Scaling Up Effective Psychotherapy for Women and Canadians of South Asian Descent

Two professors in the University of Toronto’s Department of Psychiatry have new funding to test innovative ways of bringing proven psychotherapies to more people.

Daisy Singla is leading a large clinical trial that will test whether nurses can provide talk-based mental health care for new and expecting mothers as effectively as psychiatrists and other specialists.

Farooq Naeem has received a grant from Health Canada to conduct a trial of culturally adapted Cognitive Behavioural Therapy (CBT) to determine if it has better outcomes than regular, unadapted CBT. He is a professor of Psychiatry at U of T, and chief of general adult and health systems psychiatry at the Centre for Addiction & Mental Health.

“Psychotherapy is a powerful tool for treating mental illness, but most people in Canada cannot access it,” says Benoit Mulsant, Labatt Family Chair and Professor in the Department of Psychiatry at U of T. “These studies will help address access to effective care for women in the perinatal period and Canadians of South Asian descent.”

Singla’s research will help address this issue by assessing how telemedicine compares to in-person treatment, and it could provide evidence to expand access to a proven treatment for pre- and postpartum anxiety and depression, which affect up to one in five women in Ontario.

About 80 per cent of women who need care for these conditions do not have access to it, often due to a shortage of specialists. The trial will target women’s mental health through Behavioural Activation (BA), a talk therapy that aims to increase enjoyable and fulfilling activities that can be delivered weekly in as few as six sessions.

Singla and her collaborators are supported by US$13.2 million from the Patient-Centered Outcomes Research Institute (PCORI), and will start enrolling over 1,300 participants in and around Toronto, North Carolina and Illinois early in 2020.

Read a Q&A with Professor Singla about her new clinical trial.

Naeem is very familiar with the challenges people face when trying to access psychotherapy. He has worked to promote low-intensity Cognitive Behavioural Therapy as a cost-effective way to improve access for Canadians. He has also explored how to adapt CBT to better serve individuals from different cultural backgrounds, at home and abroad.

Naeem’s new project is funded by $1 million from Health Canada and aims to demonstrate the effectiveness of culturally adapted CBT in Vancouver, Ottawa and Toronto.

CBT is an evidence-based, focused form of psychotherapy that offers patients a way to identify and modify unhelpful thoughts. The benefits of CBT are well-documented, but like most psychotherapies it was developed in the West, and has been shaped by Western values. Culture plays an important role in shaping how we think, so if a therapist doesn’t understand a patient’s culture, it can be difficult to understand the patient’s unhelpful thought patterns.

The new study will provide CBT to Canadians of South Asian descent. One group will receive an adapted form of CBT from therapists trained to work in a South Asian cultural context, while the other will receive standard CBT; Naeem and his colleagues will compare the outcomes of both groups.

“With this work, we’re taking a leadership role in North America,” says Naeem. “We hope to prove that culturally adapted CBT produces better outcomes, and provide evidence of the benefits of culturally adapted CBT for people of non-western backgrounds.” This evidence could play an essential role in convincing governments to fund the creation and implementation of culturally adapted CBT programs.

Singla’s study will soon provide therapy to perinatal women, testing if non-specialists and telemedicine can deliver effective care to mothers who need it. Naeem’s model of cultural adaptation has been used in South Asia, England, China, Morocco and the Middle East; if successful, his new study could lead to major changes to CBT practice in North America.

Together, their projects are bringing to light the challenges people face when they seek help for mental health, and paving the way for a future where psychotherapy is more available to all those who need it.