Treatment Seeking for Anxiety and Depression Among Black Adults: A Multilevel and Empirically Informed Psycho-Sociocultural Model

Black adults with anxiety and/or depressive disorders underutilize outpatient psychotherapy and pharmacological treatment compared to White adults. Notably, anxiety and depressive disorders tend to be chronic and Black individuals with these disorders experience greater functional impairment than White individuals. Documented racial disparities in mental health treatment initiation indicate a need for research that addresses culture-specific barriers to treatment. This review paper critically evaluates existing theoretical models of treatment seeking among Black adults to inform a novel integrated, culturally contextualized model. This model extends previous ones by incorporating factors relevant to treatment seeking among Black adults (e.g., racial identity, perceived discrimination, medical mistrust) and critically examines how these factors intersect with key factors at three levels of influence of the treatment seeking process: the individual level, the community level, and the societal level. We posit interactions among factors at the three levels of influence and how these may impact treatment seeking decisions among Black adults. This model informs suggestions for enhancing interventions designed to support outpatient service use among Black adults.     

The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder

Distress tolerance (DT) and intolerance of uncertainty (IU) have been identified as transdiagnostic processes that predict symptom severity across a range of distinct anxiety disorders. However, the joint effect of these two variables on therapeutic outcome has not yet been examined. It is possible that DT and IU may both impact on treatment response to cognitive-behavioural therapy (CBT) in clients with anxiety, as clients with weak DT and strong IU may be less likely to engage in exposure and cognitive restructuring tasks across treatment due to their associated distress. The purpose of this study was to examine the interaction of DT and IU as predictors of post-treatment symptom severity and treatment response to group CBT in participants with primary DSM-IV-TR diagnosed social anxiety disorder (SAD). Participants (N = 95) with SAD completed 12 weeks of manualized group CBT. Results of multilevel longitudinal analysis demonstrated an interaction effect, such that lower DT and higher IU predicted higher SAD symptom severity across the course of therapy. The findings are discussed in terms of clinical implications for the disorder-specific and transdiagnostic treatment of anxiety disorders.     

Willingness to seek counselling, and factors that facilitate and inhibit the seeking of counselling in Indonesian undergraduate students

This paper describes a study designed to investigate Indonesian undergraduates' attitudes to counselling. It focuses on the results derived from data analyses of a questionnaire measuring the level of willingness to seek counselling, factors inhibiting and facilitating the seeking of counselling in Indonesian students. The exploration was differentiated into professional counselling outside the university and the university counselling services. The self-administered questionnaire was distributed among 1,279 students. The results indicated that the level of willingness to seek counselling was low. The use of social networks was the most important discouraging factor. Wide dissemination of information about counselling services, efforts to enhance confidentiality in counselling and counsellors' understanding of students' world and ways of thinking were strongly suggested to encourage students to seek counselling.     

Deployment trauma and seeking treatment for PTSD in US soldiers

Many service members in need of mental health treatment do not seek such treatment. This study investigated the frequency of Army soldiers’ exposure to specific types of deployment stressors and whether different event-types were associated with willingness to seek and actual receipt of treatment. Male soldiers who were married (n = 600) completed online surveys that assessed posttraumatic stress disorder (PTSD), willingness to seek treatment for PTSD, actual receipt of PTSD treatment, and the frequency of exposure to 4 types of potentially traumatizing warzone experiences: committing a moral injury, observing a moral injury, threats to life, and traumatic loss. Soldiers who reported greater exposure to moral injury experiences (committed or observed) were less likely to be willing to seek treatment, regardless of PTSD symptom severity. Although exposure to moral injury did not differentiate actual treatment receipt, soldiers who endorsed loss were more likely to have received treatment, regardless of PTSD symptom severity. These results suggest that the types of trauma experienced during deployment may be a factor in postdeployment treatment-seeking attitudes and behaviors.     

Deconfounding the Effects of Local Element Spatial Heterogeneity and Sparsity on Processing Dominance

Black and White American college students were compared to determine how daily hassles, coping strategies, and social support related to depression. Although the mean intensity of hassles did not differ, Black students reported a higher frequency of hassles. Cumulative severity of hassles, defined in terms of both intensity and frequency was therefore higher for Black students. White students perceived more support from friends than from family, but the opposite held for Black students. Mean scores on type of coping (active problem solving, seeking social support, or avoidance) were similar, as were the reported levels of depression. Hierarchical multiple regression showed that the severity of hassles was directly related to depression for both groups. Race did not interact with any index of social support, except perceived family support, which was related to lower depression among Black students. There was no support for the notion that social support serves as a buffer against depression.     

GIV CARE: A Group Intervention to Reduce Accommodation Among Relatives of Individuals With Fear-Based Disorders

Fear-based disorders (FBDs) occur in an interpersonal context as relatives (e.g., partners, parents) often accommodate symptoms. Symptom accommodation, which is ubiquitous and reinforces FBD behavior, is associated with increased FBD symptom severity and interferes with treatment. Accordingly, reducing accommodation represents a crucial aim for intervention. We describe a brief, manualized group intervention to decrease symptom accommodation and caregiver burden among cohabitating relatives of individuals with FBDs. The intervention is the first to date that (a) jointly includes parents and partners to target symptom accommodation, and (b) uses a transdiagnostic group treatment approach. We also provide preliminary empirical support for this group-based intervention among adult relatives (N = 20) that participated in the five weekly intervention sessions and completed assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Preliminary results suggest that the group intervention is feasible and acceptable. Completers (n = 18) exhibited significant reductions in symptom accommodation and self-reported burden between baseline and 1MFU. The discussion identifies study limitations and future directions.     

The relationship of daily hassles, social support, and coping to depression in black and white students

Black and White American college students were compared to determine how daily hassles, coping strategies, and social support related to depression. Although the mean intensity of hassles did not differ, Black students reported a higher frequency of hassles. Cumulative severity of hassles, defined in terms of both intensity and frequency was therefore higher for Black students. White students perceived more support from friends than from family, but the opposite held for Black students. Mean scores on type of coping (active problem solving, seeking social support, or avoidance) were similar, as were the reported levels of depression. Hierarchical multiple regression showed that the severity of hassles was directly related to depression for both groups. Race did not interact with any index of social support, except perceived family support, which was related to lower depression among Black students. There was no support for the notion that social support serves as a buffer against depression.     

Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.     

Racial group differences in help-seeking behaviors

The authors evaluated variations in help-seeking behaviors among Blacks and Whites and the role of cognitive-affective variables as mediators of these variations. Participants were 70 Black and 66 White community college students who completed the SCL-90-R (L. R. Derogatis, 1977, 1994), the Revised Multidimensional Health Locus of Control (T. Bekhuis et al., 1995), the Symptom Interpretation Questionnaire (J. M. Robbins & L. J. Kirmayer, 1991), and a measure of help-seeking behaviors and demographic information. Relative to White college students, Black college students significantly less frequently used psychological or social services and significantly more frequently used religious services. The authors accounted for group differences in religious help-seeking behaviors by beliefs in the power of God and by normalizing symptom attributions. The cognitive-affective variables that were studied did not account for differences in psychological help-seeking behaviors. The authors inferred that to better meet the needs of Black college students, collaboration between mental health services and religious services would likely be beneficial.     

Illness risk representations and motivations to engage in protective behavior: The case of skin cancer risk

This study evaluates the contents of representations of skin cancer risk and their associations with risk appraisals, worry, and protection intentions and behaviors. The Assessment of Illness Risk Representations (AIRR) was used to measure conceptual and imagery contents of risk representations, as delineated by the Common-Sense Model. University students (N?=?120) completed the AIRR; measures of likelihood and severity appraisals, and worry; and measures of skin self-examination, clinical skin examination, and sun protection intentions and behaviors. Beliefs about identity, causal, and timeline risk were positively associated with likelihood appraisals, whereas consequences and timeline risk beliefs were positively associated with severity appraisals. Identity and timeline risk independently predicted worry. Representational attributes, including imagery vividness and valence, independently predicted intentions and behaviors, whereas likelihood and severity appraisals did not. Symptom imagery interacted with worry to predict detection and prevention intentions: worry predicted greater intentions for participants with symptom imagery but not for those without symptom imagery. The findings support the utility of the AIRR for assessing risk representations and identify ways in which risk representations may guide protective behavior.     

Community‐Based Participatory Research With Black Churches

Black Americans are more likely than other racial/ethnic groups to rely on spiritual and religious resources for mental health support. As such, counselors must seek unique ways to reach and understand Black communities. This article provides an overview of Black Americans' help‐seeking behaviors, the significance and culture of the Black Church, and a framework for counselors and counseling researchers to form effective partnerships to conduct community‐based participatory research initiatives that will produce empirical outcomes and promote culturally responsive mental health and wellness programming in Black communities.     

Seeking harmony in Chinese families: A dyadic analysis on Chinese parent‒child relations

Based on Leung, Koch, and Lu’s (2002) dualistic harmony model, we examined the relations of two harmony‐seeking behaviors—harmony enhancement and disintegration avoidance—to family functioning among 177 Hong Kong Chinese adolescent?parent dyads. Structural equation modeling results showed that adolescent‐rated harmony enhancement was positively related to adolescent‐rated family functioning whereas parent‐rated harmony enhancement was positively related to parent‐rated family functioning. Disintegration avoidance, however, was not related to family functioning in the two samples. Furthermore, no significant cross‐path association between harmony‐seeking behaviors and family functioning was identified, meaning that the harmony‐seeking behaviors of adolescents and their parents did not relate to each other’s perception of family functioning. Implications of these findings to our understanding of family in Chinese culture are discussed.     

Different functions of emotion regulation in linking harmony seeking and rejection avoidance to life satisfaction and social support in Germany,Hong Kong,and Japan

This study examined whether two facets of interdependence, harmony seeking and rejection avoidance, were differently related to life satisfaction and social support from friends across cultures through the differential use of emotion regulation strategies. Specifically, we propose that individuals who seek harmony and avoid rejection regulate emotions differently to achieve social adaptation in their sociocultural contexts. University students from Germany (n = 129), Hong Kong (n = 136), and Japan (n = 123) completed our online survey. Data were analysed through multigroup structural equation modelling. Across cultures, harmony seeking was positively while rejection avoidance was negatively related to indices of social functioning (life satisfaction or social support). For Germans, emotion regulation (more rumination, less reappraisal, more suppression) completely mediated the associations of rejection avoidance with life satisfaction. Germans may emotionally overreact when fearing rejection, which is reflected in using dysfunctional emotion regulation strategies. In contrast, rejection avoidance was only weakly related to emotional dysregulation among Hong Kong Chinese and Japanese who might be adapted to fearing exclusion due to living in low relational mobility societies. Our findings demonstrate cultural similarities and differences in the interplay of harmony seeking and rejection avoidance with emotion regulation, life satisfaction, and social support.     

Racial Mistrust and Deviant Behaviors Among Ethnically Diverse Black Adolescent Boys1

While it has been suggested that mistrust of the dominant White society may be an important protective factor for some members of racial minorities, the question of whether mistrust may also be related to nonnormative behaviors among minority members has not been explored. Using survey data from Miami, Florida, this study empirically tests this hypothesis among a sample of African American, Haitian, and other Caribbean island Black adolescent boys. Bivariate analyses suggest a strong relationship between racial mistrust and conventional forms of delinquency for all three ethnic groups. These findings also held in multivariate analyses in which six traditional predictors of deviance were statistically controlled. The authors conclude that racial mistrust adds a new dimension to empirical prediction models. In addition, they conclude that issues associated with racial mistrust should be considered when developing and implementing prevention strategies.     

A longitudinal test of the bi-directional relations between avoidance coping and PTSD severity during and after PTSD treatment

Avoidance coping and symptoms of posttraumatic stress disorder (PTSD) covary. However, relatively little research has examined the bi-directional relation between these constructs among individuals in treatment for PTSD. The current longitudinal study examined the reciprocal associations between avoidance coping and PTSD symptom severity during and after residential PTSD treatment among a sample of 1073 military veterans (88.9% male; M_age = 52.39 years) with chronic, treatment-resistant PTSD. Greater avoidance coping at intake predicted more severe PTSD symptoms at discharge, and severity of PTSD symptoms at discharge predicted increased avoidance at follow-up. Conversely, PTSD symptom severity at intake was not related to avoidance coping at discharge, and in turn avoidance coping at discharge was not related to PTSD symptom severity at follow-up. These findings offer a number of important clinical implications including evidence suggesting avoidance may predict poorer treatment response among individuals seeking treatment for chronic PTSD, and that greater end-of-treatment PTSD symptom severity may predict increased avoidance following treatment.     

Willingness to Seek Help as a Function of Self-Disclosure and Problem Severity

In this study the authors examined the effects of problem severity, amount of self-disclosure, and self-disclosure flexibility on willingness to seek help for a problem. The participants were 101 midwestern university students enrolled in an introductory psychology course who had not had previous counseling experience. The participants completed the Jourard Self-Disclosure Questionnaire (SDQ), the Chelune Self-Disclosure Situations Survey (SDSS), and responded to questions after reading a scenario depicting a personal problem of either high or low severity. The results indicated that the factors that predicted the greatest amount of variance in willingness to seek help were the interaction of problem severity with willingness to self-disclose to a counselor, followed by problem severity; no gender differences were found. Implications for counseling and further research are discussed.     

Gender, Self-Enhancement, and Self-Regulation of Learning Behaviors in Junior High School

Gender differences in level of self-enhancement and in relations between self-enhancement and self-regulation in 2 school subjects, math and English, were studied among Israeli junior high school students (N = 259). In English (a feminine subject) the gender groups did not differ on their self-enhancement, but in math (a masculine subject) boys revealed significantly higher self-enhancement than did girls. The same differences were found for self-regulation of learning behaviors. It was shown further that self-enhancement mediated the relations between gender and self-regulation of learning behaviors in math. The gender groups differed on the type of relations between self-enhancement and self-regulation of learning behaviors: self-enhancement was positively related to learning behaviors among girls in math, whereas it was negatively related to such behaviors among boys in English. The implications of these last findings for self-enhancement adaptiveness are discussed.     

Perceived racism and vascular reactivity in black college women: moderating effects of seeking social support.

This quasi-experimental study explored the association of perceived racism and seeking social support to vascular reactivity in a college sample of 110 Black women. Perceived racism and seeking social support were assessed via self-report, and vascular reactivity was measured before and during a standardized speaking task. Hierarchical regression analyses indicated that perceived racism was positively related to changes in systolic blood pressure. These analyses also indicated that seeking social support moderated the relationship between perceived racism and systolic blood pressure changes. This interaction effect persisted after controlling for several potential confounders. Follow-up regression analyses showed that perceived racism was positively associated with reactivity among participants who were low in seeking social support. A significant relationship was not observed between perceived racism and systolic blood pressure changes among participants who were high in seeking social support. Perceived racism and seeking social support were not significantly associated with changes in diastolic blood pressure. These findings highlight the importance of examining psychosocial factors that may mitigate the hypothesized relationship between perceived racism and reactivity.     

Mothers’ and Fathers’ Reluctance to Seek Psychological Help for Their Children

We investigated the gap between parents’ willingness to seek help for their children and their willingness to refer other parents to help, and the relationship of this gap to gender. Two hundred and eleven parent couples with elementary-school children reported their willingness to seek help from professional and informal sources for a hypothetical problem with their child, and their willingness to refer a friend’s child with an identical problem to similar help. Attitudes toward help seeking and parental behaviors were also measured. Findings revealed that parents were more willing to refer a friend’s child to professional help than they were to seek such help for their own child, although no gap was found regarding informal help. No gender differences were found regarding willingness to seek help or to refer another, although gender was related to variables that predicted help seeking.