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

Abstract

The aim of this study was to conduct a systematic literature review to ascertain whether cognitive behavioural therapy (CBT) for social anxiety disorder (SAD) can be successfully used in non-Western contexts and demonstrate sufficient effectiveness. This area is largely under-researched with conflicting evidence presented in quantitative studies, with virtually no qualitative studies published. This review utilized realist review methodology and focused on qualitative case studies presented by clinicians. A systematic search of EBSCO HOST, The Cochrane Library Database, Google, Google Scholar and reference mining, using various combinations of terms relating to: (1) CBT, (2) social anxiety and (3) cultural diversity were employed. Seven case studies of cultural adaptations of CBT treatment for culturally diverse SAD sufferers were included. The treatment outcomes were generally promising in all cases (reporting significant decrease of SAD symptoms, maintained over time) and the success of therapy was often attributed to culturally specific modifications introduced. CBT can be an acceptable and effective treatment for culturally diverse SAD sufferers with ‘modest’ modifications, without major diversions from the original CBT models and protocols, but this finding must be treated with caution and more methodologically rigorous research (qualitative and quantitative) is needed to more fully understand what works, for whom and in what circumstances.

Ethnicity as a predictor of outcomes of psychological therapies for anxiety and depression: a retrospective cohort analysis

“…The apparent disparity in recovery between populations of different ethnicities is often attributed to cultural differences, which has led to treatment that is culturally adapted for people within BMER groups (Jankowska, 2019). Although such changes are necessary, these finding suggest that at least some part of the disparity in recovery rates are attributable to general socio-demographic factors and entry level morbidity.…”

“…In a multicultural society, ensuring equity of access, treatment and outcome is an important policy objective. Recent advancements in the understanding of culture on mental health has led to suggestions that ‘modest’ modifications to treatments are necessary to make services culturally applicable (Jankowska, 2019). IAPT has recognised these ethnic disparities and commissioned the IAPT Black, Asian and Minority Ethnic Positive Practice Guide to address some of the structural issues within IAPT services (Beck et al ., 2019).…”

Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural Adaptation of CBT

“…(a) A systematic review of CBT for social anxiety within a culturally diverse population Cultural modifications of cognitive behavioural treatment of social anxiety among culturally diverse service users: a systematic literature review (Jankowska, 2019) This systematic review reports case studies, as there were no randomized controlled trials (RCTs) in this area. The review focuses on seven case studies of cultural adaptations of CBT for social anxiety disorder (SAD) for a culturally diverse population published separately.…”

“…I have tried to divide these articles according to the broader themes, although most articles will fit in more than one thematic area. There is (a) one systematic review of CBT for social anxiety among the culturally diverse population (Jankowska, 2019). There are (b) seven articles covering different aspects of adaptation of therapies for diverse populations which include: culturally adapted family intervention using case studies (Berry et al , 2018), a discussion of maladaptive schema and schema therapy in the context of Greek culture (Kolonia et al , 2019), use of a transdiagnostic intervention in low resource countries (Murray et al , 2019), application of acceptance and commitment therapy (ACT) with a Turkish population in London (Perry et al , 2019), a framework to culturally adapt CBT (Rathod et al , 2019), a case report of family-based CBT for obsessive compulsive disorder (OCD) from Saudi Arabia (Alatiq and Alrshoud, 2018) and a paper discussing CBT in military culture (Zwiebach et al , 2019).…”

Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical practice guideline for social anxiety disorder (2021)

“…However, because there are findings that outcomes of clinical trials on psychotherapy for social anxiety disorder do not vary significantly across cultures and that minor modifications that consider cultural differences can be expected to be effective, 4,5 the conclusion of this recommendation is unchanged.…”