Anxiety disorders are often developed in adolescents, influencing their social functioning and academic progress. However, the application of certain therapeutic interventions and counseling techniques in order to treat anxiety disorders in teenagers should depend on the cultural context. The cultural group that will be discussed in this paper is represented by a 13-year-old African American male who suffers from anxiety disorder. African American adolescents have high risks of developing anxiety disorders because of such factors as the social impact, chronic neighborhood stressors, possible poverty, violence, potential racial discrimination, as well as problems in their family and school (Lee et al., 2019). The treatment plan offered to address anxiety disorder in the selected 13-year-old African American male will be based on such interventions as Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Intervention (MBI) because their effectiveness is supported in randomized controlled trials and systematic reviews.
Identification and Description of Interventions to Address Anxiety in African American Adolescents
The specific interventions that are most appropriate for coping with anxiety in African American male children and adolescents are Cognitive Behavioral Therapy and the Mindfulness-Based Intervention. For this specific case of a 13-year-old African American male, it is effective to apply the culturally-relevant CBT intervention for reducing stress and anxiety known as the Adapted-Coping with Stress Course (A-CWS). In the context of this CBT-based intervention, it is necessary to reduce negative cognitions and thoughts in African American adolescents, acknowledge stressors, identify inappropriate behavioral patterns, and develop coping skills (Robinson et al., 2015). Referring to a culturally appropriate A-CWS, African American teenagers can realize the source of their anxiety and learn how to cope with it in the most efficient manner.
The focus should be on decreasing the effects of stress-related environments for young African Americans that can cause ineffective reactions and behaviors and on developing effective coping mechanisms. This culture- and age-oriented intervention helps African Americans identify stress factors, recognize their consequences, and apply stress- and anxiety-coping approaches. For young African Americans, triggers and stressors can include neighborhood violence, inappropriate social and financial conditions, racism, and discrimination, among others (Robinson et al., 2015). As a result, the CBT-based A-CWS is an effective evidence-based intervention to be used in a treatment plan for a 13-year-old African American male.
The Mindfulness-Based Intervention is grounded in the development of mindfulness in young patients suffering from anxiety. Mindfulness is usually achieved with the help of training guided by a counselor when a young client develops their awareness of the situation, focuses on the present moment and one’s feelings. Being involved in MBI, young patients learn how to develop focused attention, concentrate on the present moment and reactions, and regulate their emotions and feelings (Zoogman et al., 2015). Counselors conduct certain exercises with clients to help them improve their focused attention and concentration on current thoughts and feelings. Patients also learn decentering by reflecting on their experiences and emotions rather than judging them (Zoogman et al., 2015). As a result of MBI, young individuals learn how to cope with anxious and depressive thoughts based on their inadequate self-judgment that can be associated with their surroundings and everyday experiences at home or at school.
In order to work with African American children and adolescents, adapted variants of MBI are used to be able to focus on challenges typical of adolescence. The cultural aspect is also important, and this intervention covers the following critical factors: interpersonal relations, academic performance issues, discrimination, social aspects, stress, and the impact of the neighborhood (Zoogman et al., 2015). As a result, the modified MBI for minority children and adolescents allows for developing mindfulness, referring to a specific context, which influences these individuals’ progress and coping with anxiety.
Summary of Incorporating Interventions into the Treatment Plan
Treatment Plan: Variant One
Depending on the two proposed interventions, it is possible to develop two treatment plans based on the summary of different ways of how it is possible to incorporate the interventions into treatment. The first treatment plan for a 13-year-old African American male who was diagnosed with anxiety and a learning disability will be grounded in the CBT-based A-CWS. This intervention is most effective when applied in the form of 15 45-minute sessions that are conducted in groups and individually weekly (Robinson et al., 2015). For this case, it is most efficient to use individual sessions, each of them is related to a certain topic:
- Understanding stress and anxiety;
- Identifying negative and positive thoughts;
- Discussing positive thinking;
- Working with self-defeating thinking;
- Coping strategies.
Each session included in the treatment plan has determined elements. They include a) the focus on discussing a specific week topic; b) review of the previous topic and results; c) behavioral activities and exercises; d) the application of the Consequence-Activating Event-Belief method. During sessions, the representatives of the identified cultural group will work with their mood diaries, discuss stressors and triggers, identify emotions and feelings, recognize behavioral patterns, and learn how to change negative emotions to positive ones (Lee et al., 2019). The Consequence-Activating Event-Belief method will help to recognize activating events (triggers), certain cognitions, and specific feelings that need to be reshaped in the context of comping mechanisms. Counselors work closely with young African American individuals to help them overcome anxiety with the help of the Adapted-Coping with Stress Course as a CBT-based intervention (Robinson et al., 2015). To achieve success, counselors need to build a strong rapport with a young patient and address possible non-adherence to treatment.
Treatment Plan: Variant Two
The second variant of the treatment plan may include 8 weekly sessions based on the application of MBI. It is important to note that MBI can be realized with the help of specific approaches:
- Mindfulness exercises including different types of mindfulness meditation and body scan;
- Mindfulness practices associated with a client’s daily activities.
During these exercises and practices, African American adolescents will learn how to regulate their emotions, practice focused attention, and apply decentering.
From this perspective, the key elements of the treatment plan based on the Mindfulness-Based Intervention are a) weekly group sessions; b) mindfulness exercises during sessions; and c) mindfulness practices during daily routines. The key goal for the African American adolescent with anxiety disorder is to learn how to concentrate on the present moment and control emotions to cope with stress and anxiety provoked by environmental factors, academic progress, or inner concerns (Zoogman et al., 2015). A counselor should pay much attention to teaching young patients how to self-reflect on their emotions without judging them and developing negative emotions that lead to being anxious.
Rationale: Effectiveness of the Interventions
In order to ensure that African American adolescents with anxiety can receive the most effective treatment, it is necessary to apply only the “best practice” interventions. CBT is viewed as the most effective approach to treat anxiety in teenagers, and its effectiveness is evidenced in the academic literature (Lee et al., 2019). In this case, a culturally adapted CBT (A-CWS) has been proposed because the orientation toward an African American male adolescent requires the application of the culturally adapted intervention (Robinson et al., 2015). The reason is that it allows a counselor to address all the risks associated with African American adolescents’ surroundings, stress factors, and other aspects that have an impact on the development of their anxiety.
The effectiveness of MBI is also supported in the literature on treating anxiety in African American youth. Problems are observed when minority adolescents cannot effectively oppose triggers from their surroundings and peers, and they develop negative emotions, reactions, and anxiety associated with their image. Mindfulness practices based on concentration and decentering are effective in coping with anxiety in teenagers and contribute to their emotion regulation (Zoogman et al., 2015). Therefore, counseling sessions based on MBI are actively used to address anxiety in young minority clients.
For the selected cultural group of African American adolescents with a focus on the case of a 13-year-old African American male who suffers from anxiety and a learning disability, two “best practice” interventions have been discussed. They are the culturally adapted CBT and MBI for children and the youth. These interventions can serve as the basis for developing effective treatment plans in order to cope with the patient’s stress and anxiety associated with the impact of external factors.
Lee, P., Zehgeer, A., Ginsburg, G. S., McCracken, J., Keeton, C., Kendall, P. C., Birmaher, B., Sakolsky, D., Walkup, J., Peris, T., & Albano, A. M. (2019). Child and adolescent adherence with cognitive behavioral therapy for anxiety: Predictors and associations with outcomes. Journal of Clinical Child & Adolescent Psychology, 48(sup1), S215-S226.
Robinson, W. L., Droege, J. R., Case, M. H., & Jason, L. A. (2015). Reducing stress and preventing anxiety in African American adolescents: A culturally-grounded approach. Global Journal of Community Psychology Practice, 6(2), 1-12.
Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness interventions with youth: A meta-analysis. Mindfulness, 6(2), 290-302.