Hugh McCall, Jill Price, Jenna Ives, Angela McGinnis, Betty McKenna, Heather Hadjistavropoulos

Outcomes of Internet-Delivered Cognitive Behavioural Therapy Tailored for Canadian Public Safety Personnel Among Indigenous and White Clients

Introduction

Outcomes of internet-delivered cognitive behavioural therapy tailored for canadian public safety personnel among indigenous and white clients. Examines internet-delivered CBT outcomes for Canadian Indigenous & White public safety personnel. Finds similar benefits in symptom change & satisfaction for both groups.

Abstract

Indigenous Peoples and public safety personnel are two groups that report very high rates of mental health challenges. Internet-delivered cognitive behavioural therapy is an effective treatment for various mental health challenges with promising results among Indigenous clients and public safety personnel. However, research on the mental health of Indigenous public safety personnel and the treatment of mental health challenges among Indigenous public safety personnel is extremely scarce. In the current study—using questionnaire responses and program usage data—we compared outcomes of internet-delivered cognitive behavioural therapy (i.e., symptom change, program use, and treatment satisfaction) among 35 Indigenous and 356 White public safety personnel in Canada (N = 391) to assess whether Indigenous public safety personnel benefit similarly to White public safety personnel from internet-delivered cognitive behavioural therapy. Data analyses included multiple imputation, chi-square analyses, independent-samples t-tests, and ANCOVAs for various outcomes. We also present several illustrative quotes from Indigenous clients. Our results show elevated pre-treatment symptoms among Indigenous public safety personnel but no differences between ethnic groups with respect to symptom change, program use, or treatment satisfaction. Our findings provide preliminary evidence that internet-delivered cognitive behavioural therapy can be effective among Indigenous public safety personnel. However, we discuss several important caveats, limitations, and considerations for future efforts to develop, adapt, deliver, and evaluate psychological interventions for Indigenous public safety personnel and other Indigenous populations.

Review

This study addresses a critical gap in the literature by examining the effectiveness of internet-delivered cognitive behavioural therapy (iCBT) among Indigenous Canadian public safety personnel (PSP), a population whose mental health challenges are often severe and under-researched. The authors compare outcomes, including symptom change, program use, and treatment satisfaction, between Indigenous (N=35) and White (N=356) PSP accessing tailored iCBT. Despite observing elevated pre-treatment symptoms among Indigenous clients, a key finding is the absence of significant differences between ethnic groups across all primary outcome measures. This preliminary evidence suggests that tailored iCBT could be a promising intervention for Indigenous PSP, offering a potentially accessible treatment modality for a high-need population. While the study's premise and initial findings are highly valuable, several considerations warrant discussion. A notable limitation, acknowledged implicitly by the authors' mention of "preliminary evidence" and "caveats," is the significant disparity in sample sizes between the Indigenous and White client groups. This imbalance (35 vs. 356) could impact the statistical power to detect subtle yet clinically meaningful differences for the Indigenous cohort, potentially leading to Type II errors. Furthermore, while the iCBT was "tailored for Canadian Public Safety Personnel," the abstract doesn't detail the extent or nature of specific cultural adaptations made for Indigenous clients, which is crucial for ensuring culturally safe and effective care. The inclusion of illustrative quotes from Indigenous clients is a commendable effort to provide qualitative insight, although a more robust qualitative component could offer deeper understanding into their experiences and perceived effectiveness. Overall, this research represents an important initial step in understanding the utility of iCBT for Indigenous public safety personnel. The findings offer encouraging, albeit preliminary, evidence that such interventions can yield comparable outcomes across ethnic groups, potentially broadening access to mental health support for Indigenous PSP. Future research should prioritize replication with larger, more representative Indigenous samples to enhance statistical power and generalizability. Further exploration into the specific cultural adaptations of iCBT for Indigenous populations, including their impact on engagement and long-term outcomes, is essential. Additionally, investigating the factors contributing to elevated pre-treatment symptoms among Indigenous PSP could inform targeted early intervention strategies, ultimately contributing to more equitable and effective mental health care for this underserved population.

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