Feasibility and Acceptability of Online Culturally Adapted Cognitive Behavioural Therapy for Depression and Anxiety in Canadians of South Asian Origin: A Randomized Controlled Trial: Faisabilité et acceptabilité de la thérapie cognitivo-comportementale en ligne adaptée à la culture pour traiter la dépression et l'anxiété chez les Canadiens d'origine sud-asiatique : Essai contrôlé à répartition aléatoire.

Abstract

BackgroundThis paper reports a pilot trial of culturally adapted CBT (CaCBT) for Canadian South Asians. The primary objective of this study was to assess the feasibility and acceptability of online CaCBT to treat anxiety and depression in Canadian South Asian individuals. The secondary objective was to measure changes in depression, anxiety, and disability.MethodsAn assessor-blind randomized clinical trial was conducted at 3 sites in Canada (Greater Toronto Area, Ottawa, and Vancouver). One hundred forty-six participants were randomly allocated to 1 of 2 groups: Ca-CBT (experimental group) or standard cognitive behavioural therapy (CBT) (control group) in a 1:1 ratio. The primary outcome, feasibility, was measured through engagement, recruitment, and participant retention. Acceptability was measured through the Verona Service Satisfaction Scale. Working Alliance Inventory was used to measure therapeutic engagement. Secondary outcomes included depression (Hospital Anxiety and Depression Scale-HADS), somatic symptoms (Bradford Somatic Inventory-BSI), and disability (WHO Disability Assessment Schedule 2.0 (WHODAS). Assessments were carried out at baseline, at the end of therapy (12 weeks from baseline), and at follow-up (36 weeks from baseline).ResultsWe were able to recruit participants within the given timeframe with excellent retention rates in both arms. Most participants in the intervention group, 56 (74.7%), attended ≥ 8 sessions, and 11 (14.7%) attended 5 to 7 sessions. Eight (10.7%) participants from the intervention group and 9 (12.0%) from the control group dropped out of therapy (<5 sessions). Participants in the intervention group reported higher levels of satisfaction (P = 0.001) and therapeutic engagement (P < 0.001) compared with the control group. Participants in both groups benefited from CBT.ConclusionsThis is the first report of online CaCBT for depression and anxiety for Canadian South Asians. The intervention is acceptable and feasible. Culturally adapted CBT is as effective as standard CBT in reducing the symptoms of depression and anxiety.