Date of Award


Level of Access Assigned by Author

Open-Access Dissertation

Degree Name

Doctor of Philosophy (PhD)




Jeffrey E. Hecker

Second Committee Member

Sandra T. Sigmon

Third Committee Member

Geoffrey L. Thorpe


As a step towards evaluating the cross-cultural effectiveness of cognitive behavioral therapy for panic disorder, treatment acceptability was used in the current study to gain an understanding of the treatment utility and social validity of that treatment with a group of Passamaquoddy individuals. American Indian communities face substantial psychosocial challenges (e-g., poverty, discrimination, and high rates of violent deaths), which are associated with increased risk for psychopathology, and there is little empirical evidence of the effectiveness of cognitive behavioral therapy within these communities. The current study addressed these issues in two phases. In phase 1, qualitative methodology was used to develop the culturally-modified treatment description. In phase 2, a quasi-experimental design was used to examine the effect of Passamaquoddy or European American cultural group on treatment acceptability of the original (CBT) and culturally-modified (CST) versions of the cognitive behavioral treatment rationale. The effect of culturally-relevant variables (e.g., mental health values and cultural identification) on treatment acceptability was also examined. How a treatment is described affects its acceptability in complex ways, considering cultural variables, gender, and previous treatment. It was not found that cultural group had the expected effect, however European American individuals without previous treatment favored the CST, whereas individuals living in a Passamaquoddy cultural group with a history of treatment preferred the CST. Within the Passamaquoddy group, bicultural or European American identifying individuals, compared to the Native American or marginalized individuals, found both the CBT and CST more acceptable. The Passamaquoddy group found the CST more acceptable for their community compared to the CBT, whereas their European American counterparts did not find one type of treatment more acceptable for their community. Unexpectedly, mental health values did not affect the relationship between cultural group and treatment acceptability, and women preferred the CST, while men did not have a preference. The current study is the first to assess an aspect of social validity and culturallyrelevant factors of a cognitive behavioral intervention for panic disorder in an American Indian community. In addition, it fills a gap in the literature reporting social validity of cognitive behavioral interventions more generally.