FE Mental Health Series | Despite increasing awareness, urban-rural divide widens accessibility gap of Cognitive Behavioural Therapy in India – Healthcare News

The status of mental health is bleak. The latest data reveals that mental health is neglected or unavailable in many countries, especially in Africa and Asia. In recent years, though there has been increased awareness, accessing affordable interventions and treatment options remains challenging.

Diagnosing and treating mental health issues is complex. There are many treatment and support options to help people experiencing mental health conditions. Psychological therapies are among the most effective treatments for common mental health problems. One of most widely used psychological therapies is Cognitive behavioural therapy (CBT) which often uses a combination of techniques that may vary depending on the disorder being treated.

Interestingly, it is now a leading treatment for many other conditions, including anxiety disorders. Research has shown that CBT is an effective therapy for social anxiety disorder.

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“An evidence-based psychotherapeutic approach which has been widely recognized as a first-line approach to psychological interventions over the past decade. Developed by Aaron Beck in the 1960’s, CBT is a problem-oriented, structured and collaborative therapeutic approach focusing on the relationship between cognition, i.e. thoughts, emotions i.e. feelings, and behaviour. The core idea of CBT is that one’s thoughts directly influence how one feels and behaves. The objective is to help individuals identify and challenge negative or distorted thinking patterns,” Roshni Sondhi Abbi, Clinical Psychologist, Fortis Memorial Research Institute, Gurugram told Financial Express.com.

She also said that various meta-analyses and clinical reviews have reiterated its efficacy in the treatment of bipolar disorder, personality disorders, substance use disorders, post-traumatic stress disorder, and insomnia and chronic pain.

In fact, more than 2000 studies have demonstrated the efficacy of CBT for various psychiatric disorders, medical or chronic illnesses, as well as for other psychological stressors, she revealed.

How does Cognitive Behavioural Therapy (CBT) work?

Cognitive Behavioral Therapy (CBT) is a psychotherapeutic approach that helps people identify and change negative thought patterns and behaviors.

“It works by breaking down overwhelming problems into smaller, more manageable parts, focusing on the connection between thoughts, feelings, and actions. Through structured sessions, people learn to challenge and reframe distorted thinking, leading to healthier emotional responses and behaviors,” Dr. Rahul Chandhok, Head Psychiatrist/Head Consultant, Mental Health and Behavioural Science, Artemis Hospitals told Financial Express.com.

Rutika Khandol, Psychologist, Mpower explains how CBT Works:

• Identifying Negative Thoughts: CBT assists individuals in recognizing automatic, negative thoughts that contribute to emotional suffering.
• Challenging and Restructuring Thoughts: Patients are taught to challenge and replace negative thoughts with balanced, realistic ones.
• Developing Coping tactics: CBT teaches practical stress-management skills like relaxation techniques and problem-solving tactics.
• Behavioural activation: Encourages participation in activities that enhance pleasure and accomplishment in order to overcome sadness and anxiety.

“CBT is beneficial in treating illnesses such as depression, anxiety, OCD, and PTSD. It is structured, allowing people to manage their mental health with long-term effects. CBT is typically used in the short term to provide skills for long-term change, improving well-being and quality of life,” Khandol told Financial Express.com.

According to Abbi, CBT as developed and pioneered by Aaron Beck and Albert Ellis, has been described as the second wave of psychotherapies.

“With more recent advancements in research and development in the field, we have witnessed the third wave of psychotherapies, including approaches like mindfulness-based cognitive therapy, dialectical behaviour therapy, and acceptance and commitment-based therapy. This wave is representative of an emerging group of therapies arising out of an evolution and extension of the traditional approaches of CBT,” she told Financial Express.com.

There are several advantages of CBT. According to Dr. Chandhok, CBT is effective, time-limited, and empowers patients with skills to manage their symptoms on their own. It’s evidence-based and adaptable to various disorders.

“However, it has certain disadvantages as well. It requires active patient participation, and some people may find it challenging to engage with the process. It might not be suitable for complex mental health issues without additional support. CBT has certain challenges as well. Mental health professionals often face challenges such as cultural stigma, lack of trained therapists, and patient reluctance to engage in therapy due to misconceptions about mental health,” he told Financial Express.com.

What is the status of Cognitive Behavioural Therapy (CBT) in India?

CBT is increasingly being recognized and practiced in India. However, its access may still be limited in rural areas, Dr. Chandhok said.

“It is commonly prescribed for various mental health conditions, including depression, anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Its growing acceptance is part of a broader trend towards integrating evidence-based mental health practices in the country,” Dr. Chandhok said.

According to Dr. Chandhok, CBT has gradually gained a lot of recognition in India over the past few decades, with increased awareness and training among mental health professionals.

“Urban areas see greater access to CBT, but rural regions are still struggling with certain challenges. To make CBT more accessible and affordable, more government support is needed, including subsidized mental health services, widespread training for therapists, and public awareness campaigns,” he explained.

Integrating CBT into primary healthcare and leveraging digital platforms for teletherapy can also help in bridging the accessibility gap, especially in underserved areas, Dr Chandhok emphasised.

Given the growing prevalence of mental illnesses, with more than a 25 percent increase reported in anxiety and depressive disorders since the COVID-19 pandemic, along with a dearth of mental health professionals in the country, the treatment gap is a need that needs to be prioritised, Abbi told Financial Express.com.

“In the aftermath of the pandemic, a surge of tele-mental health was witnessed, which significantly helped increase the accessibility of mental health care services, including government initiatives like TeleMANAS and E-Sanjeevani. However, filling the treatment gap requires an insurmountable increase in the accessibility of mental health care services,” she highlighted.

Khandol also highlighted that CBT in India has evolved significantly over the years. “Initially introduced through pioneering therapists like Dr. Dinesh Bhugra, who trained abroad and brought CBT techniques to India, the approach was initially confined to major cities and academic settings. By the 2000s, institutions like the National Institute of Mental Health and Neurosciences (NIMHANS) and various universities began incorporating CBT into their training programs, leading to a broader recognition of its efficacy,” she told Financial Express.com.

In the 2010s, CBT gained traction with the integration of evidence-based practices into public and private mental health services. For instance, the Indian government’s mental health initiatives started including CBT as a recommended treatment for depression and anxiety, improving its accessibility to a wider population.

According to Khandol, the rise of digital platforms like InnerHour and Talkspace has further expanded CBT’s reach, offering online therapy options that cater to individuals in remote or underserved areas.

“Recent efforts have focused on adapting CBT to Indian cultural contexts, such as the work done by Dr. Sameer Zope, who has explored culturally sensitive modifications to CBT techniques. These advancements reflect a commitment to making CBT more accessible, affordable, and relevant to the diverse needs of the Indian population,” she explained.

Are there any alternative treatments to CBT?

While being considered as an evidence-based psychotherapeutic approach, there are various other approaches of psychotherapy besides CBT which have demonstrable efficacy for a variety of mental illnesses.

According to Abbi, these could include applied behaviour analysis, psychodynamic psychotherapy, solution-focused therapy, supportive psychotherapy, dialectical behaviour therapy, acceptance and commitment-based therapy, motivational enhancement therapy, interpersonal therapy, schema therapy, and more.

Meanwhile, Dr. Chandhok highlighted that Dialectical Behavior Therapy (DBT) focuses on emotion regulation, and Acceptance and Commitment Therapy (ACT) emphasizes accepting thoughts and feelings rather than fighting them.

Other therapies include psychodynamic therapy, interpersonal therapy, and mindfulness-based approaches. He also highlighted that taking medication is also an option, especially for more severe mental health conditions.

“Each treatment has its own strengths and is chosen based on the individual’s specific needs, symptoms, and preferences,” he added.

How the current status can be improved?

Utilising technological innovations can be considered a potential approach to ease the burden on mental health experts, with a significant increase in outreach, accessibility, and affordability of mental health care services, Abbi told Financial Express.com.

“Especially for structured psychotherapeutic approaches like CBT, AI-driven bots and applications utilizing clinical and evidence-based standards of care could pave the way forward. I believe an integrated hybrid approach could be the vision, including both increased accessibility and affordability of mental health care services, aimed at early identification as well as a preventative approach to mental health,” she informed.

DISCLAIMER: If you or someone you know is struggling with their mental health or in distress contact the Vandrevala Foundation’s helpline (+91-9999666555) which is available in 11 languages including English and can be accessed via telephone or WhatsApp 24×7. You can also contact Fortis Hospital’s National Helpline number 91-8376804102 which is available 24×7. You can also contact the Government Mental Health Rehabilitation Helpline ‘KIRAN’ at 18005990019 which is available 24×7.