Cognitive-Behavioral Therapy for an Arab College Student With Social Phobia and Depression

Abstract

Coexistent social anxiety disorder (SAD) and major depression can be highly debilitating and cause significant interference with social, occupational, and educational functioning. Cognitive-behavioral therapy (CBT) has been shown to be an effective treatment for SAD and allows for flexibility in treating individuals of diverse cultural backgrounds. At present, treatment outcome research on the efficacy of CBT among Arab individuals with anxiety and mood disorders is highly limited. The current case study presents the implementation of a manualized CBT protocol for an Arab male with SAD and a secondary diagnosis of major depression. With attention to unique cultural influences on the development and maintenance of his symptom presentation, treatment consisted of 14 individual sessions, with outcome data yielding significant reductions in social anxiety, somatic anxiety, and depression at the posttreatment assessment. This case study demonstrates the potential efficacy of manualized CBT for SAD among Arab individuals and highlights the need for further systematic investigation using randomized controlled trials.

Cultural modifications of cognitive behavioural treatment of social anxiety among culturally diverse clients: a systematic literature review

“…All reviewed case studies highlighted the importance of cultural knowledge (e.g. of cultural norms and values, Weiss et al ., 2011; Yoshinaga et al ., 2013; Ashworth et al ., 2011; McIndoo and Hopko, 2014; Toyokawa and Nedate, 1996; Fink et al ., 1996; socio-cultural and historical contexts, Yoshinaga et al ., 2013; the relevance of cultural background to the presenting problems, McIndoo and Hopko, 2014), cultural sensitivity (Weiss et al, 2011; Yoshinaga et al, 2013) and the need to develop and practice cultural awareness (including being open to and frequently discussing culture, e.g. McIndoo and Hopko, 2014).…”

“…Weiss et al ., 2011; Ashworth et al ., 2011), socio-cultural construction of therapy and therapeutic relationship (e.g. more authoritarian and directive therapist style, the need for a therapy to be more structured, concrete and focused on solutions, McIndoo and Hopke, 2014; Toyokawa and Nedate, 1996; Ashworth et al ., 2011; Yoshinaga et al ., 2013), potential difficulties in managing expectations, such as, for instance, Japanese clients’ wish for quick symptom reduction (Toyokawa and Nedate, 1996) and tackling culturally taboo topics, such as family's past and shame or sex (Toyokawa and Nedate, 1996).…”

“…Therefore, therapists need to consider taking on a much more active and directive role (McIndoo and Hopko, 2014) and keep the relationship comparatively vertical rather than horizontal (Toyokawa and Nedate, 1996).…”

“…Strong psychoeducation is recommended, and therapists’ advice may be presented in a more authoritative style, such as directing clients to engage in challenging tasks (Yoshinaga et al ., 2013). Clients coming from collectivistic backgrounds seem to benefit from highly structured sessions, concrete goals and interventions strongly focused on solutions in the present moment (McIndoo and Hopko, 2014).…”

“…Other collectivistic cultures (e.g. Arab culture, McIndoo and Hopko, 2014; or ultra-orthodox Jewish communities, Greenberg et al ., 2004) illustrate an interplay of strict social and religious norms that govern interactions within society and can lead to the development of culturally specific symptoms of anxiety.…”