Cultural Variables within CBT

Though anxiety as an emotional experience is consistent phenomenologically across racial and ethnic groups, we do find variations in the rates of this expression depending on the disorder in question. For example, though not a part of “diagnostic criteria,” it is quite common for BIPOC to experience heightened anxiety and panic symptoms in the context of situations that non-Hispanic Whites may deem as harmless. Examples include avoidance of situations where one may be the only person of color, experiencing panic symptoms when “simply” being pulled over by a police officer, symptoms of PTSD such as cognitive alterations, avoidance, and flashbacks when experiencing a microaggression, or increased somatic complaints due to the historical stigma associated with “mental” health concerns in BIPOC. You can read more about this in the PDFs below.

Depending on the nature of the individual’s symptoms and the perception of their own racial identity, research indicates that ethnic match can certainly serve as a proxy for cultural match and is related to increased disclosure of symptoms in some cases (ex: African Americans clients) as compared to lower in others (ex: Asian Americans depending on the symptoms). As previously noted, there are a plethora of idiosyncrasies here, including the client’s racial identity/preference, but ethnic match can be very important for treatment in many cases. Gordon Nagayama-Hall speaks to this issue at length in the empirical literature available for purchase here: https://guilfordjournals.com/doi/epdfplus/10.1521/jscp.2014.33.10.936

Thank you for this question. Anti-racist CBT requires cultural humility, which includes asking questions (assuming nothing), transparency with BIPOC about one’s experience with CBT but not particularly with the client’s cultural experiences and understanding the cultural variables that will need to be addressed within a CBT framework. Since the ingredients of CBT have cross-cultural effectiveness, the key is understanding the idiosyncratic application of CBT based upon the client’s cultural experiences. Along these lines, many clinicians are not particularly trained to identify “cultural alarms” that take the form of clinical manifestations, and these have not been historically addressed in the empirical literature. Dr. Monnica Williams created a meet up group that speaks to this issue https://www.meetup.com/anti-racism-international-usa-canada-and-europe/, and we also address these cultural alarms throughout treatment. See: https://drkevinchapman.com/wp-content/uploads/2017/01/Chapman_SAD-1_2013.pdf https://drkevinchapman.com/wp-content/uploads/2017/01/Chapman_SAD-2_2013.pdf

I find it extremely important to acknowledge the function of anxiety as an adaptive emotional response to the anticipation of future threat. So often, we categorize anxiety as maladaptive when this is simply not the case at its core. Along these lines, I often describe the importance of addressing “true alarms” (actual danger or threat) as it relates to BIPOC in addition to “false alarms” as it relates to conditioned fear associations (e.g., phobias, panic, etc.). In the case of anxiety about anti-Asian violence this is, in fact, a true alarm that doesn’t require modifying a maladaptive response per se but rather, being flexible cognitively versus traditional cognitive restructuring and not judging one’s response as not necessarily maladaptive. In other words, acknowledging that this anxiety is normal, that I still should confront situations that may not be dangerous so that I can continue establishing non-threatening associations in social contexts while still acknowledging that a negative outcome is indeed possible due to racism. Adopting a nonjudgmental stance toward this anxiety is essential, and self-disclosure/accurate cultural empathy go a long way in my personal experience. Read my two lessons here and here: https://drkevinchapman.com/wp-content/uploads/2017/01/Chapman_SAD-1_2013.pdf https://drkevinchapman.com/wp-content/uploads/2017/01/Chapman_SAD-2_2013.pdf for further details about cultural alarms.

Very good question and increasingly a FAQ. The short answer is that culturally sensitive adaptations require a thorough understanding of both the effective ingredients of CBT for social anxiety and the cultural variables that need to be accounted for in an idiosyncratic fashion. I speak explicitly to this adaptation for social anxiety in these two lessons here and here: