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Tools for Treating Generalized Anxiety Disorder Among Latinos

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Abstract

The Latino population has been recognized as one of the fastest-growing groups in the United States. Among this group, estimates of the prevalence rates of generalized anxiety disorder (GAD) have been reported to range from 1% to 11%. While the treatment for GAD has been well researched among the general population, the bulk of this research has not included Spanish speakers. Working with the Spanish-speaking community requires awareness of the diversity of the Latino population and the cultural factors that may impact the presentation of generalized anxiety disorder. This book chapter aims to better prepare providers to work with the Latino community, specifically Spanish-speaking individuals with GAD. In this chapter, an overview of (1) cultural considerations in the presentation of GAD among Latinos, (2) evidence-based practices as they apply to Latinos in general and with regard to GAD specifically, (3) a session plan for treating GAD from an evidence-based perspective, and (4) Spanish language worksheets and tools that can be used in session is provided.

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References

  • Adler, N. E., & Newman, K. (2002). Socioeconomic disparities in health: Pathways and policies. Health Affairs, 21(2), 60–76. doi:10.1377/hlthaff.21.2.60

    Article  PubMed  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, 857–867. doi:10.1002/jclp.20706

    Article  PubMed  PubMed Central  Google Scholar 

  • Ai, A. L., Pappas, C., & Simonsen, E. (2015). Risk and protective factors for three major mental health problems among Latino American men nationwide. American Journal of Men's Health, 9(1), 64–75.

    Article  PubMed  Google Scholar 

  • Ai, A. L., Weiss, S. I., & Fincham, F. D. (2014). Family factors contribute to general anxiety disorder and suicidal ideation among Latina Americans. Women's Health Issues, 24(3), 345–352. doi:10.1016/j.whi.2014.02.008

    Article  Google Scholar 

  • Alegría, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97(1), 68–75. http://doi.org/10.2105/AJPH.2006.087205

    Article  PubMed  PubMed Central  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Book  Google Scholar 

  • American Psychological Association. (2016). Ethnic and racial minorities & socioeconomic status. Retrieved from: http://www.apa.org/pi/ses/resources/publications/minorities.aspx

  • Asnaani, A., Richey, A., Dimaite, R., Hinton, D. E., & Hofmann, S. G. (2010). A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. The Journal of Nervous and Mental Disease, 198(8), 551–555.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barlow, D. H. (2002a). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Barlow, D. H. (2002b). The nature of anxious apprehension. In D. H. Barlow (Ed.), Anxiety and it’s disorders: The nature and treatment of anxiety and panic (2nd ed., pp. 64–104). New York: The Guilford Press.

    Google Scholar 

  • Barlow, D. H., & Craske, M. G. (2007). Mastery of your anxiety and panic. New York, NY: Oxford University Press.

    Google Scholar 

  • Barlow, D. H., Chorpita, B. F., & Turovsky, J. (1996). Fear, panic, anxiety, and disorders of emotion. In D. A. Hope (Ed.), Perspectives on anxiety, panic, fear: Volume 43 of the Nebraska symposium on motivation (pp. 251–328). Lincoln, NE: University of Nebraska Press.

    Google Scholar 

  • Barrios, V. (2010). Improving primary care outcomes for Hispanics with anxiety disorders: A randomized clinical trial evaluating the effectiveness of cognitive-behavioral therapy (Order No. 3449490). Available from ProQuest Dissertations & Theses Global. (862847716). Retrieved from http://unr.idm.oclc.org/login?url=http://search.proquest.com.unr.idm.oclc.org/docview/862847716?accountid=452

  • Beck, A. T. (1995a). Cognitive therapy: Past, present, and future. In M. J. Mahoney (Ed.), Cognitive and constructive psychotherapies: Theory, research, and practice (pp. 29–40). New York: Springer Publishing Company.

    Google Scholar 

  • Beck, J. S. (1995b). Cognitive therapy: Basics and beyond. New York, NY: The Guilford Press.

    Google Scholar 

  • Benuto, L. (2016). Contemporary issues in psychology. In C. Frisby & W. T. O’Donohue (Eds.), Handbook of cultural sensitivity. New York, NY: Springer Press.

    Google Scholar 

  • Benuto, L., & Leany, B. D. (2011). Reforms for ethnic minorities and women. In Understanding the behavioral healthcare crisis: The promise of integrated care and diagnostic reform (pp. 367–394). New York, NY: Routledge.

    Google Scholar 

  • Benuto, L., & O’Donohue, W. (2015). Is culturally sensitive cognitive Behavioral therapy an empirically supported treatment?: The case for Hispanics. International Journal of Psychology and Psychological Therapy, 15(3), 405–421.

    Google Scholar 

  • Bjornsson, A. S., Sibrava, N. J., Beard, C., Moitra, E., Weisberg, R. B., Benítez, C. P., & Keller, M. B. (2014). Two-year course of generalized anxiety disorder, social anxiety disorder, and panic disorder with agoraphobia in a sample of Latino adults. Journal of Consulting and Clinical Psychology, 82(6), 1186–1192. doi:10.1037/a0036565

    Article  PubMed  PubMed Central  Google Scholar 

  • Blumberg, S. J., Clarke, T. C., & Blackwell, D. L. (2015). Racial and ethnic disparities in men’s use of mental health treatments. National Center for Health Statistics Data Brief, No.206. Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • Borkovec, T. D. (1985). The role of cognitive and somatic cues in anxiety and anxiety disorders: Worry and relaxation-induced anxiety. In A. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders (pp. 463–478). Hillside, NJ: Lawrence Erlbum associates.

    Google Scholar 

  • Borkovec, T. D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26(1), 25–30.

    Article  PubMed  Google Scholar 

  • Borkovec, T. D., Aclaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). New York: The Guilford Press.

    Google Scholar 

  • Borkovec, T., Mathews, A., Chambers, A., Ebrahimi, S., Lytle, R., & Nelson, R. (1987). The effects of relaxation training with cognitive or nondirective therapy and the role of relaxation-induced anxiety in the treatment of generalized anxiety. Journal of Consulting and Clinical Psychology., 55, 883–888. https://doi.org/10.1037//0022-006X.55.6.883

    Article  PubMed  Google Scholar 

  • Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70(2), 288–298. https://doi.org/10.1037/0022-006X.70.2.288

    Article  PubMed  Google Scholar 

  • Burnam, M. A., Escobar, J. I., Karno, M., Hough, R. L., & Telles, C. A. (1987). Acculturation and lifetime prevalence of psychiatric disorders among Mexican Americans in Los Angeles. Journal of Health and Social Behavior, 28, 89–102. Retrieved from http://unr.idm.oclc.org/login?url=http://search.proquest.com.unr.idm.oclc.org/docview/57391225?accountid=452

  • Butler, G., Fennell, M., Robson, P., & Gelder, M. (1991). Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 59(1), 167–175. https://doi.org/10.1037/0022-006X.59.1.167

    Article  PubMed  Google Scholar 

  • Butler, A. C., Chapman, J. E., Forman, E., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31. https://doi.org/10.1016/j.cpr.2005.07.003

    Article  PubMed  Google Scholar 

  • Camacho, A., Gonzalez, P., Buelna, C., Emory, K. T., Talavera, G. A., Castañeda, S. F., … Roesch, S. C. (2015). Anxious-depression among Hispanic/Latinos from different backgrounds: Results from the Hispanic community health study/study of Latinos (HCHS/SOL). Social Psychiatry and Psychiatric Epidemiology, 50, 1669–1677. doi:10.1007/s00127-015-1120-4

    Article  PubMed  PubMed Central  Google Scholar 

  • Canino, I. A., Rubio-Stipec, M., Canino, G. J., & Escobar, J. I. (1992). Functional somatic symptoms: A cross-ethnic comparison. American Journal of Orthopsychiatry, 62(4), 605–612. doi:10.1037/h0079376

    Article  PubMed  Google Scholar 

  • Carter, M. M., Mitchell, F. E., & Sbrocco, T. (2012). Treating ethnic minority adults with anxiety disorders: Current status and future recommendations. Journal of Anxiety Disorders, 26(4), 488–501. doi:10.1016/j.janxdis.2012.02.002

    Article  PubMed  PubMed Central  Google Scholar 

  • Chapman, A. L., Gratz, K. L., & Tull, M. T. (2011). The dialectical behavior therapy skills workbook for anxiety: Breaking free from worry, panic, PTSD, & other anxiety symptoms. Oakland, CA: New Harbinger Publications.

    Google Scholar 

  • Chavira, D. A., Golinelli, D., Sherbourne, C., Stein, M. B., Sullivan, G., Bystritsky, A., … Craske, M. (2014). Treatment engagement and response to CBT among Latinos with anxiety disorders in primary care. Journal Consulting Clinical Psychology, 82(3), 392–403. doi:10.1037/a0036365

    Article  PubMed  Google Scholar 

  • Craske, M. G. (2003). The origins of phobias and anxiety disorders: Why more women than men. Oxford, England: Elsevier.

    Google Scholar 

  • de Beurs, E., Lange, A., Van Dyck, R., & Koele, P. (1995). Respiratory training prior to exposure in vivo in the treatment of panic disorder with agoraphobia: Efficacy and predictions of outcome. Australian & New Zealand Journal of Psychiatry, 29, 104–113.

    Article  Google Scholar 

  • Escovar, E. L., Hitchcock, C., & Chavira, D. A. (2017). Treatment considerations and tools for treating Latino children with anxiety. In L. Benuto & B. D. Leany (Eds.), Toolkit for Counseling Spanish-speaking clients. New York, NY: Springer Press.

    Google Scholar 

  • Feeding America. (2014). Hispanic poverty & hunger facts. Retrieved from http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/latino-hunger/latino-hunger-fact-sheet.html

  • Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.

    Article  PubMed  Google Scholar 

  • Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for post-traumatic stress disorder: A critical review. In J. Spence, J. M. Darley, & D. J. Foss (Eds.), Annual review of psychology (Vol. 48, pp. 449–480). Palo Alto, CA: Annual Reviews.

    Google Scholar 

  • Gould, R. A., Buckminster, S., Pollack, M. H., Otto, M. W., & Massachusetts, L. Y. (1997). Cognitive-Behavioral and pharmacological treatment for social phobia: A meta-analysis. Clinical Psychology: Science and Practice, 4, 291–306. https://doi.org/10.1111/j.1468-2850.1997.tb00123.x

    Google Scholar 

  • Gould, R. A., Safren, S. A., O’Neill, W. D., & Otto, M. W. (2004). A meta-analytic review of cognitive-behavioral treatments. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice. New York, NY: Guildford Publications, Inc.

    Google Scholar 

  • Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Ruan, W. J., Goldstien, R. B., … Huang, B. (2005). Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: Results from the National Epidemiological Survey on alcohol and related conditions. Psychological Medicine, 35, 1747–1759.

    Article  PubMed  Google Scholar 

  • Guarnaccia, P. J., Lewis-Fernández, R., & Marano, M. R. (2003). Toward a Puerto Rican popular nosology: Nervios and Attaque de Nervios. Culture, Medicine, and Psychiatry, 27, 339–366.

    Article  Google Scholar 

  • Guarnaccia, P. J., Lewis-Fernandez, R., Pincay, I. M., Shrout, P., Guo, J., Torres, M., … Alegria, M. (2009). Ataque de nervios as a marker of social and psychiatric vulnerability: Results from the NLAAS. International Journal of Social Psychiatry, 56(3), 298–309. doi:10.1177/0020764008101636

    Article  PubMed  PubMed Central  Google Scholar 

  • Hinton, D. E., Chong, R., Pollack, M. H., Barlow, D. H., & McNally, R. J. (2008). Ataque de Nervios: Relationship to anxiety sensitivity and dissociation predisposition. Depression and Anxiety, 25, 489–495.

    Article  PubMed  Google Scholar 

  • Hinton, D. E., Lewis-Fernández, R., & Pollack, M. H. (2009). A model of the generation of ataque de nervios: The role of fear of negative affect and fear of arousal symptoms. CNS Neuroscience & Therapeutics, 15(3), 264–275. doi:10.1111/j.1755-5949.2009.00101.x

    Article  Google Scholar 

  • Hirai, M., Stanley, M. A., & Novy, D. M. (2006). Generalized anxiety disorder in Hispanics: Symptom characteristics and prediction of severity. Journal of Psychopathology and Behavioral Assessment, 28(1), 49–56. doi:10.1007/s10862-006-4541-2

    Article  Google Scholar 

  • Hovy, J. D., & Magaña, C. G. (2002). Psychosocial predictors of anxiety among immigrant Mexican migrant farmworkers: Implications for prevention and treatment. Cultural Diversity and Ethnic Minority Psychology, 8(3), 274–289. doi:10.1037//1099-9809.8.3.274

    Article  Google Scholar 

  • Karno, M., Hough, R., Burnam, A., Escobar, J. I., Timbers, D. M., Santana, F., & Boyd, J. H. (1987). Lifetime prevalence of specific psychiatric disorders among Mexican Americans and Non-Hispanic whites in Los Angeles. Archives of General Psychiatry, 44(8), 695–701.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 617–627.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kirmayer, L. J., & Young, A. (1998). Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 60(4), 420–430. doi:10.1097/00006842-199807000-00006

    Article  PubMed  Google Scholar 

  • Mitte, K. (2005). Meta-analysis of cognitive-Behavioral treatments for generalized anxiety disorder: A comparison with pharmacotherapy. Psychological Bulletin, 131(5), 785–795. https://doi.org/10.1037/0033-2909.131.5.785

    Article  PubMed  Google Scholar 

  • Moreno-Peral, P., Conejo-Cerón, S., Motrio, E., Rodriguez-Merejón, A., Fernández, A., Garcíra-Campayo, J., … Bellón, J. Á. (2014). Risk factors for the onset of panic and generalized anxiety disorders in the general population: A systemic review of cohort studies. Journal of Affective Disorder, 168, 337–348. doi:10.1016/j.jaad.2014.06.02

    Article  Google Scholar 

  • National Education Association. (n.d.) Hispanics: Education issues. Retrieved from: http://www.nea.org/home/HispanicsEducation%20Issues.htm

  • Organista, K. C., & Muñoz, R. F. (1996). Cognitive behavioral therapy with Latinos. Cognitive and Behavioral Practice, 3, 255–270.

    Article  Google Scholar 

  • Organista, K. C., Muñoz, R. F., & González, G. (1994). Cognitive-behavioral therapy for depression in low-income and minority medical outpatients: Description of a program and exploratory analyses. Cognitive Therapy and Research, 18(3), 241–259.

    Article  Google Scholar 

  • Öst, L., & Breitholtz, E. (2000). Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy, 38(8), 777–790. https://doi.org/10.1016/S0005-7967(99)00095-9

    Article  PubMed  Google Scholar 

  • Pina, A. A., Silverman, W. K., Fuentes, R. M., Kurtines, W. M., & Weems, C. F. (2003). Exposure-based cognitive-behavioral treatment for phobic and anxiety disorders: Treatment effects and maintenance for Hispanic/Latino relative to European-American youths. Journal of Clinical Child and Adolescent Psychology, 33(2), 227–236.

    Article  Google Scholar 

  • Pina, A. A., Zerr, A. A., Villalta, I. K., & Gonzales, N. A. (2012). Indicated prevention and early intervention for childhood anxiety: A randomized trial with Caucasian and Hispanic/Latino youth. Journal of Consulting and Clinical Psychology., 80(5), 940–946.

    Article  PubMed  PubMed Central  Google Scholar 

  • Priest, J. B., & Denton, W. (2012). Anxiety disorders and Latinos: The role of family cohesion and family discord. Hispanic Journal of Behavior Sciences, 34, 5547–5575. doi:10.1177/0739986312459258

    Google Scholar 

  • Roemer, L., Orsillo, M., & Barlow, D. H. (2002). Generalized anxiety disorder. In D. H. Barlow (Ed.), Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed., pp. 477–515). New York: The Guilford Press.

    Google Scholar 

  • Roemer, L., Salters, K., Raffa, S. D., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29(1), 71–88.

    Article  Google Scholar 

  • Snipes, C. (2012). Assessment of anxiety with Hispanics. In L. T. Benuto (Ed.), Guide to psychological assessment with Hispanics. New York: Springer Science and Business Media.

    Google Scholar 

  • Street, L. I., Salman, E., Garfinkle, R., Silvertri, J., Carrasco, J., Cardenas, D., … Liebowitz, M. R. (1997). Discriminating between generalized anxiety disorder and anxiety disorders not otherwise specified in a Hispanic population: Is it only a matter of worry? Depression and Anxiety, 5, 1–6.

    Article  PubMed  Google Scholar 

  • Wasswetheirl-Smoller, S., Arredondo, E. M., Cai, J., Castaneda, S. F., Choca, J. P., Gallo, L. C., … Zee, P. C. (2014). Depression, anxiety, antidepressant use, and cardiovascular disease among Hispanic men and women of different national backgrounds: Results from the Hispanic community health study/study of Latinos. Annals of Epidemiology, 24, 822–830. doi:10.1016/j.annepidem.2014.09003

    Article  Google Scholar 

  • Woodward, A. M., Dwinell, A. D., & Arons, B. S. (1992). Barriers to mental health care for Hispanic Americans: A literature review and discussion. Journal of Mental Health Administration, 19(3), 224–236.

    Article  PubMed  Google Scholar 

  • Zvolensky, M. J., Bakhshaie, J., Garza, M., Valdivieso, J., Ortiz, M., Bogiaizian, D., … Vujanovic, A. (2015). Anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and disorders among Latinos in primary care. Journal of Anxiety Disorders, 32, 38–45. doi:10.1016/j.janxdis.2015.03.006

    Article  PubMed  Google Scholar 

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Gonzalez, F.R. (2017). Tools for Treating Generalized Anxiety Disorder Among Latinos. In: Benuto, L. (eds) Toolkit for Counseling Spanish-Speaking Clients. Springer, Cham. https://doi.org/10.1007/978-3-319-64880-4_2

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