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Effectiveness of a culturally adapted cognitive behavioural therapy-based guided self-help (CACBT-GSH) intervention to reduce social anxiety and enhance self-esteem in adolescents: a randomized controlled trial from Pakistan

Published online by Cambridge University Press:  26 May 2020

Rizwana Amin
Affiliation:
Department of Professional Psychology, Bahria University, Islamabad, Pakistan
Amna Iqbal
Affiliation:
Department of Applied Psychology, Bahauddin Zakariya UniversityMultan, Pakistan
Farooq Naeem
Affiliation:
University of Toronto and Centre for Addiction & Mental Health, Toronto, Canada
Muhammad Irfan*
Affiliation:
Department of Mental Health, Psychiatry & Behavioural Sciences, Peshawar Medical College, Riphah International University, Islamabad, Pakistan
*
*Corresponding author. Email: [email protected]

Abstract

Background:

Social anxiety is common among adolescents in Pakistan and is associated with low self-esteem. Among the recommended treatments, cognitive behavioural therapy (CBT) is effective, and self-help approaches are encouraged.

Aim:

To determine the effectiveness of culturally adapted CBT-based guided self-help (CACBT-GSH) intervention, using a manual ‘Khushi aur Khatoon’, for treating social anxiety when added to treatment as usual (TAU) compared with TAU only.

Method:

A total of 76 adolescents with social anxiety aged 13–16 years from six schools in Multan, Pakistan were recruited into this randomized controlled trial. Participants were divided into intervention and control groups in a 1:1 ratio. Social anxiety, self-esteem and fear of negative evaluation were assessed through the Liebowtiz Social Anxiety Scale for children and adolescents, the Rosenberg Self-Esteem Scale and the Brief Fear of Negative Evaluation, respectively, at baseline and at the end of the study. Guided self-help using culturally adapted CBT (CACBT)-based self-help manual (eight sessions, one session per week) was provided to the intervention group. The effect of the CACBT-GSH intervention was analysed with ANCOVA.

Results:

There was a statistically significant difference between the intervention and the control groups in favour of intervention. Participants in the intervention group showed reduced symptoms of social anxiety (p < .001), fear of negative evaluation (p < .001) and enhanced self-esteem (p < .001).

Conclusion:

The study demonstrated the effectiveness of CACBT-based guided self-help intervention in treating social anxiety and addressing the symptoms associated with it.

Type
Main
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Ahmad, Z. R., Bano, N., Ahmad, R., & Khanam, S. J. (2013). Social anxiety in adolescents: does self esteem matter? Asian Journal of Social Sciences & Humanities, 2, 9198.Google Scholar
Ahmed, R., & Bano, Z. (2013). Morbidity of social anxiety in adolescent students in Pakistan. Procedia World Academy of Science, Engineering and Technology, 79.Google Scholar
Aguilera, A., Garza, M. J., & Muñoz, R. F. (2010). Group cognitive-behavioral therapy for depression in Spanish: culture-sensitive manualized treatment in practice. Journal of Clinical Psychology, 66, 857867. doi: 10.1002/jclp.20706CrossRefGoogle ScholarPubMed
Al-Naggar, R. A. (2012). Prevalence and Associated Factors of Phobia and Social Anxiety among University Students. Association of Southeast Asian Nations Journal of Psychiatry, 13, 112121.Google Scholar
Bagley, C., & Mallick, K. (2001). Normative data and mental health construct validity for the Rosenberg Self-Esteem Scale in British adolescents. International Journal of Adolescence and Youth, 9, 117126.CrossRefGoogle Scholar
Bano, N., Riaz, Z., & Khanam, S. A. (2009). Translation and adaptation of Brief Fear of Negative Evaluation Scale (BFNE) in Pakistan. Pakistan Journal of Psychology, 40, 97106.Google Scholar
Baumeister, R. F., Campbell, J. D., Krueger, J. I., & Vohs, K. D. (2003). Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public Interest, 4, 144. doi: 10.1111/1529-1006.01431CrossRefGoogle ScholarPubMed
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25, 31863191.CrossRefGoogle ScholarPubMed
Berger, T., Caspar, F., Richardson, R., Kneubühler, B., Sutter, D., & Andersson, G. (2011). Internet-based treatment of social phobia: a randomized controlled trial comparing unguided with two types of guided self-help. Behaviour Research and Therapy, 49, 158169. doi: 10.1016/j.brat.2010.12.007CrossRefGoogle ScholarPubMed
Beidel, D. C., Turner, S. M., & Morris, S. M. (1999). Psychopathology of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 643650.CrossRefGoogle ScholarPubMed
Beidel, D. C., Turner, S. M. & Morris, T. L. (2000). Behavioral assessment of childhood social phobia. Journal of Consulting and Clinical Psychology, 68, 10721080.CrossRefGoogle Scholar
Beesdo-Baum, K., Knappe, S., Fehm, L., Hofler, M., Lieb, R., Hofmann, S.et al. (2012). The natural course of social anxiety disorder among adolescents and young adults. Acta Psychiatrica Scandinavica, 126, 411e425.CrossRefGoogle ScholarPubMed
BigFoot, D. S., & Schmidt, S. R. (2010). Honoring children, mending the circle: cultural adaptation of trauma-focused cognitive-behavioral therapy for American Indian and Alaska Native children. Journal of Clinical Psychology, 66, 847856. doi: 10.1002/jclp.20707CrossRefGoogle ScholarPubMed
Burstein, M., He, J. P., Kattan, G., Albano, A. M., Avenevoli, S., & Merikangas, K. R. (2011). Social phobia and subtypes in the National Comorbidity Survey adolescent supplement: prevalence, correlates, and comorbidity. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 870880.CrossRefGoogle ScholarPubMed
Cheek, J. M., & Melchior, L. A. (1990). Shyness, self-esteem and self-consciousness. In Leitenberg, H. (ed), Handbook of Social and Evaluation Anxiety, pp. 4782. New York, USA: Plenum Press.CrossRefGoogle Scholar
Cheng, G., Zhang, D., & Ding, F. (2014). Self-esteem and fear of negative evaluation as mediators between family socioeconomic status and social anxiety in Chinese emerging adults. International Journal of Social Psychiatry, 61, 569576. doi: 10.1177/0020764014565405CrossRefGoogle ScholarPubMed
Cherry, K. (2018). What is test anxiety?; https://www.verywellmind.com/what-is-test-anxiety-2795368 (accessed 3 November 2018).Google Scholar
Clark, D. M., & McManus, F. (2002). Information processing in social phobia. Biological Psychiatry, 51, 92100. https://doi.org/10.1016/S0006-3223(01)01296-3CrossRefGoogle ScholarPubMed
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A., & Schneier, F. R. (eds), Social Phobia: Diagnosis, Assessment, and Treatment, pp. 6993. New York, USA: Guilford Press.Google Scholar
Costello, E., J. Egger, H. L., Copeland, W., Erkanli, A., & Angold, A. (2011). The developmental epidemiology of anxiety disorders: phenomenology, prevalence, and comorbidity. In Silverman, W. K., & Field, A. P. (eds), Anxiety Disorders in Children and Adolescents, pp. 5675. Cambridge, UK: Cambridge University Press. http://doi.org/10.1017/CBO9780511994920.004CrossRefGoogle Scholar
Coutinho, F. C., Dias, G. P., Marques, R. S., Range, B. P., Brasil, M. A. A., Filpi, A., & Nardi, A. E. (2017). Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patients with low educational attainment. Trends in Psychology, 25, 14111426. http://dx.doi.org/10.9788/TP2017.3-22Google Scholar
Cuncic, A. (2018). Tips for Managing Public Speaking Anxiety. https://www.verywellmind.com/tips-for-managing-public-speaking-anxiety-3024336 (accessed 24 September, 2018).Google Scholar
Cuijpers, P. (2017). Treatment of depression. In SAGE Encyclopedia of Abnormal and Clinical Psychology (pp. 10631066).Google Scholar
Cuijpers, P., Eylem, O., Karyotaki, E., Zhou, X., & Sijbrandij, M. (2019). Psychotherapy for depression and anxiety in low and middle income countries. In Stein, D., Bass, J. & Hofmann, S. (eds), Global Mental Health and Psychotherapy: Adapting Psychotherapy for Low and Middle Income Countries, pp. 173192. USA: Academic Press. https://doi.org/10.1016/B978-0-12-814932-4.00008-2CrossRefGoogle Scholar
Dilbaz, N., Enez, A., & Cavus, S. Y. (2011). Social anxiety disorder. In Saleh, S. (ed), Different Views of Anxiety Disorders, pp, 2336. USA: InTech.Google Scholar
Edelmann, R. J., & Baker, S. R. (2002). Self-reported and actual physiological responses in social phobia. British Journal of Clinical Psychology, 41, 114. https://doi.org/doi:10.1348/014466502163732CrossRefGoogle ScholarPubMed
Fenn, K. & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6, 579585. https://doi.org/10.1177/1755738012471029CrossRefGoogle Scholar
Furmark, T. (2002). Social phobia: overview of community studies. Acta Psychiatra Scandinavica, 105, 8493.CrossRefGoogle Scholar
Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., … Andersson, G. (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. British Journal of Psychiatry, 195, 440447. doi: 10.1192/bjp.bp.108.060996CrossRefGoogle ScholarPubMed
Gilbert, P. (2000). The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clinical Psychology & Psychotherapy, 7, 174189. doi: 10.1002/1099-0879(200007)7:33.0.CO;2-U>CrossRefGoogle Scholar
Guo, F., & Hanley, T. (2014). Adapting cognitive behavioral therapy to meet the needs of Chinese clients: opportunities and challenges. PsyCh Journal, 4, 5565. doi: 10.1002/pchj.75CrossRefGoogle ScholarPubMed
Hewitt, J. P. (2009). Oxford Handbook of Positive Psychology, pp. 217224. Oxford, UK: Oxford University Press.Google Scholar
Heimberg, R. G., & Becker, R. E. (2002). Cognitive-Behavioral Group Therapy for Social Phobia. New York, USA: Guilford Press.Google Scholar
Heimberg, R. G., Stein, M. B., Hiripi, E., & Kessler, R. C. (2000). Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades, European Psychiatry, 15, 2937.CrossRefGoogle ScholarPubMed
Hinton, D. E., Hofmann, S. G., Rivera, E., Otto, M. W., & Pollack, M. H. (2011). Culturally adapted CBT (CA-CBT) for Latino women with treatment-resistant PTSD: a pilot study comparing CA-CBT to applied muscle relaxation. Behaviour Research and Therapy, 49, 275280. doi: 10.1016/j.brat.2011.01.005CrossRefGoogle ScholarPubMed
Horrell, L., Goldsmith, K. A., Tylee, A. T., Schmidt, U. H., Murphy, C. L., Bonin, E. M., Beecham, J., Kelly, J., Raikundalia, S., & Brown, J. S. (2014). One-day cognitive–behavioural therapy self-confidence workshops for people with depression: randomised controlled trial. British Journal of Psychiatry, 204, 222233. doi: 10.1192/bjp.bp.112.121855CrossRefGoogle ScholarPubMed
Hullu, E., Sportle, B. E., Nauta, M. H., & de Jong, P. J. (2017). Cognitive bias modification and CBT as early interventions for adolescent social and test anxiety: two-year follow-up of a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 55, 8189. doi: https://doi.org/10.1016/j.jbtep.2016.11.011CrossRefGoogle ScholarPubMed
Iqbal, A., & Ajmal, A. (2018). Fear of negative evaluation and social anxiety in young adults. Peshawar Journal of Psychology and Behavioral Sciences, 4, 4957.Google Scholar
Izgic, F., Akyüz, G., Dogan, O., & Kugu, N. (2004). Social phobia among university students and its relation to self-esteem and body image. Canadian Journal of Psychiatry, 49, 630634. PMID: 15503736CrossRefGoogle ScholarPubMed
Jankowska, M. (2019). Cultural modifications of cognitive behavioural treatment of social anxiety among culturally diverse clients: a systematic literature review. the Cognitive Behaviour Therapist, 12.CrossRefGoogle Scholar
Kananian, S., Ayoughi, S., Farugie, A., Hinton, D., & Stangier, U. (2017). Transdiagnostic culturally adapted CBT with Farsi-speaking refugees: a pilot study. European Journal of Psychotraumatology, 8, 1390362. doi: 10.1080/20008198.2017.1390362CrossRefGoogle ScholarPubMed
Kessler, R. C., Avenevoli, S., Costello, E. J., Georgiades, K., Green, J. G., Gruber, M. J., … & Sampson, N. A. (2012). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry, 69, 372380.Google ScholarPubMed
Khan, H., Kalia, S., Itrat, A., Khan, A., Kamal, M., Khan, M. A., & Naqvi, H. (2007). Prevalence and demographics of anxiety disorders: a snapshot from a community health centre in Pakistan. Annals of General Psychiatry, 6, 30. doi: 10.1186/1744-859x-6-30.CrossRefGoogle ScholarPubMed
Kocovski, N. L., & Endler, N. S. (2000). Social anxiety, self regulation, and fear of negative evaluation. European Journal of Personality, 14, 347358.3.0.CO;2-7>CrossRefGoogle Scholar
Kumar, G. J., Athilakshmi, R., Maharishi, R., & Maya, R. (2015). Relationship between fear of negative evaluation and anxiety. International Journal of Indian Psychology, 3, 6. DIP: C03100V3I12015Google Scholar
Gren-Landell, M., Tillfors, M., Furmark, T., Bohlin, G., Andersson, G., & Svedin, G. (2009). Social phobia in Swedish adolescents: prevalence and gender differences. Social Psychiatry and Psychiatric Epidemiology, 44, 17.CrossRefGoogle ScholarPubMed
Lawrence, D., Johnson, S., Hafekost, J., Boterhoven De Haan, K., Sawyer, M., Ainley, J.et al. (2015). The mental health of children and adolescents. Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra, Australia: Department of Health.Google ScholarPubMed
Leary, M. R. (1983). A brief version of the fear of negative evaluation scale. Personality and Social Psychology Bulletin, 9, 371375. doi: 10.1177/0146167283093007CrossRefGoogle Scholar
Liebowitz, M. R. (2014). Test for Social Anxiety Disorder. Columbia University Medical Center.Google Scholar
Marsh, H. W. (1990). Causal ordering of academic self-concept and academic achievement: a multiwave, longitudinal path analysis. Journal of Educational Psychology, 82, 646656. doi: 10.1037/0022-0663.82.4.646CrossRefGoogle Scholar
Masia, C. L., Klein, R. G., & Liebowitz, M. R. (1999). The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) (available from Carrie Masia-Warner, NYU Child Study Center, 215 Lexington Avenue, 13th floor, New York, NY 10016, USA).Google Scholar
Masia-Warner, C., Storch, E. A., Pincus, D. B., Klein, R. G., Heimberg, R. G., & Liebowitz, M. R. (2003). The Liebowitz Social Snxiety Scale for children and adolescents: an initial psychometric investigation. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 10761084.CrossRefGoogle Scholar
Mehtalia, K., & Vankar, G. K. (2004). Social anxiety in adolescents. Indian Journal of Psychiatry, 46, 221227.Google ScholarPubMed
Mir, G., Ghani, R., Meer, S., & Hussain, G. (2019). Delivering a culturally adapted therapy for Muslim clients with depression. the Cognitive Behaviour Therapist, 12, e26. doi: 10.1017/S1754470X19000059CrossRefGoogle Scholar
Mirza, I., & Jenkins, R. (2004). Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. British Medical Journal, 328, 794799. doi: 10.1136/bmj.328.7443.794CrossRefGoogle ScholarPubMed
Naeem, F., Gobbi, M., Ayub, M., & Kingdon, D. (2010). Psychologists experience of cognitive behaviour therapy in a developing country: a qualitative study from Pakistan. International Journal of Mental Health Systems, 4, 19. doi: 10.1186/1752-4458-4-2CrossRefGoogle Scholar
Naeem, F., Irfan, M., & Ayub, M. (2015). Khushi aur Khatoon, self help guide. Pakistan Association of cognitive therapists (PACT). http://www.pact.com.pkGoogle Scholar
Naeem, F., Phiri, P., Rathod, S., & Ayub, M. (2019). Cultural adaptation of cognitive-behavioural therapy. BJPsych Advances, 25, 387395.CrossRefGoogle Scholar
Naeem, F., Sarhandi, S., Gul, M., Khalid, M., Aslam, M., Anbrin, A., Saeed, S., Noor, M., Fatima, G., Minhas, S., Husain, N., Ayub, M. (2014). A multicentre randomized controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan. Journal of Affective Disorders, 156, http://dx.doi.org/10.1016/j.jad.2013.10.051Google ScholarPubMed
Nall, R. (2017). Shy bladder (paruresis). https://www.healthline.com/health/shy-bladder (accessed 24 July 2017).Google Scholar
Naz, S., Gregory, R., & Bahu, M. (2019). Addressing issues of race, ethinicity and culture in CBT to support therapist and service managers to deliever culturally competent therapy and reduce inequalities in mental health provision for BAME service users. the Cognitive Behaviour Therapist, 12, e22. doi: 10.1017/S1754470X19000060CrossRefGoogle Scholar
Quinn, E. (2018), Overcoming performance anxiety with sports psychology. https://www.verywellfit.com/sports-psychology-for-performance-anxiety-3119436 (accessed 4 September 2018).Google Scholar
Radek (2013). Fear of Authority Figures: 7 Tips on How to Talk to Authority Figures. http://www.socialanxietyhome.com/fear-of-authority-figures-how-to-talk-to-authority-figures/ (accessed 14 December 2013).Google Scholar
Ranta, K., Kaltiala-Heino, R., Koivisto, A. M., Pelkonen, M., & Marttunen, M. (2007). Age and gender differences in social anxiety symptoms during adolescence: the Social Phobia Inventory (SPIN) as a measure. Psychiatry Research, 153, 261270.CrossRefGoogle ScholarPubMed
Ranta, K., Kaltiala-Heino, R., Rantanen, P., & Marttunen, M. (2009). Social phobia in Finnish general adolescent population: prevalence, comorbidity, individual and family correlates, and service use. Depression and Anxiety, 26, 528536.Google ScholarPubMed
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741756. http://10.1016/S0005-7967(97)00022-3CrossRefGoogle ScholarPubMed
Rao, P. A., Deborah, C. B., Turner, S. M., Ammermanb, R. T., Crosby, L. E., & Sallee, F. R. (2007). Social anxiety disorder in childhood and adolescence: descriptive psychopathology. Behaviour Research and Therapy, 45, 11811191.CrossRefGoogle ScholarPubMed
Rathod, S., Phiri, P. & Naeem, F. (2019). An evidence-based framework to culturally adapt cognitive behaviour therapy. the Cognitive Behaviour Therapist, 12. doi: 10.1017/S1754470X18000247CrossRefGoogle Scholar
Rizwan, M., Aftab, S., Shah, I., & Dharwarwala, R. (2012). Psychometric properties of the Rosenberg self-esteem scale in Pakistani late adolescents. The International Journal of Educational and Psychological Assessment, 10, 125138.Google Scholar
Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 16, 169.CrossRefGoogle ScholarPubMed
Rosenberg, M. (1965). Society and Adolescent Self-Image. Princeton, NJ, USA: Princeton University Press.CrossRefGoogle Scholar
Schlenker, B. (1980). Impression Management: The Self-Concept, Social Identity, and Interpersonal Relations. Monterey, CA, USA: Brooks/Cole Publishing.Google Scholar
Smith, E. R. & Mackie, D. M. (2007). Social Psychology (3rd edn). Hove, UK: Psychology Press. ISBN 978-1-84169-408-5Google ScholarPubMed
Soltani, R., Ahghar, Q., & Asadzadeh, H. (2013). Determining the effectiveness of cognitive–behavioral therapy on social anxiety reduction of female high school students. Pelagia Research Library European Journal of Experimental Biology, 3, 653657.Google Scholar
Spence, S. H., Donovan, C., & Brechman-Toussaint (1999). Social skills, social outcomes, and cognitive features of childhood social phobia. Journal of Abnormal Psychology, 108, 211221.CrossRefGoogle ScholarPubMed
Spence, S. H., & Rapee, R. M. (2016). The etiology of social anxiety disorder: an evidence-based model. Behaviour Research and Therapy, 86, 5667. http://dx.doi.org/10.1016/j.brat.2016.06.007CrossRefGoogle Scholar
Supple, A. J., & Plunkett, S. W. (2011). Dimensionality and validity of the Rosenberg Self-Esteem Scale for use with Latino adolescents. Hispanic Journal of Behavioral Sciences, 33, 3953.CrossRefGoogle Scholar
Wang, P. S., Guilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Borges, G., Bromet, E. J.et al. (2007). Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet, 370, 841850.CrossRefGoogle ScholarPubMed
Warwick., H., Reardon, T., Cooper, P., Murayama, K., Reynolds, S., Wilson, C. & Creswell, C. (2017). Complete recovery from anxiety disorders following cognitive behavior therapy in children and adolescents: a meta-analysis. Clinical Psychology Review, 52, 7791. doi: http://dx.doi.org/10.1016/j.cpr.2016.12.002CrossRefGoogle ScholarPubMed
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448457. doi: 10.1037/h0027806CrossRefGoogle ScholarPubMed
Yamey, G. (2012). What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science. Globalization and Health, 8, 11.CrossRefGoogle ScholarPubMed
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