(PS5-22) Cross-cultural Expressions of Emotional Vocabulary in CBT Sessions for Childhood Anxiety Disorders: A Comparison Between Australia and Japan

Introduction

    Although CBT has been transported to Asian countries, empirical data focusing on culturally specific verbal expressions within CBT sessions across the different countries is scarce. This study aimed to examine verbalization as cultural expressions of emotional states across CBT treatment delivered in between Australia and Japan. In addition, this study explanatory examined whether verbalization predicted presence of diagnoses of anxiety disorders.

Methods

    Participants: From both countries, 30 children and adolescents between 7-15 years old participated in this study (i.e., in total 60). All participants in both countries were diagnosed as anxiety disorders by using a version of the Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV-C/P; Silverman & Albano, 1996).

Behavioral observation: The words uttered by both children and therapists were integrated into negative emotional words, positive emotional words, and onomatopoeia by the first author based on the Cross-cultural Behavioural Observation System (C-BOS; Ishikawa & Hudson, 2019).

Outcome measure: The remission of primary and all anxiety disorder diagnoses by an independent masked diagnostician using the ADIS-IV-C/P (Silverman & Albano, 1996) was obtained at post-treatment and 6-month follow-up. 

Results

Frequency of emotional words between Australia and Japan

Australian children uttered more negative words than Japanese while children in both countries significantly decreased number of negative words from first to last sessions (ps < .01). Therapists’ negative emotional words significantly decreased from first to last sessions in both countries (ps < .01) and Australian therapists used more negative emotional words than Japanese at both sessions (ps < .01). Only Australian children significantly decreased the use of positive words (p < .01). In addition, Japanese children showed more positive emotional words than Australian at last session (p < .01). Finally, onomatopoeia was only observed in Japan and its frequency was relatively low. Only therapists significantly decreased the use of onomatopoeia from first to last session (p < .01).

Prediction of frequency of emotional words to treatment outcomes

In Australia, occurrences of positive emotional words from therapists at first session predicted remission of all anxiety disorders at 6 months (r = - .474, p < .05), and those from children at last session predicted remission of primary anxiety disorders at 6 months (r = - .469, p < .05). In Japan, positive emotional words from children at last session were correlated with remissions of all anxiety disorders at post-treatment (r = - .469, p < .05). Moreover, negative emotional words by therapists at last session predicted remission of primary anxiety disorders after 6 months (r = -.387, p < .05).

Discussion

     This study is the first to examine culturally specific expressions of emotional states across CBT treatment delivered with two different countries. The result suggests there are cultural differences regarding emotional expressions between two countries and the frequency of these words could predict diagnostic free ratio.