@article{linnarantaViewsCulturallySafe2025,

title = {Views on a Culturally Safe Psychotherapeutic Treatment by Inuit in Quebec: Co-Design of Cognitive Behavioral Therapy Manual and Virtual Exposure Environments},

author = {O. Linnaranta and L. G. Cardona and Q. Seon and A. Tukkiapik and J. Outerbridge and S. Bouchard},

url = {https://www.scopus.com/pages/publications/85199212719?origin=resultslist},

doi = {10.1016/j.cbpra.2024.04.006},

issn = {10777229 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Cognitive and Behavioral Practice},

volume = {32},

number = {4},

pages = {513–525},

publisher = {Elsevier Inc.},

abstract = {Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide culturally safe and remotely delivered emotion regulation interventions. We conducted a co-design process of a CBT treatment manual and complementary VR environments for the Inuit populations from Nunavik. Here, we describe the knowledge gained during the adaptation process on the approach to mental well-being and psychotherapy. We followed qualitative, participatory, and research co-design methods. After an initial concept of VR-CBT, an advisory group made up of 7 adults identifying as or working with Inuit participated in 4 focus group meetings. A thematic analysis of the discussions was carried out. A non-symptom-focused approach with the therapist guiding the individual in empowerment and emotion management was accepted in the advisory group, replacing a symptom-focus. Several CBT in- and between-session techniques were seen critically or rejected, and time for working on a certain theme was increased. Some elements in the proposed landscape were rejected as unsafe, other elements added as culture-specific to increase safety. Future work should confirm broader acceptance and utility. Culturally specific factors play an essential role in acceptance of concepts and approaches used in psychotherapy. Accordingly, they can have an impact on acceptance and attendance in therapy. © 2024 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/},

keywords = {Adaptation, adult, article, behavior therapy, clinical article, cognitive behavioral therapy, cultural adaptation, cultural safety, emotion regulation, Environment, environmental exposure, female, health care quality, health service, human, information processing, Inuit, male, manipulative medicine, Mental health, mental health care access, participatory co-design, Problem solving, psychotherapist, psychotherapy, Quebec, software, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{linnaranta_views_2024,

title = {Views on a Culturally Safe Psychotherapeutic Treatment by Inuit in Quebec: Co-Design of Cognitive Behavioral Therapy Manual and Virtual Exposure Environments},

author = {O. Linnaranta and L. G. Cardona and Q. Seon and A. Tukkiapik and J. Outerbridge and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85199212719&doi=10.1016%2fj.cbpra.2024.04.006&partnerID=40&md5=196f0e70c5d372d4384226d9452bc8f8},

doi = {10.1016/j.cbpra.2024.04.006},

issn = {10777229 (ISSN)},

year  = {2024},

date = {2024-01-01},

journal = {Cognitive and Behavioral Practice},

publisher = {Elsevier Inc.},

abstract = {Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide culturally safe and remotely delivered emotion regulation interventions. We conducted a co-design process of a CBT treatment manual and complementary VR environments for the Inuit populations from Nunavik. Here, we describe the knowledge gained during the adaptation process on the approach to mental well-being and psychotherapy. We followed qualitative, participatory, and research co-design methods. After an initial concept of VR-CBT, an advisory group made up of 7 adults identifying as or working with Inuit participated in 4 focus group meetings. A thematic analysis of the discussions was carried out. A non-symptom-focused approach with the therapist guiding the individual in empowerment and emotion management was accepted in the advisory group, replacing a symptom-focus. Several CBT in- and between-session techniques were seen critically or rejected, and time for working on a certain theme was increased. Some elements in the proposed landscape were rejected as unsafe, other elements added as culture-specific to increase safety. Future work should confirm broader acceptance and utility. Culturally specific factors play an essential role in acceptance of concepts and approaches used in psychotherapy. Accordingly, they can have an impact on acceptance and attendance in therapy. © 2024},

note = {Publisher: Elsevier Inc.},

keywords = {cognitive behavioral therapy, cultural adaptation, cultural safety, emotion regulation, Inuit, participatory co-design, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{linnarantaViewsCulturallySafe2024,

title = {Views on a Culturally Safe Psychotherapeutic Treatment by Inuit in Quebec: Co-Design of Cognitive Behavioral Therapy Manual and Virtual Exposure Environments},

author = {O. Linnaranta and L. G. Cardona and Q. Seon and A. Tukkiapik and J. Outerbridge and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85199212719&doi=10.1016%2fj.cbpra.2024.04.006&partnerID=40&md5=196f0e70c5d372d4384226d9452bc8f8},

doi = {10.1016/j.cbpra.2024.04.006},

issn = {10777229 (ISSN)},

year  = {2024},

date = {2024-01-01},

journal = {Cognitive and Behavioral Practice},

publisher = {Elsevier Inc.},

abstract = {Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide culturally safe and remotely delivered emotion regulation interventions. We conducted a co-design process of a CBT treatment manual and complementary VR environments for the Inuit populations from Nunavik. Here, we describe the knowledge gained during the adaptation process on the approach to mental well-being and psychotherapy. We followed qualitative, participatory, and research co-design methods. After an initial concept of VR-CBT, an advisory group made up of 7 adults identifying as or working with Inuit participated in 4 focus group meetings. A thematic analysis of the discussions was carried out. A non-symptom-focused approach with the therapist guiding the individual in empowerment and emotion management was accepted in the advisory group, replacing a symptom-focus. Several CBT in- and between-session techniques were seen critically or rejected, and time for working on a certain theme was increased. Some elements in the proposed landscape were rejected as unsafe, other elements added as culture-specific to increase safety. Future work should confirm broader acceptance and utility. Culturally specific factors play an essential role in acceptance of concepts and approaches used in psychotherapy. Accordingly, they can have an impact on acceptance and attendance in therapy. © 2024},

keywords = {cognitive behavioral therapy, cultural adaptation, cultural safety, emotion regulation, Inuit, participatory co-design, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{seon_virtual_2023,

title = {A Virtual Reality-Assisted Cognitive Behavioral Therapy for and With Inuit in Québec: Protocol for a Proof-of-Concept Randomized Controlled Trial},

author = {Q. Seon and N. Mady and M. Yang and M. Karia and M. Lashley and C. Sescu and M. Lalonde and S. Puskas and J. Outerbridge and E. Parent-Racine and C. Pagiatakis and L. Gomez-Cardona and D. Jiang and S. Bouchard and O. Linnaranta},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85162096695&doi=10.2196%2f40236&partnerID=40&md5=81cbdc49f182df3c2a0062b0de21e496},

doi = {10.2196/40236},

issn = {19290748 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {JMIR Research Protocols},

volume = {12},

publisher = {JMIR Publications Inc.},

abstract = {Background: Emotion regulation is an ability related to psychological well-being; when dysregulated, individuals may have psychiatric symptoms and maladapted physiological responses. Virtual reality-assisted cognitive behavioral therapy (VR-CBT) is an effective psychotherapy to target and strengthen emotion regulation; however, it currently lacks cultural sensitivity and can be improved by adapting it to the cultural context of service users. During previous participatory research, we co-designed a culturally adapted cognitive behavioral therapy (CBT) manual and 2 virtual reality (VR) environments to function as a complement to therapy (VR-CBT) for Inuit who would like to access psychotherapy. Emotion regulation skill building will occur in virtual environments that have interactive components such as heart rate biofeedback. Objective: We describe a protocol for a proof-of-concept 2-arm randomized controlled trial (RCT) with Inuit (n=40) in Québec. The primary aims of this research are to investigate the feasibility, benefits, and challenges of the culturally adapted VR-CBT intervention versus an established VR self-management that is available commercially. We will also investigate self-rated mental well-being and objective psychophysiological measures. Finally, we will use proof-of-concept data to identify suitable primary outcome measures, conduct power calculations in a larger trial for efficacy, and collect information about preferences for on-site or at-home treatment. Methods: Trial participants will be randomly assigned to an active condition or active control condition in a 1:1 ratio. Inuit aged 14 to 60 years will receive a culturally adapted and therapist-guided VR-CBT with biofeedback or a VR relaxation program with nonpersonalized guided components over a 10-week period. We will collect pre- and posttreatment measures of emotion regulation and biweekly assessments over the treatment and at 3-month follow-up. The primary outcome will be measured by the Difficulties in Emotion Regulation Scale (DERS-16) and a novel psychophysiological reactivity paradigm. Secondary measures include psychological symptoms and well-being via rating scales (eg, anxiety or depressive symptoms). Results: As this is the prospective registration of an RCT protocol, we do not yet report any results from the trial. Funding was confirmed in January 2020, and recruitment is expected to start in March 2023 and is set to finish in August 2025. The expected results are to be published in spring 2026. Conclusions: The proposed study responds to the community's desire for accessible and appropriate resources for psychological well-being, as it was developed in active collaboration with the Inuit community in Québec. We will test feasibility and acceptance by comparing a culturally adapted, on-site psychotherapy with a commercial self-management program while incorporating novel technology and measurement in the area of Indigenous health. We also aim to fulfill the needs for RCT evidence of culturally adapted psychotherapies that are lacking in Canada. © Quinta Seon, Noor Mady, Michelle Yang, Maharshee Karia, Myrna Lashley, Claudia Sescu, Maud Lalonde, Stephen Puskas, Joy Outerbridge, Echo Parent-Racine, Catherine Pagiatakis, Liliana Gomez-Cardona, Di Jiang, Stéphane Bouchard, Outi Linnaranta. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 24.05.2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.},

note = {Publisher: JMIR Publications Inc.},

keywords = {Biofeedback, co-design, cognitive behavioral therapy, cultural adaptation, emotion regulation, Indigenous, Inuit health, randomized controlled trial, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{seonVirtualRealityAssistedCognitive2023,

title = {A Virtual Reality-Assisted Cognitive Behavioral Therapy for and With Inuit in Québec: Protocol for a Proof-of-Concept Randomized Controlled Trial},

author = {Q. Seon and N. Mady and M. Yang and M. Karia and M. Lashley and C. Sescu and M. Lalonde and S. Puskas and J. Outerbridge and E. Parent-Racine and C. Pagiatakis and L. Gomez-Cardona and D. Jiang and S. Bouchard and O. Linnaranta},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85162096695&doi=10.2196%2f40236&partnerID=40&md5=81cbdc49f182df3c2a0062b0de21e496},

doi = {10.2196/40236},

issn = {19290748 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {JMIR Research Protocols},

volume = {12},

publisher = {JMIR Publications Inc.},

abstract = {Background: Emotion regulation is an ability related to psychological well-being; when dysregulated, individuals may have psychiatric symptoms and maladapted physiological responses. Virtual reality-assisted cognitive behavioral therapy (VR-CBT) is an effective psychotherapy to target and strengthen emotion regulation; however, it currently lacks cultural sensitivity and can be improved by adapting it to the cultural context of service users. During previous participatory research, we co-designed a culturally adapted cognitive behavioral therapy (CBT) manual and 2 virtual reality (VR) environments to function as a complement to therapy (VR-CBT) for Inuit who would like to access psychotherapy. Emotion regulation skill building will occur in virtual environments that have interactive components such as heart rate biofeedback. Objective: We describe a protocol for a proof-of-concept 2-arm randomized controlled trial (RCT) with Inuit (n=40) in Québec. The primary aims of this research are to investigate the feasibility, benefits, and challenges of the culturally adapted VR-CBT intervention versus an established VR self-management that is available commercially. We will also investigate self-rated mental well-being and objective psychophysiological measures. Finally, we will use proof-of-concept data to identify suitable primary outcome measures, conduct power calculations in a larger trial for efficacy, and collect information about preferences for on-site or at-home treatment. Methods: Trial participants will be randomly assigned to an active condition or active control condition in a 1:1 ratio. Inuit aged 14 to 60 years will receive a culturally adapted and therapist-guided VR-CBT with biofeedback or a VR relaxation program with nonpersonalized guided components over a 10-week period. We will collect pre- and posttreatment measures of emotion regulation and biweekly assessments over the treatment and at 3-month follow-up. The primary outcome will be measured by the Difficulties in Emotion Regulation Scale (DERS-16) and a novel psychophysiological reactivity paradigm. Secondary measures include psychological symptoms and well-being via rating scales (eg, anxiety or depressive symptoms). Results: As this is the prospective registration of an RCT protocol, we do not yet report any results from the trial. Funding was confirmed in January 2020, and recruitment is expected to start in March 2023 and is set to finish in August 2025. The expected results are to be published in spring 2026. Conclusions: The proposed study responds to the community's desire for accessible and appropriate resources for psychological well-being, as it was developed in active collaboration with the Inuit community in Québec. We will test feasibility and acceptance by comparing a culturally adapted, on-site psychotherapy with a commercial self-management program while incorporating novel technology and measurement in the area of Indigenous health. We also aim to fulfill the needs for RCT evidence of culturally adapted psychotherapies that are lacking in Canada. © Quinta Seon, Noor Mady, Michelle Yang, Maharshee Karia, Myrna Lashley, Claudia Sescu, Maud Lalonde, Stephen Puskas, Joy Outerbridge, Echo Parent-Racine, Catherine Pagiatakis, Liliana Gomez-Cardona, Di Jiang, Stéphane Bouchard, Outi Linnaranta. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 24.05.2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.},

keywords = {Biofeedback, co-design, cognitive behavioral therapy, cultural adaptation, emotion regulation, Indigenous, Inuit health, randomized controlled trial, virtual reality},

pubstate = {published},

tppubtype = {article}

}