“Walk on the Land”: Lessons from Virtual Reality Cognitive Behavioural Therapy Co-Designed with Inuit in Quebec

Background: Digital mental health (DMH) has grown exponentially; however, its therapeutic effects, while impressive, may exclude marginalized populations. Aims: We investigated the feasibility, acceptability and impacts of a culturally adapted DMH for Inuit in Quebec. Methods: The longitudinal trial is grounded in interpretative phenomenology and participatory action methodologies. We interviewed seven trial participants over the course of the study for a total of k=12 brief, semi-structured interviews. The therapist was also interviewed in-depth at the conclusion of recruitment. Triangulated data were analyzed with reflexive thematic methodology. Results: Six themes emerged. We discuss therapeutic effects and participant perceptions of the culturally adapted virtual environments and biofeedback. We also discuss expectations and knowledge about therapy, how adapted and sensitive the therapy was to Inuit, issues with study feasibility, relationships between therapist, research team and participants, and the perceived impacts of the therapy. Conclusions: We conclude with discussion and recommendations for stakeholders that are generalizable across DMH, VR, and culturally adapted projects. Trial Registration Number: International Standard Randomized Controlled Trial Number (ISRCTN) 21831510; https://www.isrctn.com/ISRCTN21831510