Talk therapy overcomes massive stigma in developing countries
Conducted by Northeastern researchers, one of the largest therapy trials ever performed with young people in a developing country revealed both deep stigma and deep interest in talk therapy.
Americans are going to therapy in droves, but that’s not the case across the globe. In some countries, particularly developing nations, there is often still a stigma around seeking mental health support.
To address that issue and understand the impact talk therapy can have, a group of researchers conducted one of the largest therapy studies ever performed among developing nations, in this case, Nepal. What they found was shocking evidence that despite the stigma, there is still deep interest and openness for particularly young people to take part in therapy, says Nishith Prakash, a professor of public policy and economics at Northeastern University.
“When students come crying to you, what do you do?” Prakash says. “Most people don’t know what you do. They become very uncomfortable. The idea is you don’t have to do anything. You just have to listen to them.”
Born out of a World Bank mandate during the COVID-19 pandemic, Prakash found the perfect opportunity to measure the impact of talk therapy in challenging environments like Nepal. In collaboration with a local NGO, Prakash and his collaborators designed and conducted a large-scale therapy trial that involved sending counselors to the homes of 1,707 adolescents from 40 government schools.
They offered each adolescent free one-on-one in-person talk therapy. The young people involved in the study attended four weekly hour-long sessions with the option of two additional sessions with a trained counselor focused on their specific needs. Counselors also involved parents and caregivers in the process with two family therapy sessions.
The goal, Prakash says, was to provide support in sessions but also to help young people build coping skills they could use outside of therapy.
Given the stigma that exists around talk therapy in Nepal and even the general lack of awareness of mental health resources, Prakash was prepared for the worst: that no one would even go to the sessions.
“That was the shocking part: It [had] very high take-up,” Prakash says.
Editor’s Picks
Around 89% of the young people who were offered therapy attended at least one session, while 82% finished every session. Parents were just as involved: 94% of parents and caregivers took part in the family therapy sessions.
Prakash says it was encouraging that even without targeting a specific mental health issue, as is traditionally done with studies like this, offering a resource with no cost or accessibility limits can have positive health effects as well.
The researchers found that providing talk therapy had a slightly larger impact on participants with symptoms associated with depression. However, broadly, young people reported feeling less afraid of the future and suffering from fewer sleep problems.
Parents also said their children generally appeared “less down” and more capable of managing their worries. Emotional regulation, the ability to manage emotions and stress, also improved along with the participants’ outlook on life.
However, all of these positive effects failed to translate into educational outcomes, like attendance and engagement in the classroom. It inspired Prakash to begin work on a broader curriculum to test in schools, not at home, to target issues that are much deeper than four talk therapy sessions can address.
As part of that work, he’s started to rethink who should even be delivering therapy in the first place. Stigma isn’t the only issue around mental health support in Nepal. There is also just a fundamental lack of counselors to help provide services in the first place.
“This is a question that has nothing to do with developing countries,” Prakash says. “Everywhere you do not have enough counselors, and if you couple that with the setting, which is schools in developing countries that do not have resources, this whole thing becomes very difficult.”
Hiring counselors isn’t easy or cheap. Prakash says there might be a need to start training schoolteachers and others who intersect with adolescents on a daily basis in basic talk therapy techniques.
“This is something we are currently developing, but the idea we want to understand is who is best suited to deliver it because you don’t want to wait until they’re depressed to address this problem,” Prakash says. “Let’s go to a very early stage when kids are still thinking about how to approach problems –– life –– and think about developing a curriculum and think about who is best suited to deliver it and fix it at the root level.”
