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Cognitive Behavioral Therapy Strategies for Treating Anxiety
The distinct presentation of social anxiety among Asians and Asian Americans has also received attention in the research literature. Okazaki  reported that Asian Americans endorsed significantly more social avoidance and distress than Caucasian Americans. Furthermore, researchers have noted the similarity between the presentation of social phobia and the reportedly culture-bound syndrome of Taijin Kyofusho in Asian countries, wherein individuals fear that their anxiety will embarrass or offend others.
Worry generally refers to a connected series of negative thoughts and images which represent an attempt to solve a problem whose outcome is uncertain and potentially negative. Worry is related to, but not the same as anxiety; worry can be described as a cognitive response to anxiety and an attempt to problem-solve a perceived threat. It has been proposed that individuals with GAD use worry to decrease the experience of anxiety.
Given sociocultural differences, ethnic groups may differ not only in the degree to which they worry excessively, but also in the content areas about which they have concerns. In the current study, we add to this scant literature by examining whether ethnic minority college students differ from each other and from Caucasian students in the degree to which they experience pathological worry, the topics about which they worry, and the rate at which they meet self-reported criteria for GAD.
Only Newman et al.’s [in press] examination of the GAD-Q-IV included data on the ethnicity of participants (88% were Caucasian), and reliability in specific ethnic groups was not reported; all other psychometric studies of these anxiety measures did not report the ethnicity of participants.
Ethnic groups did not differ on PSWQ scores [F (2,449) = 2.05, n.s.]. However, they did differ on total WDQ scores [F (2, 475) = 10.61, P < .001], with African Americans scoring lower than both Caucasians and Asian Americans (Table 1). Reliability of both measures in our samples was high in all ethnic groups. For the WDQ total score, 0.95 in Caucasians, 0.94 in African Americans, and 0.95 in Asian Americans. For the PSWQ, 0.93 in Caucasians, 0.84 in African Americans, and 0.90 in Asian Americans. Although more Caucasians met self-reported diagnostic criteria for GAD than was the case for the other ethnic groups, this difference was not significant [Caucasians= 11%, n = 30; African Americans = 4.7%, n = 7; Asian Americans = 6.6%, n = 4].
Between-group analyses demonstrated that for the WDQ Relationships, Lack of Confidence, and Work Incompetence domains, African Americans scored significantly lower than both Caucasians and Asian Americans, who did not differ from each other. For the Aimless Future domain, African Americans again scored lower than Caucasians, who in turn, scored significantly lower than Asian Americans. Within-group analyses demonstrated significant differences among WDQ domains for Caucasians [F (4, 1080) = 7.10, P < .001] and African Americans [F (4, 584) = 24.13, P < .001], but not for Asian Americans [F (4, 236) = 1.25, n.s.]. Follow up t-tests with Bonferonni correction (.05/10 = .005) showed that Caucasians experienced significantly more worry in the Lack of Confidence domain than in the Relationships (t (270 ) = –2.87, P = .004) and Aimless Future (t (270) = 4.65, P < .001) domains. As well, they reported more worry in the Work Incompetence (t (270) = –4.57, P <.001) and Financial (t (270) = –3.94, P < .001) domains than in the Aimless Future domain.
Significant differences were found in all paired comparisons of WDQ domains in the African American sample (n = 147, P’s< .001) except between the Work Incompetence and Financial domains and between the Work Incompetence and Lack of Confidence domains. Overall, African Americans reported the greatest worry in the Financial domain, followed by the Relationships domain, which was greater than the worry they experienced in both the Lack of Confidence and the Work Incompetence domains (which were not different from each other). The lowest reported worry for African Americans was in the Aimless Future domain (see Table 1).
Table 1. Ethnic groups differences in WDQ total and domain scores*
Within ethnic groups, Caucasians and African Americans experienced different amounts of worrying across specific domains. African Americans reported the greatest level of worry in the financial domain, whereas Asian Americans experienced a consistent, relatively high level of worry across domains. Mean scores for all ethnic groups were within one standard deviation of previously reported student means for the WDQ total and subscale scores and within one standard deviation of general population means for the PSWQ.
Interpretation of these findings is facilitated by revisiting the constructs assessed by the worry measures. While the PSWQ was designed to assess pathological worry, the WDQ was specifically designed to assess worry across content areas, without regard to excessiveness or uncontrollability. Our findings of ethnic differences on the WDQ, but not the PSWQ, suggest that African Americans may worry as much as other ethnic groups although their concerns may focus on content areas not tapped by the WDQ. This suggests that a more culturally relevant measure of worry content may be necessary or that current measures may need to be revised in order to more fully assess the worries experienced by ethnic minority populations. It may also be possible that the PSWQ and WDQ are not reliable and valid assessments of worry in ethnic minority populations. For example, Carter et al.  demonstrated that the psychometric properties of the Anxiety Sensitivity Index in African Americans differed from previously published reports using Caucasian samples. Our finding of universally high internal consistency in Caucasians, African Americans, and Asian Americans suggest adequate reliability; however, further exploration of the validity of these measures is necessary in order to fully establish their usefulness in ethnic minority populations. Heurtin-Roberts et al.  have suggested that African Americans may respond differently than other ethnic groups to survey methods; in particular, the authors suggest that African Americans may be more cautious about sharing personal information. They reported that African Americans endorsed frequent somatic manifestations of distress in ethnographies, although they did not report more of these symptoms than European Americans in structured diagnostic interviews administered in the ECA study. Therefore, we must further evaluate the validity of self-report measures, in general, in ethnic minority populations.
Asian Americans generally reported worry similar to Caucasians. However, they reported significantly more worries in the Aimless Future domain than both Caucasians and African Americans. This finding is consistent with the reported greater focus on academic and occupational success in Asian families than in Caucasian-American families and Asian American students’ greater self-reported fear of academic failure compared to non-Asian students. However, despite this difference between ethnic groups, Asian Americans did not differ across domains in their experience of worry. Examination of their mean scores also shows that Asian Americans generally reported the highest mean scores for each worry domain, but, perhaps because of their smaller sample size, these differences were not statistically significant.
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