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I enjoyed reading your post. I totally agree with you that Alana might be dealing with the stress of breaking away from negative family influences that are a source of anxiety for her. I want to reemphasize that cognitive restructuring is paramount to helping Alana to discover, challenge, and modify or replace her negative, irrational thoughts or cognitive distortions. The use of cognitive restructuring is based on the premise that many of our problems are caused by faulty ways of thinking about ourselves and the world around us. Cognitive restructuring aims to help people reduce their stress through cultivating more positive and functional thought habits. According to Graham, Sorenson, and Hayes-Skelton (2018) the first step toward fixing faulty thinking is to identify your faulty thinking. Increasing your awareness of your own thoughts, particularly your overly negative or biased thoughts, is a vital piece of this process. In dealing with clients like Alana, Alana should be reassured that it will take time and effort to improve her awareness of her own thoughts. This process begins with looking for cognitive distortions by turning on your internal “radar” for negative emotions, and thinking about when your depression, anxiety, or anger symptoms are at their worst. If it’s too difficult to start with your emotions, start with behaviors instead. Ask yourself what behaviors you would like to change, then identify what triggers those behaviors, thus, this act welcomes the idea of active journaling which helps clients identify and note situations as “alarm” situations, or situations that alert them to the presence of one or more cognitive distortion (Hoffman & Smits, 2017). 

I would like to add that visualization and guided imagery can be a great tool for relaxing, managing pain, getting anxiety under control, and neutralizing anger. Once the client is able to identify the image that is calming or distressing to him/her, the therapist and client work together to identify the meanings attached to the image, the next step will be to help them to begin challenging, restructuring, or replacing harmful assumptions and beliefs (Corey, 2016).


Corey, G. (2016). Theory and Practice of Counseling and Psychotherapy (10th ed.). Cengage Learning.

Graham, J. R., Sorenson, S., & Hayes-Skelton, S. A. (2018). Enhancing the cultural sensitivity of cognitive-behavioral interventions for anxiety in diverse populations. The Behavior Therapist36(5), 101–108.

Hoffman, S., & Smits, J. (2017). Cognitive Behavioral Therapy for depression and anxiety (1st ed.). Elsevier Press.



Thank you so much for your well-written and very informative post on the best Cognitive Behavioral Therapy (CBT) techniques to use for the client described in the case study and the use of CBT techniques in a culturally sensitive way. The perspectives you shared are well appreciated and provided me insights for a better understanding of the case study. The technique you close that will be effective in Alana’s case is somewhat similar to mine. Both mindfulness-based cognitive therapy (MBCT) and cognitive homework are based on the premise that clients can be taught to identify unhealthy thinking and resolve the unhealthy thinking by making the necessary connections needed to identify how their irrational thoughts affect behavior and mood (Corey, 2017). Additionally, I agree with you that cultural adaptation is needed in order to provide CBT to patients such as Alana in a manner that is consistent with their cultural preferences and cultural constraints. Cultural sensitivity and gender sensitivity can be applied to the CBT therapy in Alana’s case by tailoring the technique in a way that incorporates the patient’s gender, cultural beliefs, values, and perspectives into the therapy session. The first step towards achieving this is by being aware of how culture impacts a client’s attitude towards irrational thoughts. By asking questions, a culturally sensitive therapist can elicit more information about depressive symptoms and how it has impacted the patient’s life. In addition, it is important to consider how depression is perceived in the patient’s culture as well as the degree of stigmatization associated with a depression diagnosis. (Shea, 2017). When culturally competent care is lacking, instead of a place to explore the client’s trauma, therapy can quickly become a place where clients feel like they are not being understood or feel the need to explain their culture and faith practice because the therapist has no reference point by which to understand the patient. In light of this, educating oneself about the client’s culture is an important aspect to consider. This education can be initiated by “learning about the history, beliefs, values, and modal experiences of diverse groups (including institutional and systemic barriers to mental health treatment) which will enable clinicians to connect with clients’ experiences, improving their case conceptualizations and intervention approaches” (Graham et al., 2013, p.5). By incorporating these approaches in CBT, a nurturing and supportive environment is created where patients feel that they are understood and heard and in response share their deep and unconscious thoughts with the therapist, thereby strengthening the therapeutic alliance. References Corey, G. (2017). Theory and practice of counseling and psychotherapy. (10th ed.) Cengage Learning. Graham, J. R., Sorenson, S., & Hayes-Skelton, S. A. (2013). Enhancing the Cultural Sensitivity of Cognitive Behavioral Interventions for Anxiety in Diverse Populations. The Behavior therapist, 36(5), 101–108. Shea, S.C. (2017). Psychiatric interviewing: The art of understanding. (3rd edition). Elsevier.

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