Taoist cognitive therapy: Treatment of generalized anxiety disorder in a Chinese immigrant woman.

Abstract

This case report describes the application of Taoist cognitive therapy (TCT) to a 32-year old Chinese (Fujianese) American immigrant woman with generalized anxiety disorder (GAD). TCT is a manualized adaptation of an indigenous psychotherapy developed in China (Zhang & Young, 1998; Zhang et al., 2002). Mrs. Liu received 16 sessions of TCT administered in Mandarin by a Chinese American social worker in conjunction with psychopharmacologic treatment. Sources of data included case notes, transcripts of session recordings, client thought records, and a battery of standardized measures. Mrs. Liu presented with significant guilt regarding her perceived failures to fulfill her filial obligations postmigration, which resulted in constant worry about family members’ health, reassurance-seeking, and controlling behavior. Her anxiety and worry were conceptualized as the result of rigid attachments to beliefs, goals, and desires that are not reflective of the natural order of the universe (Tao). Mrs. Liu was guided in reevaluating stressful situations from the perspective of 8 Taoist principles that promote collective benefit, noncompetition, moderation, acceptance, humility, flexibility, wuwei (nonaction), and harmony with the laws of nature. Clinically significant reductions in anxiety, worry, and experiential avoidance were observed after 16 sessions. However, results were attenuated by the 4-month follow-up due to acute stress surrounding her husband’s deportation proceedings. This case highlights how immigration-related stressors, including transnational family separation and cultural values, can shape the experience and expression of GAD. Further, the positive treatment response provides some evidence of the acceptability and applicability of TCT to Chinese immigrants with GAD.

Let Nature Take Its Course: Cultural Adaptation and Pilot Test of Taoist Cognitive Therapy for Chinese American Immigrants With Generalized Anxiety Disorder

“…One was identified as Buddhist; the other four reported no religious affiliation. Only one reported “a little bit” of knowledge of Taoism; the rest reported “no knowledge.” See Chang et al (2016) for a case study of Mrs. Liu.…”

“…TCT was administered using the final manualized protocol ( Chang et al, 2016 , Unpublished). Stage 1 (Orientation and Assessment) assesses current difficulties, values, and coping strategies, introduces self-monitoring skills (thought records), and orients the patient to the TCT approach.…”

“…Stories and proverbs are used to illustrate these teachings, which are presented in a series of rhyming couplets so as to be culturally familiar and easy to recall, accessible to patients who are semi-literate. Rather than using thought records to correct cognitive distortions, the patient learns to use these core Taoist principles to analyze situational stressors and relationships and practice new ways of responding (Chang et al, 2016).…”

“…In striving to achieve your goals, do your best according to your own capacity. Accurately appraise your abilities, talents, and resources, as well as your limits and weaknesses so that you can set a realistic goal" (Chang et al, 2016). To help the therapist explain each principle to the patient, the treatment manual includes numerous teaching examples drawn from core Taoist texts as well as contemporary life.…”

“…For these cases, RCIs computed for Ch-PSWQ and STICSA-Trait data were statistically significant (p < 0.05) at termination and 4mFU except in one case, indicating reliable improvement in pre-post scores. At the 4mFU, Ch-PSWQ scores were attenuated for Ms. Liu due to an acute stressor in the month prior to the assessment period (husband's deportation proceedings; see Chang et al, 2016). The two participants (Mrs. Chan and Ms. Xiao) who did not show improvements in worry and anxiety were both older (in their 50s) and had comorbid depression.…”