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Internet Interventions Worldwide: Considerations for Cultural Adaptations

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    October 30, 2018

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    psychological services, online evidence-based treatments, mental health gap, clinical blog

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Considerations for cultural adaptations 2

by Alicia Salamanca-Sanabria, M.Sc PhD

Mental disorders (e.g. anxiety, depression) are highly prevalent in all regions around the world, with an upward trend in Low-Middle-Income Countries (LMICs). 

For the most part, there is good availability of psychological treatments and mental health services in high-income countries (HICs) (e.g. UK, Australia). Whereas in LMICs most people who need mental health services do not receive any, this is known as the ‘mental health gap’. For instance, the World Health Organisation estimated that between 76-85% of the people with severe mental health problems receive no treatment at all in LMICs. Therefore, internet interventions may be a valuable resource to reduce the treatment gap, thus ameliorating social health inequalities between regions. Additionally, there is little knowledge of emerging Internet-based interventions in such countries and also in culturally and linguistically diverse populations.

SilverCloud Health has started to implement internet-interventions in low middle-income countries. This year a study in Colombia has finalised with the programme “Space from depression”, demonstrating to be efficacious with this population. The study was the first experience in South America, showing the importance of cultural adaptations when translating and tailoring interventions to help achieve similar results to those programmes that have been achieved in high-income countries.

Generally speaking, psychotherapy is influenced by context and history in Western countries. However, studies have shown that mental illness is understood differently across cultures. For instance, there is evidence that South American and Eastern countries may express depression by somatic symptoms (e.g. a headache, digestive problems) and Europeans through cognitive symptoms (e.g. beliefs, thoughts).  Therefore, context shapes the ways in which mental disorders are expressed. The influence of culture, therefore, provides the foundation in mental illness, which is a consideration to develop culturally sensitive interventions.

Carrying out cultural adaptations in the context of treatment outcome studies presents an opportunity to advance knowledge on how psychotherapy works in terms of including a broader perspective of the client (e.g., cultural ideas of mental illness) and to match core components of the intervention to cultural expectations. Cultural adaptation of internet-interventions may be a valuable route to promoting mental health and preventing mental health disorders around the world, especially in countries that do not have developed infrastructure to deliver healthcare.

It is therefore important that we consider cultural adaptations as an important next step to establish the efficacy of internet-interventions in different populations. Cultural differences may facilitate the engagement in treatment and can be related to the efficacy of the intervention.


About the Author

AliciaAlicia Salamanca Sanabria is a researcher and clinical psychologist with a broad interest in psychotherapeutic processes including psychological assessment, psychopathology, cognitive behavioural therapy, internet-delivered treatment, depression, anxiety and methods to develop culturally adapted psychotherapy.  Alicia developed an approach to implement a culturally adapted internet-delivered treatment for Colombians with the SilverCloud programme “Space from Depression”.   Alicia has finished her PhD in Trinity College Dublin, she is a researcher in SilverCloud Health and she is member of the e-mental health research group in Trinity College Dublin.

For a list of Alicia’s publications visit:




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