Culturally Attuned Behavior Therapy for Anxiety and Depression in Asian Americans: Addressing Racial Microaggressions and Deconstructing the Model Minority Myth

Extant research has shown that racial discrimination and microaggressions can have negative effects on anxiety and depression among Asian Americans. However, not much has been published regarding how to process and integrate experiences of racism into culturally attuned behavior therapy specifically for Asian Americans. In this article, I describe the process of culturally attuned behavior therapy for two Asian American clients, with an emphasis on integrating racial microaggressions into exposures for social anxiety, and deconstructing the model minority stereotype through value-driven behavioral activation for depression. Cultural attunements common to both case examples are then summarized, alongside practical recommendations for clinicians. Limits to generalizability are also discussed. Finally, the article closes by addressing the importance of cultural humility in effective culturally attuned behavior therapy with Asian Americans.     

Social Work with Asian Americans

This paper is based upon an extensive review of the literature on Asian Americans, the practice experience of the senior author, and the research work of the junior author with one of the Asian American groups. An attempt is made to describe the socio-economic conditions of the major Asian American groups and the antecedents of those conditions, as well as the major problems experienced by most Asian Americans. The common features of the cultural values held by most Asian Americans are discussed and the reasons for their difficulty in using the available human services are analyzed. Social work approaches likely to work with Asian American clients are suggested.     

Addressing Mental Health Disparities With Asian American Clients: Examining the Generalizability of the Common Factors Model

Although mental health disparities for Asian Americans are known, reasons for the disparities are not well understood within the counseling process. This study coded Asian American and White clients' reports of helpful counselor actions into empirically supported common factors to determine which within‐session processes might reduce mental health disparities for Asian American clients. Asian American clients' reports of helpful therapist actions did not differ from those of White clients, suggesting that disparities do not originate in differences in the foundational aspects of counseling. Implications for addressing disparities are discussed.     

Are positive emotions just as "positive" across cultures?

Whereas positive emotions and feeling unequivocally good may be at the heart of well-being among Westerners, positive emotions often carry negative associations within many Asian cultures. Based on a review of East-West cultural differences in dialectical emotions, or co-occurring positive and negative feelings, we predicted culture to influence the association between positive emotions and depression, but not the association between negative emotions and depression. As predicted, in a survey of over 600 European-, immigrant Asian-, and Asian American college students, positive emotions were associated with depression symptoms among European Americans and Asian Americans, but not immigrant Asians. Negative emotions were associated with depression symptoms among all three groups. We also found initial evidence that acculturation (i.e., nativity) may influence the role of positive emotions in depression: Asian Americans fell "in between" the two other groups. These findings suggest the importance of studying the role of culture in positive emotions and in positive psychology. The use of interventions based on promoting positive emotions in clinical psychology among Asian clients is briefly discussed.     

Effects of combining disparate groups in the analysis of ethnic differences: Variations among asian american mental health service consumers in level of community functioning

The Asian American population comprises historically, socially, and culturally diverse ethnic groups. Given this diversity, investigators caution that combining disparate ethnic groups together may lead to erroneous conclusions. Whether by choice or necessity, however, mental health studies still typically consider Asian Americans as a single ethnic category rather than as separate ethnic groups. Few investigations have addressed the consequences of this practice. This paper examines the implications of conceptualizing Asian Americans as an ethnic category versus ethnic groups, in an investigation of the community functioning status of clients in publicly funded mental health programs in King County, Washington. When treated as a single ethnic category in a multivariate linear regression model, Asian Americans are found to have a lower level of functioning difficulty than their white counterparts. However, when treated as separate ethnic groups (e.g., Vietnamese, Japanese), only one of five Asian ethnic groups has a significantly lower level of difficulty. In a separate analysis of the Asian American subsample, groups are found to differ significantly from one another with respect to functional status. Several factors, including refugee status, account for this difference.     

Counseling Native Americans: An introduction for Non-Native American Counselors

This article provides a primer on counseling Native American clients for non-Native American counselors and psychotherapists. The diversity of this population is described and a general model of healing from a traditional Native American perspective is presented, with implications for counseling practice. Relevant research is reviewed and practical suggestions are offered for providing counseling services to Native Americans.     

Using mediators and moderators to test assumptions underlying culturally sensitive therapies: an exploratory example

Factors hypothesized to impact Asian American responses to counseling were tested as mediators and moderators of perceived counselor credibility and working alliance. Asian and European American college students (N = 182) were assigned randomly to view simulated directive or nondirective therapy approaches. Mediation analyses examined whether ethnic group differences in initial perceptions were accounted for by therapist understandability and previous therapy experiences. Moderation analyses examined whether expectations for directive therapy, ambiguity tolerance, and resistance influenced initial perceptions across directive and nondirective counseling. Asian Americans rated the counseling approaches significantly less favorably than Europeans Americans. A significant mediation effect was found for therapist understandability, whereas a significant moderation effect was found for expectation for directive therapy on initial perceptions of counselor credibility.     

Counseling Thai Americans: An Emerging Need

This article identifies the unique issues of Thai Americans as a cultural minority in the United States. The authors propose ways of understanding and responding to Thai American clients and recommend strategies for working more effectively with these clients.     

Cognitive-Behavioral Therapy With Chinese Americans: Research, Theory, and Clinical Practice

In this article, we discuss how to conduct cognitive-behavioral therapy with Chinese Americans. We present an integration of theory, research, and clinical practice to help mental health practitioners understand how Chinese culture may potentially influence the CBT treatment process for Chinese immigrants. Several recommendations are provided as to how to adapt and modify CBT to better meet the therapeutic needs of Chinese American clients. A case example demonstrates how cultural modifications of CBT can lead to effective psychotherapy outcomes for Chinese American clients.     

In the World or in the Head: External and Internal Implicit Theories of Creativity

This research is an initial step to bringing existing research on cultural differences in attribution and holism to the study of implicit theories of creativity. Two studies examined the tendency to consider creativity to be prototypically expressed internally via reflection and internal states versus expressed externally via interaction and products. Study 1 had Caucasian American, Asian American, and Japanese undergraduates list activities and traits they associated with creative groups and individuals. In Study 2, Japanese, Chinese, Caucasian Americans, and Asian Americans chose specific professions as more creative using a paired forced-choice method. In both studies, East Asians had a greater propensity to choose external traits, activities, and professions as creative, whereas Caucasian Americans and to a lesser degree, Asian Americans showed a preference for internal items. The implications of cross-cultural differences in implicit theories of creativity are discussed.     

Development and initial validation of the internalization of Asian American stereotypes scale

This research consists of four studies on the initial reliability and validity of the Internalization of Asian American Stereotypes Scale (IAASS), a self-report instrument that measures the degree Asian Americans have internalized racial stereotypes about their own group. The results from the exploratory and confirmatory factor analyses support a stable four-factor structure of the IAASS: Difficulties with English Language Communication, Pursuit of Prestigious Careers, Emotional Reservation, and Expected Academic Success. Evidence for concurrent and discriminant validity is presented. High internal-consistency and test-retest reliability estimates are reported. A discussion of how this scale can contribute to research and practice regarding internalized stereotyping among Asian Americans is provided.     

Adapting Manualized Treatments: Treating Anxiety Disorders Among Native Americans

Although there is a small but growing body of literature examining the psychopathology of anxiety among Native Americans, no data are available regarding the efficacy of empirically supported treatments for anxiety disorders among Native Americans. Moreover, exceptional challenges arise in adapting mainstream approaches to Native Americans, such as language barriers, contrasting beliefs about the cause and treatment of emotional illness between mainstream and traditional Native American culture, problems with homework compliance, allowing extra time for rapport building, and the need for a spiritual component in the treatment of anxiety disorders. Native Americans also confront the challenges of rural living and low socioeconomic status. The focus of this article is largely conceptual in nature, informed by the limited psychopathology data and the first author’s experience with cognitive behavioral treatment protocols for anxiety disorders and the provision of mental health services to Native Americans. In this article we highlight the unique challenges of adapting manualized anxiety treatments for Native American clients.     

What does "being American" mean? A comparison of Asian American and European American young adults

Two studies found that the meaning of "being American" differs for Asian Americans and European Americans. In Study 1, Hmong and European American undergraduates described what "being American" meant to them. In Study 2, Chinese American and European American undergraduates described what "American culture" meant to them. Responses were coded for references to cultural exposure, customs/traditional behavior, ethnic diversity, political ideology, and patriotism. Across both studies, Asian Americans referred to American customs and traditional behavior more than European Americans. European Americans referred to patriotism more than Hmong (in Study 1) and to ethnic diversity more than Chinese Americans (in Study 2). The authors suggest that these differences reflect the distinct statuses, concerns, and experiences of Asian Americans and European Americans.     

Close relationships between Asian American and European American college students

The authors examined attitudes and behaviors regarding close relationships between European and Asian Americans, with a particular emphasis on 5 major subgroups of Asian Americans (Chinese, Japanese, Korean, Vietnamese, and Filipino Americans). Participants were 218 Asian American college students and 171 European American college students attending a culturally diverse university. The European Americans did not differentiate among the various subgroups of Asian Americans. Their attitudes regarding close relationships were less positive toward Asian Americans than toward Mexican and African Americans, a finding contrary to the prediction of social exchange theory (H. Tajfel, 1975). In contrast to the European Americans' view of homogeneity among Asian Americans, the 5 major subgroups of Asian Americans expressed a distinctive hierarchy of social preference among themselves. Results are discussed in terms of their implications for future research on interethnic relations involving Asian Americans.     

Media exposure, internalization of the thin ideal, and body dissatisfaction: comparing Asian American and European American college females

Internalization of the thin ideal mediates the media exposure-body dissatisfaction relation in young adult European American females. There is little related research on Asian Americans. We used structural equations modeling to test: (1) whether media exposure was associated with body dissatisfaction in Asian American young adult females, (2) internalization of the thin ideal mediated any such association, and (3) whether the mediational model provided equivalent fit for European American and Asian American samples. Participants were 287 college females (154 Asian Americans, 133 European Americans). Internalization of the thin ideal explained the media exposure-body dissatisfaction association equally well for both groups. Results suggest that Asian Americans may be employing unhealthy weight control behaviors, and may be prone to developing eating disorders, at rates similar to European American young adult females. Clinicians need to screen carefully for body dissatisfaction, unhealthy weight control behaviors, and eating disorders in Asian American females.     

Close Relationships Between Asian American and European American College Students

Abstract

The authors examined attitudes and behaviors regarding close relationships between European and Asian Americans, with a particular emphasis on 5 major subgroups of Asian Americans (Chinese, Japanese, Korean, Vietnamese, and Filipino Americans). Participants were 218 Asian American college students and 171 European American college students attending a culturally diverse university. The European Americans did not differentiate among the various subgroups of Asian Americans. Their attitudes regarding close relationships were less positive toward Asian Americans than toward Mexican and African Americans, a finding contrary to the prediction of social exchange theory (H. Tajfel, 1975). In contrast to the European Americans' view of homogeneity among Asian Americans, the 5 major subgroups of Asian Americans expressed a distinctive hierarchy of social preference among themselves. Results are discussed in terms of their implications for future research on interethnic relations involving Asian Americans.     

Prejudice in the Lives of Asian Americans

Expressions of prejudice were compared between Asian American and Black, Hispanic, Jewish, and White respondents to social distance and stereotype items on 5 recent nationwide public opinion surveys. There was much prejudice toward Asian Americans. Their prejudice was greatest toward Blacks and Hispanics and least toward Jews and Whites. Among Asian American subgroups, prejudice toward Blacks, Hispanics, and Whites was greatest by Chinese Americans and Japanese Americans; and least by Filipino Americans and Asian Indian Americans. Suggestions are made for further research.     

Frequency and intensity of social anxiety in Asian Americans and European Americans

Asian American students have typically reported greater levels of social anxiety than European American students on self-report measures (e.g., Okazaki, 1997; Norasakkunkit & Kalick, 2002). This study employed an event-contingent experience sampling methodology to examine whether Asian American university students experienced social anxiety more often and more intensely than European Americans in their daily lives. Forty-five Asian American and 38 European American students participated in a two-week diary study. The results showed that on average, Asian Americans and European Americans reported a similar number of events that evoked anxiety in social situations, but Asian Americans reported more negative emotions on average in social situations than did European Americans.     

Perfectionism and ethnicity: implications for depressive symptoms and self-reported academic achievement

Ethnic differences in perfectionism were examined among Asian American, African American, and Caucasian American college students. Analyses revealed that Asian American students scored significantly higher than the other groups on 3 of 6 perfectionism subscales. Minority students reported significantly higher parental expectations than Caucasian students. Significant correlations emerged for all 3 groups between depressive symptoms and concerns about making mistakes, perceived criticism from parents, and self-doubt. In regression analyses, perfectionism explained significant variance in depressive symptoms for Asian Americans and Caucasians and explained significant variance in cumulative grade point average for Asian Americans and African Americans. Self-doubt emerged as a robust individual predictor in these analyses.