Cognitive-Behavioral Therapy for Immigrants Presenting With Social Anxiety Disorder

Abstract

Cognitive-behavioral therapy (CBT) for the treatment of Social Anxiety Disorder (SAD) has demonstrated efficacy in numerous randomized trials. However, few studies specifically examine the applicability of such treatment for ethnic minority clients. Thus, the purpose of this article is to present two case studies examining the utility of individualized CBT for SAD with two clients who immigrated to the United States, one from Central America and one from China, for whom English was not their primary language. Both clients demonstrated improvement on a semi-structured interview and self-report measures. Necessary adaptations were modest, suggesting that therapy could be conducted in a culturally sensitive manner without much deviation from the treatment protocol. Results are discussed in terms of adapting treatment to enhance acceptability for and better fitting the needs of ethnic minority clients and non-native speakers of English. Implications for treating ethnic minority clients, as well as the practice of culturally sensitive treatment, are discussed.

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

“…Two of the reviewed cases emphasized the role of native languages in therapy (Weiss et al ., 2011) and indicated that much more consideration needs to be given to the utilization of native languages in CBT. Clients who do not have English as their first language may find it difficult to access their thoughts or the thoughts can be ‘lost in translation’, making cognitive work less beneficial.…”

“…Weiss et al . (2011) advocate the incorporation of native language in CBT, especially in written homework assignments, such as thought records. Yet, asking clients to express themselves in their native languages needs to be introduced carefully, not to give them an impression that a therapist perceives them as unable to speak the language of the dominant culture, as this may perpetuate their fear of social judgement and/or distorted perception of their language proficiency.…”

“…Weiss et al . (2011) also observed that with clients who are not proficient in the dominant language, the therapist may need to slow down the pace of the protocol and it is likely that the treatment will progress more slowly than usual.…”

“…Cognitive behavioural therapy (CBT) for the treatment of social anxiety disorder (SAD) has demonstrated efficacy in numerous research studies (Hofmann and Smits, 2008), systematic reviews (Voss Horrell, 2008;) and meta-analyses (Acaturk et al ., 2009; Stewart and Chambless, 2009). However, most of these were conducted in Europe and North America (limiting their universal applicability) and less is known about the efficacy of CBT for ethnic minorities and other under-represented groups (Weiss et al ., 2011). Moreover, the theoretical orientations underlying CBT models and treatment interventions developed in Western countries are constrained by Western conceptualizations of SAD (Yoshinaga et al ., 2013).…”

“…Despite the awareness of the need to provide culturally sensitive treatments, Voss Horrell (2008) argues that few studies examine the applicability of CBT treatment for ethnic minority clients and Weiss et al (2011) note the paucity of research addressing the effectiveness of CBT treatment specifically for SAD patients of various cultural backgrounds.…”