Views on a Culturally Safe Psychotherapeutic Treatment by Inuit in Quebec: Co-Design of Cognitive Behavioral Therapy Manual and Virtual Exposure Environments

Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide culturally safe and remotely delivered emotion regulation interventions. We conducted a co-design process of a CBT treatment manual and complementary VR environments for the Inuit populations from Nunavik. Here, we describe the knowledge gained during the adaptation process on the approach to mental well-being and psychotherapy. We followed qualitative, participatory, and research co-design methods. After an initial concept of VR-CBT, an advisory group made up of 7 adults identifying as or working with Inuit participated in 4 focus group meetings. A thematic analysis of the discussions was carried out. A non-symptom-focused approach with the therapist guiding the individual in empowerment and emotion management was accepted in the advisory group, replacing a symptom-focus. Several CBT in- and between-session techniques were seen critically or rejected, and time for working on a certain theme was increased. Some elements in the proposed landscape were rejected as unsafe, other elements added as culture-specific to increase safety. Future work should confirm broader acceptance and utility. Culturally specific factors play an essential role in acceptance of concepts and approaches used in psychotherapy. Accordingly, they can have an impact on acceptance and attendance in therapy.