Does one-size-fit-all? Exploring the cross-cultural validity of evidence-based psychological interventions offered by Improving Access to Psychological Therapies (IAPT) services

Purpose. This thesis explored the effectiveness of evidence-based psychological interventions for Black, Asian and Minority Ethnic (BAME) communities accessing Improving Access to Psychological Therapies (IAPT) services in England, UK. Methods. Multiple-methodologies were guided by the Transdisciplinary model of evidence-based practice. This included 1) a systematic literature review; 2) examination of predictors of recovery and therapeutic effectiveness; 3) exploration of whether therapies were suitable to BAME service users’ needs; and 4) exploration of IAPT practitioners’ cultural competency. Findings. Findings from the systematic review highlighted scarce inclusion of BAME participants in clinical trials. Only two studies met the inclusion criteria which found that psychoeducation at an early stage of referral was more effective in reducing depression when compared to delayed access (N = total 217 participants). Examination of routine clinical data revealed that ethnicity, religion, age, and initial baseline severity were predictors of recovery (N = 13,710 patients). For therapeutic effectiveness, there were significant main effects for treatment modality and ethnicity after controlling for baseline severity and age, however, there was no significant interaction (N = 9,925 patients). Poor recovery outcomes (< 35%) were observed across the entire clinical sample. Findings from BAME service users recovery narrative (N = 9) revealed the importance of recognising cultural dissonance within therapy; the need for therapists to develop cultural competency; and evaluations of their road to recovery. Service users felt therapy was not a cure, but generally found it helpful. Interviews with therapists (N = 16) revealed that only nine therapists received one day of formal cultural competence training and seven received none at all. Therapists discussed the cultural dissonance encountered during therapy; the challenges in making cultural adaptations to therapy; and their cultural competency needs. Conclusion. Overall, evidence suggests that the ‘one-size-fits-all’ approach adopted by Western evidence-based psychological interventions fails to consider the cultural complexities that may present in ethnically diverse communities. Implications and considerations for decision-making processes are discussed in the context of clinical psychology practice, education, leadership, policy and research