada will ensure equitable access to effective and culturally appropriate interventions. Methods The primary aim of the study is to develop and evaluate CaCBT for Canadian South Asian persons with depression and anxiety and to gather data from stakeholders to develop guidelines to culturally adapt CBT. This mixed methods study will use three phases: (1) cultural adaptation of CBT, (2) pilot feasibility of CaCBT and (3) implementation and evaluation of CaCBT. Phase 1 will use purposive sampling to recruit individuals from four different groups: (1) SA patients with depression and anxiety, (b) caregivers and family members of individuals affected by anxiety and depression, (c) mental health professionals and (d) SA community opinion leaders. Semi-structured interviews will be conducted virtually and analysis of interviews will be informed by an ethnographic approach. Phase 2 will pilot test the newly developed CaCBT for feasibility, acceptability and effectiveness via quantitative methodology and a randomized controlled trial, including an economic analysis. Phase 3 will recruit therapists to train and evaluate them in the new CaCBT. Discussion The outcome of this trial will benefit health services in Canada, in terms of helping to reduce the burden of depression and anxiety and provide better care for South Asians. We expect the results to help guide the development of better services and tailor existing services to the needs of other vulnerable groups. Trial registration ClinicalTrials.gov NCT04010890. Registered on July 8, 2019

Download Full-text

Transforming mental health services: a participatory mixed methods study to promote and evaluate the implementation of recovery-oriented services

Implementation Science ◽

10.1186/s13012-014-0119-7 ◽

2014 ◽

Vol 9 (1) ◽

Cited By ~ 20

Author(s):

Melissa M Park ◽

Hiba Zafran ◽

Janet Stewart ◽

Jon Salsberg ◽

Carolyn Ells ◽

...

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Mental Health Services ◽

Health Services ◽

Mixed Methods Study

Download Full-text

Nature: the cure we've been looking for

10.24124/2021/59143 ◽

2021 ◽

Author(s):

◽

Sarah Knowles

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Group Therapy ◽

Health Services ◽

Effective Treatment ◽

Behavioural Therapy ◽

Context Information ◽

Ethical Concerns ◽

Cognitive Behavioural ◽

Western Psychology

Nature-based therapy is a therapeutic lens that utilizes nature as a co-therapist. This approach addresses the disconnect between land and people, a disconnect that negatively impacts the mental health of many of those seeking mental health services. Consequently, this approach is now considered an effective treatment for youth and is used as a standalone approach or integrated with cognitive behavioural therapy, gestalt, or group therapy. In either case, this nature-based lens provides a bridge between traditional Indigenous practices and Western psychology. My project highlights various activities and ideas in order to incorporate nature into one’s practice as a therapist, specifically within a northern context. Information regarding benefits, ethical concerns and various types of nature-based therapy will be discussed and guide the development of the manual. The guidebook will assist those interested in nature therapy by creating a place where tangible and realistic ideas for how to incorporate it into practice are located.

Download Full-text

Cognitive Behavioural Therapy for Anger Management: Effectiveness in Adult Mental Health Services

Behavioural and Cognitive Psychotherapy ◽

10.1017/s135246580600333x ◽

2006 ◽

Vol 35 (02) ◽

pp. 201 ◽

Cited By ~ 6

Author(s):

Katherine E. Bradbury ◽

Isabel Clarke

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Cognitive Behavioural Therapy ◽

Anger Management ◽

Behavioural Therapy ◽

Management Effectiveness ◽

Adult Mental Health ◽

Cognitive Behavioural

Download Full-text

Stakeholder perspectives on integration of mental health services into primary care: a mixed methods study in Northern Iraq

International Journal of Mental Health Systems ◽

10.1186/s13033-019-0330-7 ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Amanda J. Nguyen ◽

Natalie Rykiel ◽

Laura Murray ◽

Ahmed Amin ◽

Emily Haroz ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mixed Methods ◽

Mental Health Services ◽

Health Services ◽

Mixed Methods Study ◽

Working Environment ◽

Government Support ◽

Northern Iraq ◽

Stakeholder Perspectives

Abstract Background Integrating evidence-based mental health services into primary care has been identified as one strategy for overcoming the treatment gap in low and middle-income countries, yet their uptake into standard practice remains poor. The purpose of this study was to understand stakeholder perspectives regarding barriers and facilitators to integration of mental health services into primary care settings in Northern Iraq. Methods Using a convergent mixed methods study design, quantitative and qualitative questionnaires assessed respondent perceptions of implementation factors under the domains of Autonomy, Acceptability, Appropriateness, Feasibility, Penetration/Accessibility, Sustainability, and Organizational Climate. We interviewed four types of stakeholders: clients, providers of mental health services, non-mental health (MH) staff working at the centers, and center directors. Interviews were conducted with clients at the completion of services, and with all other stakeholder groups in the latter half of the first year of program implementation, by Kurdish-speaking interviewer pairs. Qualitative and quantitative data were analyzed separately and merged using qualitative data transformation to quantify frequency of theme and integrate with quantitative findings through woven narrative. Results 123 clients, 26 providers, 40 non-MH staff, and 12 directors provided data. Positive perceptions of the program’s acceptability, appropriateness, feasibility, and positive impacts were reported across all stakeholder levels. Providers reported that the program length (8–12 sessions) was a challenge. Clients described logistical challenges (e.g.: transportation, childcare, home duties); support from family and friends appeared to be critical. Lack of private space, insufficient staffing, and need for greater government support were also important issues. Conclusions This mixed methods study is unique in its inclusion of non-MH staff and director perspectives on integration of mental health services in primary care clinics. Their inclusion proved vital since they included critical human resource barriers to feasibility. Providers reported generally positive integration experiences but that some colleagues (clinic staff not involved in mental health services) were unsupportive. Most non-MH staff were supportive, but some did report negative impacts on their working environment. Future studies of integration of mental health services into other service platforms should include the perspectives of stakeholders not involved in provision of mental health services.

Download Full-text

Promoting recovery-oriented practice in mental health services: a quasi-experimental mixed-methods study

BMC Psychiatry ◽

10.1186/1471-244x-13-167 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 53

Author(s):

Helen Gilburt ◽

Mike Slade ◽

Victoria Bird ◽

Sheri Oduola ◽

Tom KJ Craig

Keyword(s):

Mental Health ◽

Mixed Methods ◽

Mental Health Services ◽

Health Services ◽

Mixed Methods Study ◽

Quasi Experimental

Download Full-text

Are Depressed Adolescents Routinely Offered CBT? A Brief Review of Current Practice

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465807003979 ◽

2007 ◽

Vol 36 (1) ◽

pp. 113-117 ◽

Cited By ~ 3

Author(s):

Gill Ross ◽

Chris Brannigan

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Adolescent Depression ◽

Behavioural Therapy ◽

Postal Questionnaire ◽

Evidence Based ◽

Empirically Supported ◽

Cognitive Behavioural ◽

Research Findings

AbstractAn increasing body of research in support of cognitive-behavioural therapy (CBT) for adolescent depression has emerged during the last two decades. However, it has been suggested that empirically supported treatments are seldom carried out in clinical practice. Although the reasons for this are likely to be diverse, it is argued that mental health services have an ethical responsibility to offer evidence-based interventions. Whether empirically supported interventions, such as CBT, are consistently offered to depressed adolescents attending Child and Adolescent Mental Health Services (CAMHS) is currently unknown. A primary aim of this study was to survey the use of CBT for depression in a number of United Kingdom (UK) CAMHS settings. A postal questionnaire was sent to 117 members of the BABCP Children, Adolescents and Families Special Interest Branch, of which 44 completed questionnaires were returned. Descriptive statistics indicate that just over half of the organizations represented routinely offered CBT to depressed adolescents. CBT practice and the transportation of evidence-based research findings to CAMHS settings are discussed.

Download Full-text

Status of Computerized Cognitive Behavioural Therapy for Adults

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048670601109873 ◽

2007 ◽

Vol 41 (2) ◽

pp. 95-114 ◽

Cited By ~ 88

Author(s):

Nickolai Titov

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Cognitive Behavioural Therapy ◽

Cost Effective ◽

Behavioural Therapy ◽

Treatment Delays ◽

Cognitive Behavioural ◽

Key Issues ◽

Considerable Work

A growing body of evidence supports the efficacy of computerized cognitive behavioural therapy (CCBT). This technology has the potential to increase the capacity of mental health services, and to overcome some of the barriers to accessing mental health services, including stigma, traveling time for rural patients, treatment delays, and the low availability of skilled clinicians. This review discusses key issues around the implementation of CCBT in current mental health services, and summarizes recent evidence for the efficacy of CCBT in anxiety and depression. Many CCBT systems exist, and the evidence for each varies in quality and quantity. It is concluded that CCBT, particularly guided by a therapist, represents a promising resource. However, considerable work needs to be done to develop CCBT techniques that are appropriate to Australasian populations, acceptable to patients and clinicians, easy to use, and are clinically and cost effective. Suggestions are made for further research and useful website addresses are provided to assist clinicians in familiarizing themselves with CCBT.

Download Full-text