Cultural differences in psychotherapy: implications for internet interventions

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February 27th 2019 - Cross-cultural studies have confirmed that mental disorders occur worldwide. However, studies examining differences in both diagnosis and treatment are scarce and a limited number of studies have analysed cultural differences in mental health. For instance, research has shown that differences in depression rates represent problems with definition and measurement, which do not capture the current diagnostic criteria. Similarly, available diagnostic instruments do not reflect the experience of mental disorders worldwide.

 Traditionally, classification systems of mental disorders have been conceptualised by Western European clinicians. However, mental disorder symptoms are universal and might be expressed in varied forms in other cultures. For example, in some parts of South Asia (e.g. India, Bangladesh) people identify depression in social and moral terms.  Moreover, studies suggest that even North Americans identify depression as a loss or lack of personal strength or fortitude.

Furthermore, behavioural patterns in different cultures can provide tolerance for specific emotions, whilst also serving as coping mechanisms for negative emotions. For instance, China has one of the lowest rates of depression and one theory suggests in China there is a tendency to express depression through somatic symptoms, such as appetite or sleep issues. Therefore, culture and mental health have a complex relationship; culture has relevance for aetiology, the course of mental health conditions, and mental health treatment. In this way, culture involves beliefs systems, values and norms that are learned in a specific context through significant members of the community (e.g. parents, leaders, teachers).

When applying psychotherapy through internet-delivered interventions, these cultural differences can be accounted for through images, videos, personal stories, quizzes, and the general educational information on the intervention. Also, the supporter has a relevant role in always considering the cultural awareness of their clients (e.g. values, perceptions, preferences).  For instance, studies suggest that Asian clients tend to have less tolerance for ambiguity and prefer structured treatment sessions with practical and immediate solutions to their problems, when compared to Europeans

Likewise, studies have examined cultural preferences for treatment, suggesting that for example, Hispanics are more likely than whites to prefer their treatment provider to be of the same gender. African Americans have a stronger desire for a provider of the same ethnicity compared with whites, Asian/pacific Islanders, Hispanics and Native Americans.

In conclusion, knowing cultural differences helps us to be fully aware about the necessities and preferences of the clients, and thus can allow for incorporation of cultural adaptations in internet interventions. Cultural differences allow us to gain a broader perspective of the client in psychotherapy. This should be used to inform the development of interventions by basing them on the necessities of the populations and the individuals within these different populations. This would certainly have an impact on the efficacy of the intervention and allow it to have a wider reach, benefiting people across borders and cultures alike.

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:

https://www.researchgate.net/profile/Alicia_Salamanca-Sanabria