How Can Culturally Specific Mental Health Interventions Improve Treatment Outcomes?

Do psychological treatments work equally well across all cultures and ethnicities? Some evidence from clinical studies suggests that they may not. Mental health interventions developed in primarily European cultural frameworks and tested in majority-white populations might not always be as effective for people from other backgrounds. To address this issue, clinicians and researchers are investigating the possibility that adapting mental health treatment to account for sociocultural differences might improve their effectiveness. 

Efforts to develop culturally specific mental health interventions are still in their early stages. Although they’ve shown reliable effectiveness compared to treatment as usual, it’s not yet clear if they work better than existing evidence-based therapies. Still, some trials suggest that culturally adapted interventions conducted by licensed therapists might lead to better treatment adherence and beneficial outcomes for some patients. 

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Why use culturally specific mental health treatments?

Decades of psychological research have identified several kinds of evidence-based psychotherapy that show significant positive effects on a variety of mental health conditions. They’ve repeatedly demonstrated effectiveness in randomized clinical trials for symptoms of depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, substance use disorder, and other disorders.

However, some emerging evidence suggests that these practices might not be equally effective for all types of clients. For example, a 2023 research review found that cognitive-behavioral therapy (CBT)—widely considered the “gold standard” of evidence-based mental health care— in ethnic minorities than in white individuals. Although these differences don’t rise to the level of statistical significance, their appearance suggests that they may represent some genuine differences in effectiveness.

There are several ways that current psychological treatment approaches may be less effective when applied to people of diverse cultural backgrounds:

Racial and cultural bias in diagnosis

Inaccurate diagnoses can compromise the effectiveness of treatment since mental health professionals may offer misguided recommendations or overlook relevant symptoms. In some cases, this can prevent people from receiving potentially effective treatments, such as ADHD medication for minority youth misdiagnosed with conduct disorders.

Microaggressions in treatment

A therapist with a limited understanding of the client’s culture may make incorrect assumptions or suggestions during the treatment process. They may misinterpret a patient’s needs or suggest life strategies that don’t make sense for the person’s background. 

Incidents like these can cause individuals to feel misunderstood, belittled, or dismissed. This can disrupt the therapeutic alliance—the sense of trust and cooperation between therapist and client—which research suggests can be a significant driving factor of treatment effectiveness.

Culturally preconditioned treatment approaches

Treatment approaches like CBT were developed in a primarily Western cultural context. Their methods of fostering change and assessing mental health outcomes may be specific to the values and assumptions that come with this background. Potential examples include:

• Differences in treatment goals. Traditional psychotherapeutic methods may aim at goals that seem less valuable to certain clients. For instance, some cultures place greater emphasis on community and collectivism, and people from these backgrounds may care more about relationship maintenance than individual self-actualization.
• Lack of awareness of culture-specific symptoms. Some mental health disorders, known as culture-bound syndromes, appear only in people from a specific cultural group. Clinicians who aren’t familiar with these conditions may fail to recognize them or may not know how to treat them. Even more widespread conditions, like depression, may differ in reported symptoms across cultural groups.
• Effectiveness of different treatment strategies. Many things that Westerners may take for granted about psychology may not be universal across cultures. For example, some research suggests that emotion suppression may be more adaptive in parts of the world where harmony is valued more highly. 

Are culturally adapted therapies effective?

Treatment providers have developed several ways to adjust psychological interventions to address the mental health needs of minority communities. These updated therapeutic modes are typically referred to as “culturally adapted” therapies. 

In most cases, cultural adaptation does not involve creating a totally new psychotherapeutic approach. Instead, mental health professionals usually adapt their practice of existing techniques, such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), to account for culture-specific factors. 

There’s not yet a scientific consensus on the effectiveness of specific types of adaptation. A 2018 meta-analysis of existing research concluded that there is value in adaptation, but there have not been enough studies comparing culturally adapted therapies to traditional methods to draw firm conclusions. While it seems clear that these therapies can and do produce significant reductions in symptoms, it may be too early to say whether they work better than standard evidence-based treatment. 

How to find a culturally responsive therapist

What can you do if you’re experiencing mental health concerns but you’re concerned that traditional therapeutic approaches may clash with your cultural background? Here are a few strategies that may help you find a provider with whom you work well.

Ask for a referral

One of the most common ways to get in touch with a mental health provider is to request a referral from your primary care provider. If you go this route, you can explain to your doctor that you’d like to work with a therapist who’s experienced in navigating intercultural issues or working with people from your background. 

You might also consider asking members of local community organizations, clergy members in your religious congregation (if applicable), or other people within your cultural context for recommendations of trusted mental health providers. 

Search provider databases

Many professional organizations, nonprofit groups, and government agencies maintain searchable directories of practitioners or facilities offering mental health services. These tools may enable you to find a wide range of therapists with relevant experience. They may also provide information you can use to get a sense of each provider’s approach to therapy (such as provider bios or client reviews). 

Examples include:

• APA Psychologist Locator: Maintained by the American Psychological Association, this tool allows you to filter search results for providers who specialize in treating people of your nationality, ethnicity, religion, age group, and more.
• ADAA Find Your Therapist: This directory from the Anxiety & Depression Association of America may help you narrow your search by specific languages spoken and populations treated, such as various ethnicities and LGBTQ+ individuals.
• FindTreatment.gov: This locator tool from the Substance Abuse and Mental Health Services Administration (SAMHSA) can help you search for mental health facilities on a wide variety of parameters, including language services.

Ask relevant questions

You might consider treating your search for a mental health provider a bit like you’re interviewing candidates for a job. Rather than simply accepting the first qualified person, you can ask them some pertinent questions. Possible examples include:

• What’s your experience with these types of mental health conditions? What kinds of outcomes have past clients had?
• How would you describe your approach to treating someone with a different cultural framework from yours?
• What kinds of therapy are you certified to provide?
• Have you ever treated someone from my background before? If so, can you describe the experience and outcomes?

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Paying attention to how they answer these questions may help you gauge whether you’d feel comfortable receiving treatment from this person. 

Consider online therapy

Your options when it comes to looking for a culturally competent therapist may be somewhat limited depending on factors like where you live and what your schedule allows. An online mental health intervention might be a better option than in-person treatment. Internet therapy platforms typically offer a large pool of mental health professionals and can pair you with one based on your specific requirements. 

Online therapy is backed by a growing body of clinical evidence. A 2019 paper examining prior studies of this type of therapy found that it was convenient and effective for symptoms of common mental disorders like anxiety and depression.