A 21-year-old Korean, single, and immigrant male presented to therapy with significant symptoms of social anxiety disorder (SAD) for treatment at a university training clinic. At the time of intake, he was experiencing intense distress and remarkable adaptations in his life to accommodate rather chronic physiological symptoms related to social interactions. He immigrated to the United States 5 years prior to treatment from Seoul, Korea. He endured social anxiety for 6 years preceding treatment. The case was conceptualized and treated from a cognitive-behavioral framework. Treatment gains were measured using behavioral markers and a reliable change index using standardized outcome measures. This case illustrates the ability to adhere to a cognitive-behavioral treatment model for SAD while considering pertinent cultural factors. Furthermore, it highlights the generalizability of a specific treatment model when working with Korean immigrants. The authors discuss the need for future research, and treatment implications of this case are described.
AbbottM. J.RapeeR. M. (2004). Post-event rumination and negative self-appraisal in social phobia before and after treatment. Journal of Abnormal Psychology, 113, 136-144.
2.
AddisM. E.WadeW. A.HatgisC. (1999). Barriers to dissemination of evidence-based practice: Addressing practitioners’ concerns about manual-based psychotherapies. Clinical Psychology: Science and Practice, 6, 430-441.
3.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
4.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
5.
BeckA. T.SteerR. A.BrownG. K. (1996). Beck Depression Inventory Manual (2nd ed.). San Antonio, TX: Psychological Corporation.
6.
BeckerC. B.ZaefertC.AndersonE. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277-292.
7.
BeutlerL. E.HarwoodT. M. (2001). Antiscientific attitudes: What happens when scientists are unscientific?Journal of Clinical Psychology, 57, 43-51.
8.
BrownE. J.TurovskyJ.HeimbergR. G.JusterH. R.BrownT. A.BarlowD. H. (1997). Validation of the Social Interaction Anxiety Scale and the Social Phobia Scale across the anxiety disorders. Psychological Assessment, 9, 21-27.
9.
BrownT. A.Di NardoP. A.BarlowD. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). San Antonio, TX: Psychological Corporation/Graywind Publications Incorporated.
10.
CarletonR. N.PelusoD. L.CollimoreK. C.AsmundsonG. J. G. (2011). Social anxiety and posttraumatic stress symptoms: The impact of distressing social events. Journal of Anxiety Disorders, 25, 49-57.
11.
ChamblessD. L.OllendickT. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.
12.
ChenS. W.-H.DavenportD. S. (2005). Cognitive-behavioral therapy with Chinese American clients: Cautions and modifications. Psychotherapy: Theory, Research, Practice, Training, 42, 101-110.
13.
ChoM. J.KimJ. K.JeonH. J.SuhT.ChungI. W.HongJ. D.. . . HahmB. J. (2007). Lifetime and 12-month prevalence of DSM-IV psychiatric disorders among Korean adults. Journal of Nervous and Mental Disease, 195, 203-210.
14.
ClarkD. M.WellsA. (1995). A cognitive model of social phobia. In HeimbergR.LiebowitzM.HopeD. A.SchneierF. R. (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69-93). New York, NY: Guilford.
15.
DalrympleK. L.ZimmermanM. (2011). Age of onset of social anxiety disorder in depressed outpatients. Journal of Anxiety Disorders, 25, 131-137.
16.
DozoisD. J. A.DobsonK. S.AhnbergJ. L. (1998). A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment, 10, 83-89.
17.
EbyM. D.ChinJ. L.RollockD. R.SchwartzJ. P.WorrellF. C. (2011). Professional psychology training in the era of a thousand flowers: Dilemmas and challenges for the future. Training and Education in Professional Psychology, 5, 57-68.
18.
ErwinB. A.HeimbergR. G.JusterH.MindlinM. (2002). Comorbid anxiety and mood disorders among persons with social anxiety disorder. Behaviour Research and Therapy, 40, 19-35.
19.
Falk DahlC. A.DahlA. A. (2010). Lifestyle and social network in individual with high level social anxiety symptoms: A community-based study. Social Psychiatry and Psychiatric Epidemiology, 45, 309-317.
20.
FeenyN. C.HembreeE. A.ZoellnerL. A. (2003). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice, 10, 85-90.
21.
FeskeU.ChamblessD. L. (1995). Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis. Behavior Therapy, 26, 695-720.
22.
FoaE. B.McNallyR. J. (1996). Mechanisms of change in exposure therapy. In RapeeR. M. (Ed.), Current controversies in the anxiety disorders (pp. 329-443). New York, NY: Guilford.
23.
FyerA. J.MannuzzaS.ChapmanT. F.LiebowitzM. R.KleinD. F. (1993). A direct interview family study of social phobia. Archives of General Psychiatry, 50, 286-293.
24.
GouldR. A.BuckminsterS.PollackM. H.OttoM. W.YapL. (1997). Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis. Clinical Psychology: Science and Practice, 4, 291-306.
25.
HaackS. (1996). Concern for truth: What it means, why it matters. In GrossP. R.LevittN.LewisM. W. (Eds.), The flight from science and reason (pp. 57-63). New York: New York Academy of Sciences.
26.
HahnH. M.YumT. H.ShinY. W.KimK. H.YoonD. J.JungK. J. (1986). A standardization study of Beck Depression Inventory. Journal of Korean Neuropsychiatric Association, 25(3), 487-500.
27.
HaydenM. J.DixonJ. B.DixonM. E.O’BrienP. E. (2010). Confirmatory factor analysis of the Beck Depression Inventory in obese individuals seeking surgery. Obesity Surgery, 20, 432-439.
28.
HaysP. A. (2001). Addressing cultural complexities in practice: A framework for clinicians and counselors. Washington, DC: American Psychological Association.
29.
HeimbergR. G.BeckerR. E. (2002). The nature and treatment of social fears and phobias. New York, NY: Guilford.
30.
HeinrichsN.HofmannS. G. (2001). Information processing in social phobia: A critical review. Clinical Psychology Review, 21, 751-770.
31.
HerbertJ. D.CardaciottoL. (2005). An acceptance and mindfulness-based perspective on social anxiety disorder. In OrsilloS. M.RoemerL. (Eds.), Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment (pp. 189-212). New York, NY: Springer.
32.
HerbertJ. D.LilienfeldS. O.LohrJ. M.MontgomeryR. W.O’DonohueW. T.RosenG. M.TolinD. F. (2000). Science and pseudoscience in the development of eye movement desensitization and reprocessing: Implications for clinical psychology. Clinical Psychology Review, 20, 945-971.
33.
HofmannS. G. (2010). Recent advances in the psychosocial treatment of SAD. Depression and Anxiety, 27, 1073-1076.
34.
HofmannS. G.AsnaaniA.HintonD. F. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depression and Anxiety, 27, 1117-1127.
35.
HofmannS. G.MoscovitchD. A.KimH. J.TaylorA. N. (2004). Changes in self-perception during treatment of social phobia. Journal of Consulting and Clinical Psychology, 72, 588-596.
36.
HofmannS. G.OttoM. W. (2008). Cognitive behavioral therapy for SAD: Evidenced-based and disorder specific treatment techniques. New York, NY: Routledge.
37.
HsuL.AldenL. (2007). Social anxiety in Chinese- and European-heritage students: The effect of assessment format and judgments of impairment. Behavior Therapy, 38, 120-131.
38.
HsuL.AldenL. (2008). Cultural influences on willingness to seek treatment for social anxiety in Chinese- and European-heritage students. Cultural Diversity & Ethnic Minority Psychology, 14, 215-223.
39.
HuangL. N. (1994). An integrative approach to clinical assessment and intervention with Asian-American adolescents. Journal of Clinical Child Psychology, 23, 21-31.
40.
JacobsonN. S.TruaxP. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.
41.
KendlerK. S.NealeM. C.KesslerR. C.HeathA. C.EavesL. J. (1992). The genetic epidemiology of phobias in women: The inter-relationship of agoraphobia, social phobia, situational phobia and simple phobia. Archives of General Psychiatry, 49, 273-281.
42.
KesslerR. C.McGonagleK. A.ZhaoS.NeslonC. B.HughesM.EshlemanS.. . . KendlerK. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the national comorbidity survey. Archives of General Psychiatry, 51, 8-19.
43.
LeeC. K.KwakY. S.YamamotoJ.RheeH.KimY. S.HanJ. H.. . . LeeY. H. (1990). Psychiatric epidemiology in Korea: Part II: Urban and rural differences. Journal of Nervous and Mental Disease, 18, 247-252.
44.
LeeY.SongJ. (1991). A study of reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean Journal of Clinical Psychology, 10, 98-113.
45.
LuborskyL.SingerB.LuborskyL. (1975). Comparative studies of psychotherapies: Is it true that “Everyone has won and all must have prices?”Archives of General Psychiatry, 32, 995-1008.
46.
MallottM.ManerJ. K.DeWallC. N.SchmidtN. B. (2009). Compensatory deficits following rejection: The role of social anxiety in disrupting affiliative behavior. Depression and Anxiety, 26, 438-446.
47.
MattickR. P.ClarkeJ. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470.
48.
MattickR. P.PetersL. (1988). Treatment of severe social phobia: Effects of guided exposure with and without cognitive restructuring. Journal of Consulting and Clinical Psychology, 56, 251-260.
49.
MattickR. P.PetersL.ClarkeJ. C. (1989). Exposure and cognitive restructuring for social phobia: A controlled study. Behavior Therapy, 20, 3-23.
50.
MoreyL. C. (1991). The Personality Assessment Inventory Professional Manual. Odessa, FL: Psychological Assessment Resources.
51.
MoreyL. C. (2003). Essentials of PAI assessment. New York, NY: John Wiley.
52.
MowrerO. H. (1960). “Sin,” the lesser of two evils. American Psychologist, 15, 301-304.
53.
OkazakiS. (1997). Sources of ethnic differences between Asian American and White American college students on measures of depression and social anxiety. Journal of Abnormal Psychology, 106, 52-60.
54.
OkazakiS.LiuJ. F.LongworthS. L.MinnJ. Y. (2002). Asian American-White American differences in expressions of social anxiety: A replication and extension. Cultural Diversity & Ethnic Minority Psychology, 8, 234-247.
55.
RachmanS.Gruter-AndrewJ.ShafranR. (2000). Post-event processing in social anxiety. Behaviour Research and Therapy, 38, 611-617.
56.
RuscioA. M.BrownT. A.ChiuW. T.SareenJ.SteinM. B.KesslerR. C. (2008). Social fears and social phobia in the USA: Results from the national comorbidity survey replication. Psychological Medicine, 38(1), 15-28.
57.
SchreierS.HeinrichsN.AldenL.RapeeR. M.HofmannS. G.ChenJ. . . BogelsS. (2010). Social anxiety and social norms in individualistic and collectivistic countries. Depression and Anxiety, 27, 1128-1134.
58.
SingelisT. M.SharkeyW. F. (1995). Culture, self-construal, and embarrassability. Journal of Cross-Cultural Psychology, 26, 622-644.
59.
StewartR. E.ChamblessD. L. (2009). Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology, 77, 595-605.
60.
SueD. W.SueD. (2008). Counseling the culturally diverse: Theory and practice. New Jersey, NJ: Wiley & Sons.
61.
SuhE.DienerE.OishiS.TriandisH. C. (1998). The shifting basis of life satisfaction judgment across cultures: Emotions versus norms. Journal of Personality and Social Psychology, 74, 482-493.
62.
SuzukiK.TakeiN.KawaiM.MinabeY.MoriN. (2003). Is Taijin kyofusho a culture-bound syndrome?American Journal of Psychiatry, 160, 1358.
63.
TataS. P.LeongF. T. L. (1994). Individualism-collectivism, social-networking orientation, and acculturation as predictors of attitudes toward seeking professional psychological help among Chinese-Americans. Journal of Counseling Psychology, 41, 280-287.
64.
TurkC. L.HeimbergR. G.MageeL.BarlowD. H. (2008). Social anxiety disorder. In BarlowD. H. (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed., pp. 123-163). New York, NY: Guilford.
65.
WechslerD. (1999). Wechsler Abbreviated Scale of Intelligence (WASI). San Antonio, TX: Harcourt Assessment.
66.
WellsA.ClarkD. M.SalkovskisP.LudgateJ.HackmannA.GelderM. G. (1995). Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy, 26, 153–161.
67.
WellsA.PapageorgiouC. (1998). Social phobia: Effects of external attention on anxiety, negative beliefs, and perspective taking. Behavior Therapy, 29, 357-370.
68.
WittchenH. U.BelochE. (1996). The impact of social phobia on quality of life. International Clinical Psychopharmacology, 11(3), 15-23.
69.
YingY.MillerL. S. (1992). Help-seeking behavior and attitude of Chinese Americans regarding psychological problems. American Journal of Community Psychology, 20, 549-555.
70.
YomanJ. (2008). A primer on functional analysis. Cognitive and Behavioral Practice, 15, 325-340.
71.
ZhangN.DixonD. N. (2003). Acculturation and attitudes of Asian international students toward seeking psychological help. Journal of Multicultural Counseling and Development, 31(3), 205-222.
