Juan Valladares; Hanna Prieto; Niyeli Herrera; Yerina Flores, Brigham Young University
The goal of this meta-analysis is to establish the overall comparative efficacy of culturally adapted mental health treatments. Mental health care given to ethnic minorities has been a central focus of those seeking to improve psychological and therapeutic care. Cultural values, ideas, and beliefs may affect the way an intervention is received and therefore its ultimate effectiveness. The influence of culture is present across all aspects of psychotherapy, impacting the theoretical conceptualization, delivery, and assessment of an intervention. Tailoring and modifying mental health treatments to better fit clients’ cultural needs is commonly known in the literature as cultural adaptations. Through the process of cultural adaptation, (1) the cultural and historical biases and assumptions that are inherently intertwined in psychotherapy are addressed and (2) empathic attunement to the client’s culture facilitate the successful reception of the mental health treatment. Although various cultural adaptations of mental health treatments have added to the existing literature, there is an impending need to examine these studies together in order to provide empirically supported recommendations to guide practice. To address this need, we conducted a meta-analysis to establish the relative effect of those mental health interventions that have been explicitly adapted to clients’ racial, ethnic, or cultural backgrounds. We conducted a number of searches through various electronic databases in an attempt to grasp the totality of the literature on this subject. We included studies that used experimental or quasi-experimental research designs comparing mental health treatments that were culturally adapted to those that did not contain cultural adaptations. We examined only interventions that explicitly intended to improve emotional or psychological well-being. Data was extracted from 99 studies, containing 13,183 individuals, and the aggregate random effects weighted effect size was d = 0.499 (se = .039, 95% CI = 0.42 to 0.58, p < .0001). The types of cultural adaptations reported in individual studies varied substantially, both in terms of the number of adaptations and in terms of the specific types of adaptations. In addition, Egger’s regression test (an estimate of effect size asymmetry) was statistically significant (p < .001), providing evidence of publication bias which was statistically accounted for in our overall results. We review the importance of this research in terms of its implications in training, therapeutic practices, and research construction. Ultimately, cultural adaptations to mental health treatments prove somewhat more effective than treatment as usual with clients of color in North America.