Culturally Adapting CBT for East Asian Youth in Ontario

Improving Access to High Quality, Culturally Relevant Treatment for East Asian Canadian Youth in Ontario

East Metro Youth Services, Hong Fook Mental Health Association, Ontario Centre of Excellence for Child and Youth Mental Health

This mixed methods study proposes a culturally adapted cognitive behavioural therapy (CA-CBT) model for an East Asian demographic in Canada. The client population of East Asian youth who have been diagnosed with anxiety and/or depression are the focus of the study. CBT has been proven as a very effective form of therapy, and when adapted can promote positive mental health outcomes for a growing and increasingly vulnerable population. Developing a culturally adapted version of CBT (CA-CBT) for this population adds a practical treatment that improves access to culturally relevant care.

There is a major lack of culturally relevant mental health services for East Asian youth in Ontario and Canada. Beginning with a participatory/qualitative research approach, common themes amongst clients, caregivers, healthcare professionals, and community leaders, will divulge basic elements needed to develop a culturally adapted model of cognitive behavioural therapy. The information from the adapted model will be taught to participating psychologists who will deliver the therapy in a randomized control trial design, with feasibility testing of the intervention using a quantitative approach ensuing. Immediate guidelines will then be developed for use by therapists working with East Asian youth.

East Asian youth diagnosed with Anxiety and/or depression will be randomly assigned to either the experimental group (receives the cultural adapted version of cognitive behavioral therapy) or the control group (non-culturally adapted cognitive behavioral therapy). It is a randomized control trial design.

The intervention will be administered by therapists working at community agencies who are experienced at providing Cognitive Behavioral Therapy.

Severity levels of depression and anxiety will be rated pre- and post-intervention by the Hospital Anxiety and Depression Scale (HADS). The scale ranges from 0 to 21 for anxiety and 0 to 21 for depression. A score of 0 to 7 for depression and/or anxiety is considered a normal range. A score of 8 to 10 suggests the potential presence of depression and/or anxiety. A score of 11 or more suggests a likely presence of depression and/or anxiety.

Severity levels of depression and anxiety will be rated pre- and post-intervention by the Bradford Somatic Inventory (BSI). The Bradford Somatic Inventory uses "yes" or "no" questions relating to somatic symptoms of anxiety and/or depression. A "yes" response to a question equates to a somatic symptom linked to depression and/or anxiety. The maximum number of "yes" responses is 46 and the minimum is 0. A higher number of "yes" responses suggests a potential increase in the severity of depression and/or anxiety.

Satisfaction of the culturally adapted Cognitive Behavioral Therapy assessed using the Verona Satisfaction Scale.

Satisfaction will be measured using the Verona Satisfaction Scale. This scale measures patients satisfaction with health care services. The items are rated by 4 categories labelled: "strongly disagree", "disagree", "agree", and "strongly agree", on a scale of 1 to 4. A higher sub-scale/domain score indicates better satisfaction. All sub-scales are summed up to compute total/domain score. This scale will be used to identify the strengths and weaknesses of the therapy service and provide guidance for further development.

Inclusion Criteria: Self identification as East Asian origin Between the ages of 12 to 21 Diagnosed as having depression and/or anxiety Exclusion Criteria: Have been affected by psychosis Have been affected by serious addiction Have been affected by cognitive impairment