Culturally Affirming Therapy for Depression and Anxiety

(CARE Trial)

Overseen By Doris F Chang, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: New York University

Disqualifiers: Severe symptoms, Other study, Psychotherapy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 15

Duration: 15 weeks

40 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on psychotherapy, so it's best to discuss your medications with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Culturally-Affirming Racial Equity Framework for depression and anxiety?

Research shows that culturally adapted treatments, like the Culturally Focused Psychiatric consultation program, are well-received by ethnic minority groups, such as Latino Americans, and may improve engagement and satisfaction with mental health care. Additionally, cognitive behavioral therapy (CBT), which is often adapted for cultural relevance, has been effective for reducing anxiety and depression symptoms in diverse racial and ethnic groups. ^{1 2 3 4 5}

Is Culturally Affirming Therapy for Depression and Anxiety safe for humans?

The available research suggests that culturally adapted therapies, like the Culturally Focused Psychiatric consultation and the Oh Happy Day Class, are generally safe and well-received by participants from diverse backgrounds, with high satisfaction rates and no reported safety concerns. ^{1 3 4 6 7}

How is the Culturally-Affirming Racial Equity Framework treatment different from other treatments for depression and anxiety?

This treatment is unique because it incorporates cultural values and addresses racial equity, making it more effective for racial and ethnic minorities compared to traditional therapies. It adapts mental health interventions to be culturally sensitive, which can help reduce disparities in mental health care for these groups. ^{1 2 8 9 10}

What is the purpose of this trial?

The goal of this clinical trial is to learn if a new Culturally Affirming Racial Equity (CARE) intervention works to improve the cultural fit of psychotherapy for diverse populations, even when the therapist and patient do not share the same cultural background. We will refine and test the intervention with a sample of non-Asian therapists working with Asian American participants receiving short-term individual psychotherapy delivered online. The main questions the study aims to answer are: * Does the CARE framework, adapted for and delivered by non-Asian therapists, work to engage and retain Asian American participants in treatment? * Is the CARE framework associated with a) the development of a positive therapeutic relationship between non-Asian therapists and Asian American participants and b) significant improvements in participants' presenting problems? Participants will: * Receive up to 15 weekly sessions of individual psychotherapy * Complete different online surveys after every session and on a monthly basis

Eligibility Criteria

This trial is for Asian American individuals experiencing depression or anxiety who are interested in online psychotherapy. Participants should be willing to engage with non-Asian therapists using a new Culturally Affirming Racial Equity (CARE) framework and complete regular surveys.

Inclusion Criteria

Patient Participants: English-language proficient

Therapist Participants: 2+ years of clinical experience post-licensure

Patient Participants: Willingness to have sessions videorecorded and complete online assessments

Exclusion Criteria

Therapist Participants: Licensure violations or enforcement actions as documented on the New York State Office of the Professions website https://www.op.nysed.gov/

I am not currently in another study or receiving psychotherapy from another provider.

My symptoms are severe and cannot be managed with short-term online treatments.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive up to 15 weekly sessions of individual psychotherapy using the CARE framework

15 weeks

15 visits (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments of depression and anxiety

3 months

Monthly assessments

Treatment Details

Interventions

• Culturally-Affirming Racial Equity Framework

Trial Overview The study tests if the CARE intervention helps improve therapy outcomes when therapists and patients have different cultural backgrounds. It involves up to 15 weekly online sessions, aiming to enhance therapist-client relationships and reduce symptoms of depression and anxiety.

Participant Groups

Group I: Culturally Affirming Racial Equity (CARE) framework Experimental Treatment 1 Intervention

In this single-arm study, all participants will receive the CARE protocol, which includes a) 3-4 session protocol aimed at cultivating the cross-racial/cross-cultural therapeutic alliance, b) therapist and patient collaboration on a case formulation and treatment plan, c) evidence-based approaches to treating the presenting problem, d) alliance-focused training to address ruptures, and e) cultural case consultation.

Who Is Running the Clinical Trial?

New York University

Lead Sponsor

Trials

249

Recruited

229,000+

Findings from Research

In a study comparing treatment outcomes of cognitive behavioral therapy (CBT) for participants of color (n = 43) and White participants (n = 136), there were no significant differences in treatment retention or symptom outcomes, indicating that CBT is equally effective across these groups.

Participants of color, including Black, Latinx, and Asian American individuals, showed moderate to large improvements in anxiety and depression symptoms after CBT, suggesting that this treatment is effective for historically excluded racial and ethnic groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of People of Color in an Efficacy Trial of Cognitive-Behavioral Treatments for Anxiety, Depression, and Related Disorders: Preliminary Evidence. Cardona, ND., Ametaj, AA., Cassiello-Robbins, C., et al.[2023]

Suicide rates among youth of color are highest before age 30, and existing prevention strategies often overlook the role of structural racism in creating disparities in mental health service access and effectiveness.

The authors propose a new framework that highlights how structural racism affects suicide prevention across mental health services, schools, and crisis care, and they recommend comprehensive interventions to address these systemic issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. Alvarez, K., Polanco-Roman, L., Samuel Breslow, A., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Outcomes of People of Color in an Efficacy Trial of Cognitive-Behavioral Treatments for Anxiety, Depression, and Related Disorders: Preliminary Evidence. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Treatment of culturally diverse children and adolescents with depression. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Evaluating patient acceptability of a culturally focused psychiatric consultation intervention for Latino Americans with depression. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Comparative effectiveness of standard versus patient-centered collaborative care interventions for depression among African Americans in primary care settings: the BRIDGE Study. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Cultural competence and evidence-based practice in mental health services: a complementary perspective. [2009]

6. United States pubmed.ncbi.nlm.nih.gov

A culturally adapted depression intervention for African American adults experiencing depression: Oh Happy Day. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

A systematic review of depression psychotherapies among Latinos. [2022]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. [2018]

9. United States pubmed.ncbi.nlm.nih.gov

A critical review of culturally sensitive treatments for depression: recommendations for intervention and research. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. [2022]