Abstract
This dissertation analyzed how culinary therapy can be used in the treatment of adolescents struggling with anxiety to decrease symptoms through skill building, mastery,
improved self-esteem and confidence, social competency, and identity formation. I contend that transformation and generative change for adolescents in culinary therapy results from a particular kind of conversation and the therapist’s “way of being” (Anderson, 1997). This study demonstrated the importance of relating with adolescents positively, communicating their importance, letting them know that they are valued and appreciated, and approaching the therapeutic relationship from a position of equality as partners (Anderson, 2012b) engaging in processes of mutual inquiry, discovery, creating meaning, and knowledge together, and allowing other voices and perspectives to be part of the conversation. Adolescents facing anxiety have not received the help they need and deserve to decrease their troublesome symptoms for numerous
reasons such as 1) Shame, guilt, and the stigma attached to “therapy,” 2) limited or no access due to lack of insurance or ability to pay, 3) transportation problems, 4) anxiety is under-diagnosed or not diagnosed at all, 5) traditional therapy doesn’t work well, and 5) society unknowingly or unwittingly continues to reinforce the dominant discourse of pathologizing and reinforcing a narrative of failure for developing adolescents. This ritualized way of diagnosing and treating anxiety in adolescents does not lessen the number of adolescents with anxiety but instead perpetuates it.
The theoretical frames of this study are social construction and collaborative-dialogic practices. From this philosophical orientation, I observe traditional and collaborative-dialogic assumptions about adolescent anxiety and examine the developmental theories of childhood development, highlighting their importance for vulnerable adolescents in any treatment process. From this social construction perspective, I describe the problem and contemplate other possibilities for treating adolescent anxiety in a more accessible, natural, and nurturing environment.
Problem Definition
Anxiety in adolescents is a rising epidemic and deserves alternative therapeutic approaches or processes for effective treatment that are easily accessible and that adolescents
want to participate in. Adolescence is the period of time between childhood and adulthood when the development of self-esteem, confidence, identity formation, and beliefs and values are at the forefront of every adolescent. This is a critical stage in development as the adolescent negotiates between role confusion and identity. Erik Erickson, a developmental psychologist, was the first to refer to this period of time as the “identity crisis” years (Gross, 2020). Adolescents are exceptionally vulnerable during this time, and the onset of anxiety symptoms often begins during this developmental stage and carries with it a substantial number of adverse effects on the social and emotional development and academic success of the adolescent (Locke et al., 2015).
While several empirically supported treatments for adolescents facing anxiety have been developed, cognitive behavioral therapy (CBT) alone or with the addition of pharmacotherapy is considered the gold standard for treating anxious adolescents. However, after reviewing the literature, CBT has substantially high non-completion rates and does not demonstrate long-term remission stability (Heiervang et al., 2018; Asarnow et al., 2019). CBT has shown very limited success (Baker et al., 2021), and according to Heiervang et al. (2018), many therapists who use CBT know it doesn’t work. Simply stated, we need more effective treatments for adolescents with anxiety.
Aims
Designing accessible, developmentally appropriate, and effective treatment for adolescents struggling with anxiety is essential to stabilize and reverse the surging trend of the
current epidemic. The aim of this dissertation was to determine if culinary therapy, using collaborative dialogue in a safe, natural, and nurturing environment of a school, would be an appropriate and operational method of treatment for anxious adolescents. An analysis of all participants’ interviews provided a rich narrative of the adolescent participants' experience and if they noticed changes in their self-esteem or identity or had increased or decreased anxiety.
Methods
The processes of this research were guided by a social construction epistemology that emphasized the socially constructed nature of reality (Gergen & Gergen 2008). The focus was on the social interaction between researcher and participant, a relational process of shared meaning through language and socially negotiated reality (Roy-Chowdhury, 2010).
Seventeen adolescents struggling with symptoms of anxiety participated in this study, each completing between 10-12 culinary therapy sessions with the researcher, who is both a therapist and a pastry chef. Data was collected through interviews with the adolescent participants, one parent per participant, and a teacher with whom the student indicated having a positive relationship. The result was subjective experiences of the adolescent participant, as well as observations from the parents and teachers after the culinary sessions. A Generalized Anxiety Disorder 7-Item Scale was used to assess the symptoms of anxiety of each adolescent participant before the start of the first culinary session and after the final culinary session.
The researcher used thematic analysis as a method to analyze and interpret the entire data set while paying careful attention to the meaningfulness of the data as the most essential criterion for forming codes and themes. This data was more accurate and richer due to the close relationship between student participants and the researcher, as knowledge and meaning are constructed through relationships. The analysis revealed underlying patterns that illustrate how particular meanings develop.
Results
The analysis confirmed that student participants indicated they preferred culinary therapy to traditional therapy as it was comforting and calm. They were relaxed, exploring their own beliefs without feeling intimidated. Student participants appreciated the opportunity to co-create with the therapist, opportunities to connect with their peers, and establish authentic relational engagement that created a sense of belonging. As student participants’ kitchen and baking skills improved, so did their self-esteem, class attendance, and grades. Student participants developed resiliency and were more comfortable facing their futures as they saw failure as an opportunity to learn something new, not as a label that would define them. All seventeen student participants experienced a decrease in anxiety symptoms when comparing their pre and post-scaled results.
Conclusion
Current treatment protocols for treating adolescent anxiety, including the gold standard, cognitive behavioral therapy, are ineffective. Culinary therapy, an activity-based intervention using a collaborative-dialogic approach, is successful in decreasing adolescent anxiety and is a treatment option that is enjoyed by adolescents. Locating culinary therapy in a natural and safe school environment significantly improves access and adherence to therapy. Action-oriented therapy, like culinary therapy, in the school environment provides practical, accessible, positive, and efficacious treatment for adolescents struggling with anxiety, and they like it!
improved self-esteem and confidence, social competency, and identity formation. I contend that transformation and generative change for adolescents in culinary therapy results from a particular kind of conversation and the therapist’s “way of being” (Anderson, 1997). This study demonstrated the importance of relating with adolescents positively, communicating their importance, letting them know that they are valued and appreciated, and approaching the therapeutic relationship from a position of equality as partners (Anderson, 2012b) engaging in processes of mutual inquiry, discovery, creating meaning, and knowledge together, and allowing other voices and perspectives to be part of the conversation. Adolescents facing anxiety have not received the help they need and deserve to decrease their troublesome symptoms for numerous
reasons such as 1) Shame, guilt, and the stigma attached to “therapy,” 2) limited or no access due to lack of insurance or ability to pay, 3) transportation problems, 4) anxiety is under-diagnosed or not diagnosed at all, 5) traditional therapy doesn’t work well, and 5) society unknowingly or unwittingly continues to reinforce the dominant discourse of pathologizing and reinforcing a narrative of failure for developing adolescents. This ritualized way of diagnosing and treating anxiety in adolescents does not lessen the number of adolescents with anxiety but instead perpetuates it.
The theoretical frames of this study are social construction and collaborative-dialogic practices. From this philosophical orientation, I observe traditional and collaborative-dialogic assumptions about adolescent anxiety and examine the developmental theories of childhood development, highlighting their importance for vulnerable adolescents in any treatment process. From this social construction perspective, I describe the problem and contemplate other possibilities for treating adolescent anxiety in a more accessible, natural, and nurturing environment.
Problem Definition
Anxiety in adolescents is a rising epidemic and deserves alternative therapeutic approaches or processes for effective treatment that are easily accessible and that adolescents
want to participate in. Adolescence is the period of time between childhood and adulthood when the development of self-esteem, confidence, identity formation, and beliefs and values are at the forefront of every adolescent. This is a critical stage in development as the adolescent negotiates between role confusion and identity. Erik Erickson, a developmental psychologist, was the first to refer to this period of time as the “identity crisis” years (Gross, 2020). Adolescents are exceptionally vulnerable during this time, and the onset of anxiety symptoms often begins during this developmental stage and carries with it a substantial number of adverse effects on the social and emotional development and academic success of the adolescent (Locke et al., 2015).
While several empirically supported treatments for adolescents facing anxiety have been developed, cognitive behavioral therapy (CBT) alone or with the addition of pharmacotherapy is considered the gold standard for treating anxious adolescents. However, after reviewing the literature, CBT has substantially high non-completion rates and does not demonstrate long-term remission stability (Heiervang et al., 2018; Asarnow et al., 2019). CBT has shown very limited success (Baker et al., 2021), and according to Heiervang et al. (2018), many therapists who use CBT know it doesn’t work. Simply stated, we need more effective treatments for adolescents with anxiety.
Aims
Designing accessible, developmentally appropriate, and effective treatment for adolescents struggling with anxiety is essential to stabilize and reverse the surging trend of the
current epidemic. The aim of this dissertation was to determine if culinary therapy, using collaborative dialogue in a safe, natural, and nurturing environment of a school, would be an appropriate and operational method of treatment for anxious adolescents. An analysis of all participants’ interviews provided a rich narrative of the adolescent participants' experience and if they noticed changes in their self-esteem or identity or had increased or decreased anxiety.
Methods
The processes of this research were guided by a social construction epistemology that emphasized the socially constructed nature of reality (Gergen & Gergen 2008). The focus was on the social interaction between researcher and participant, a relational process of shared meaning through language and socially negotiated reality (Roy-Chowdhury, 2010).
Seventeen adolescents struggling with symptoms of anxiety participated in this study, each completing between 10-12 culinary therapy sessions with the researcher, who is both a therapist and a pastry chef. Data was collected through interviews with the adolescent participants, one parent per participant, and a teacher with whom the student indicated having a positive relationship. The result was subjective experiences of the adolescent participant, as well as observations from the parents and teachers after the culinary sessions. A Generalized Anxiety Disorder 7-Item Scale was used to assess the symptoms of anxiety of each adolescent participant before the start of the first culinary session and after the final culinary session.
The researcher used thematic analysis as a method to analyze and interpret the entire data set while paying careful attention to the meaningfulness of the data as the most essential criterion for forming codes and themes. This data was more accurate and richer due to the close relationship between student participants and the researcher, as knowledge and meaning are constructed through relationships. The analysis revealed underlying patterns that illustrate how particular meanings develop.
Results
The analysis confirmed that student participants indicated they preferred culinary therapy to traditional therapy as it was comforting and calm. They were relaxed, exploring their own beliefs without feeling intimidated. Student participants appreciated the opportunity to co-create with the therapist, opportunities to connect with their peers, and establish authentic relational engagement that created a sense of belonging. As student participants’ kitchen and baking skills improved, so did their self-esteem, class attendance, and grades. Student participants developed resiliency and were more comfortable facing their futures as they saw failure as an opportunity to learn something new, not as a label that would define them. All seventeen student participants experienced a decrease in anxiety symptoms when comparing their pre and post-scaled results.
Conclusion
Current treatment protocols for treating adolescent anxiety, including the gold standard, cognitive behavioral therapy, are ineffective. Culinary therapy, an activity-based intervention using a collaborative-dialogic approach, is successful in decreasing adolescent anxiety and is a treatment option that is enjoyed by adolescents. Locating culinary therapy in a natural and safe school environment significantly improves access and adherence to therapy. Action-oriented therapy, like culinary therapy, in the school environment provides practical, accessible, positive, and efficacious treatment for adolescents struggling with anxiety, and they like it!
| Original language | English |
|---|---|
| Awarding Institution |
|
| Supervisors/Advisors |
|
| Award date | 28 Aug 2024 |
| Publication status | Published - 2024 |