Evaluating the Effectiveness of a Culturally-Attuned Cognitive-Behavior Therapy for Chinese Adolescents with Anxiety Problems: A Randomized Control Design

Background and Purpose: Recent available data have suggested that Chinese adolescents may have a higher rate of anxiety problems than other cultural groups, and approximately 11.5% of children and adolescents in Hong Kong may have some forms of anxiety problems. However, there is a dearth of an effective psychological intervention for anxiety problems in Chinese adolescents. While Western studies have consistently documented the efficacy of cognitive-behavior therapy (CBT) for adolescent anxieties, there are still many queries about its applications. For example, previous studies have mostly focused on clinical samples rather than the at-risk population. Another example is that there is a lack of empirical evidence for the potential additive effects of parental involvement in the CBT intervention on adolescent anxieties. To address these issues, this study aimed to develop and evaluate the effectiveness of a culturally-attuned group CBT intervention for Chinese adolescents at risk for anxiety disorders in school settings in Hong Kong.

Methods: This study adopted a randomized control design. A total of 68 participants (31 males and 37 females) aged from 12 to 19 were randomly assigned into three conditions: (1) CBT group (n = 23), (2) CBT plus parental involvement group (n = 23), and (3) social activity group (n = 22) as a control condition. The CBT group included 8 sessions covering 4 components: recognizing anxious feelings and physical reactions to anxiety, developing a coping plan, learning adaptive cognitive and behavioral strategies to deal with anxiety (e.g., cognitive restructuring), and using exposure. The parent component included: psychoeducation on parental anxieties, family accommodation, parental over-involvement, and exposure coaching. The participants completed a questionnaire with validated Chinese measures at pre-test, post-test, and 6-month follow-up.

Results: The results of two-way mixed ANOVAs revealed significant main effects of time on anxiety symptoms, self-esteem, and the cognitive emotion strategy of rumination, indicating that participants showed improvements in these variables over time. Moreover, compared with the social activity group, the CBT group showed a significantly greater improvement in the cognitive emotion strategy of other-blame from pre-test to follow-up. Furthermore, compared with the CBT group and the social activity group, the CBT plus parental involvement group showed a greater improvement in the cognitive emotion strategy of refocusing on planning from pre-test to post-test, and greater improvements in self-esteem and the cognitive emotion strategies of refocusing on planning and positive reappraisal from pre-test to follow-up. Besides, changes in some cognitive emotion strategies significantly predicted changes in anxiety symptoms and self-esteem. Specifically, decreases in anxiety symptoms were significantly predicted by decreases in the strategies of self-blame, rumination, and catastrophizing. The increase in self-esteem was predicted by decreases in the strategies of self-blame, acceptance, and catastrophizing and increases in the strategies of positive refocusing, refocus on planning, and positive reappraisal.

Conclusions and Implications: These findings provide evidence for the effectiveness of the culturally attuned group CBT intervention in treating anxiety problems among Chinese adolescents and the additive effects of parental involvement in the CBT intervention on adolescent anxieties.