Culturally Responsive
Case Conceptualization Guide
Goals:
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Integrate cultural and contextual understanding of the client’s mental health difficulties and symptom experience to inform case conceptualization and treatment planning for anxiety and OCD.
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Select culturally and contextually relevant treatment strategies to address anxiety and OCD.
This section provides guidance for conceptualization of your client’s mental health difficulties within their cultural context and the development of culturally responsive treatment plan. It is meant to be referenced throughout the treatment process as your case conceptualization evolves.
A primary question for any youth with anxiety and OCD is whether Ex-CBT is appropriate, considering the client’s presenting problem(s) and cultural and environmental context.
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The aim of Ex-CBT is to empower youth to face feared situations and learn to tolerate difficult emotions that lead to maladaptive avoidance, defined as distress that is driven by anxiety, fear, or intrusive thoughts. Ex-CBT is the gold-standard, frontline psychosocial treatment approach for anxiety/OCD. Ex-CBT may need to be augmented with additional treatment strategies to specifically address cultural and environmental context. However, in some cases, when facing feared situations is not appropriate, Ex-CBT may be contraindicated.
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Many youth, especially those from marginalized or minoritized backgrounds, experience realistic fears and chronic stressors that contribute to anxious distress. Such stressors can lead both to adaptive ("helpful") or maladaptive ("unhelpful") avoidance. Determining the extent to which a youth experiences helpful avoidance and unhelpful avoidance, is critical for shaping a treatment plan – Ex-CBT targets unhelpful avoidance, and augmented strategies can be used to address other stressors. Importantly, we acknowledge that fears and avoidance are not binary and instead exist on a continuum.
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We must be careful not to attribute symptoms of anxiety-related distress to internal client experiences (e.g., distorted thought patterns) when they may be caused, at least in part, by environmental conditions associated with adverse social determinants of health.​
Summary
We want youth to learn to listen to their anxiety alarms when they are adaptive and helping them stay safe, remain healthy, or be successful.
Ex-CBT is the recommended treatment strategy when youth are struggling with maladaptive avoidance.
We do not recommend using Ex-CBT for realistic or helpful fears that drive adaptive avoidance.
However, youth who have realistic fears may also benefit from Ex-CBT strategies in addition to augmented supportive and advocacy strategies (See Augmentation Strategies Section) IF realistic fears are causing maladaptive avoidance or compulsive behaviors to reduce distress or if they are co-occurring with other unhelpful fears that are causing distress or unhelpful avoidance.