Challenges in Developing a Cultural Evidence‐Based Psychotherapy in the USA: Suggestions for International Studies

In this article, we underscore some of the cultural challenges and limitations of the evidence‐based psychotherapy (EBP) utilised within the USA with the hope that these problems will be avoided or ameliorated in Australia and other countries. Although the EBP research is very diverse and complex, we categorise this fast‐growing literature using a threefold classification system that underscores culture. This classification system is proposed to examine the influence of culture on EBPs. The three categories used are (a) universal evidence‐based psychotherapies or universal psychotherapies, (b) race and ethnic minority evidence‐based psychotherapies or racial/ethnic psychotherapies, and (c) cultural evidence‐based psychotherapies or cultural psychotherapies. After each category is described, its benefits and limitations are discussed, emphasising implications for culturally diverse and international studies. We conclude with suggestions to promote the advancement of a more effective and inclusive cultural EBP in which researchers from different countries can collaborate and learn from each other.     

An Evidence‐Based Model for Understanding the Mental Health Experiences of Transgender Australians

A growing body of empirical research has documented the mental health experiences of Australian transgender people. This research indicates three key factors that appear to play a role in determining outcomes for adult transgender Australians: (a) discrimination, (b) access to hormones and/or surgery, (c) community connectedness. Two theoretical frameworks clarify why these factors exist and how they can lead to either negative or positive mental health outcomes. The first is cisgenderism, which describes the ideology that delegitimises people's own understanding of their genders and bodies. Although anyone can experience cisgenderism, it is a particularly common experience for transgender people. The second is decompensation, which describes the processes through which the cumulative effects of stressors may lead to poor mental health. Drawing on both previous empirical findings and these two theoretical frameworks, this article proposes, and provides initial testing of, a model for understanding the mental health of transgender adults in Australia. The article concludes by suggesting the need for changes regarding how decisions are made about mental health service provision for transgender people, how mental health professionals understand the lives of transgender people, and how legislation can better ensure the full inclusion of transgender people in Australia.     

Diversity and Community: The Role of Agent‐Based Modeling

Community psychology involves several dialectics between potentially opposing ideals, such as theory and practice, rights and needs, and respect for human diversity and sense of community. Some recent papers in the American Journal of Community Psychology have examined the diversity‐community dialectic, some with the aid of agent‐based modeling and concepts from network science. This paper further elucidates these concepts and suggests that research in community psychology can benefit from a useful dialectic between agent‐based modeling and the real‐world concerns of community psychology.     

Robustness of Decision‐Making Competence: Evidence from Two Measures and an 11‐Year Longitudinal Study

Decision‐making competence (DMC) is the ability to follow normative principles when making decisions. In a longitudinal analysis, we examine the robustness of DMC over time, as measured by two batteries of paper‐and‐pencil tasks. Participants completed the youth version (Y‐DMC) at age 19 and/or the adult version (A‐DMC) 11 years later at age 30, as part of a larger longitudinal study. Both measures are composed of tasks adapted from ones used in experimental studies of decision‐making skills. Results supported the robustness of these measures and the usefulness of the construct. Response patterns for Y‐DMC were similar to those observed with a smaller initial sample drawn from the same population. Response patterns for A‐DMC were similar to those observed with an earlier community sample. Y‐DMC and A‐DMC were significantly correlated, for participants who completed both measures, 11 years apart, even after controlling for measures of cognitive ability. Nomological validity was observed in correlations of scores on both tests with measures of cognitive ability, cognitive style, and environmental factors with predicted relationships to DMC, including household socioeconomic status, neighborhood disadvantage, and paternal substance abuse. Higher Y‐DMC and A‐DMC scores were also associated with lower rates of potentially risky and antisocial behaviors, including adolescent delinquency, cannabis use, and early sexual behavior. Thus, the Y‐DMC and A‐DMC measures appear to capture a relatively stable, measurable construct that increases with supportive environmental factors and is associated with constructive behaviors. Copyright © 2017 John Wiley & Sons, Ltd.     

Photography and Social Media Use in Community‐Based Participatory Research with Youth: Ethical Considerations

Community‐based participatory researchers increasingly incorporate photography and social media into their work. Despite its relative infancy, social media has created a powerful network that allows individuals to convey messages quickly to a widespread audience. In addition to its potential benefits, the use of social media in research also carries risk, given the fast pace of exchanges, sharing of personal images and ideas in high accessibility, low privacy contexts and continually shifting options and upgrades. This article contributes to the literature examining ethical considerations for photography and social media use in community‐based participatory research. We describe three key ethical dilemmas that we encountered during our participatory photography project with Latina/o youth: (a) use and content of images and risk; (b) incentives and coercion; and (c) social media activity and confidentiality. We provide our responses to these challenges, contextualized in theory and practice, and share lessons learned. We raise the question of how to contend with cultural shifts in boundaries and privacy. We propose that evaluating participant vulnerability versus potential empowerment may be more fitting than the standard approach of assessing risks and benefits. Finally, we recommend upholding the principles of participatory research by co‐producing ethical practices with one's participants.     

Identifying and Treating Race‐Based Trauma in Counseling

This study investigated 106 counseling professionals’ experiences with identifying and treating race‐based trauma and the relationship between training and treatment. Competency was assessed with the Race‐Based Trauma Survey for Counselors. Although most participants reported working with clients who had symptoms associated with race‐based trauma, many had not received training in identifying and treating race‐based trauma among individuals of color. This finding highlights the disparities between health care and the provision of related services. Recommendations for counseling professionals and researchers are included. Este estudio investigó las experiencias de 106 profesionales en consejería con la identificación y el tratamiento de traumas basados en la raza, así como la relación entre la capacitación y el tratamiento. La competencia se evaluó usando la Encuesta para Consejeros sobre Traumas Basados en la Raza. A pesar de que la mayoría de participantes informó que había trabajado con clientes que tenían síntomas asociados con traumas basados en la raza, muchos no habían recibido capacitación para identificar y tratar traumas basados en la raza en personas de color. Este hallazgo resalta las disparidades entre la atención sanitaria y la provisión de servicios relacionados. Se incluyen recomendaciones para profesionales en consejería e investigadores.     

Self‐esteem mediates the relationship between spirituality and subjective well‐being in Iran

Self‐esteem appears to play a central role in the spiritual life and ethical behaviour of the typical Iranian. For example, for many Iranians, humankind is believed to be the crown of creation, and each person is believed to be individually valued by God. Previous empirical studies also indicate that in Iran spirituality is positively associated with self‐esteem. On this basis, it was hypothesised that self‐esteem would be one of the mechanisms through which spirituality leads to increased mental well‐being. Mediation analysis showed that self‐esteem was a partial mediator of the spirituality–well‐being relationship. Moreover, results of moderated mediation analysis revealed that this mediation was not significantly moderated by gender, and that the indirect path through self‐esteem was significant in both genders. Implications of the results and their relevance to other western and eastern religions (e.g. Christianity and Buddhism) are discussed.     

Waimānalo Pono Research Hui: A Community–Academic Partnership to Promote Native Hawaiian Wellness through Culturally Grounded and Community‐Driven Research and Programming

Although Hawai‘i is often portrayed as an idyllic paradise and is recognized as one of the healthiest States in the United States, pervasive health disparities exist among Native Hawaiians. Similar to other indigenous populations across the globe, these disparities are linked to unjust social and economic policies rooted in colonization and historical trauma. Western‐centric efforts to address these disparities have yielded limited results. Consequently, indigenous frameworks to decolonize western‐centric research processes have emerged. The Waimānalo Pono Research Hui is an example of a community–academic partnership that uses indigenous methodologies and principles of community‐based participatory research as the foundation to engage Native Hawaiian community members in research. Monthly gatherings are held where community members and academic researchers share a meal and discuss community priorities with the goal of shaping research and programming that are rooted in Native Hawaiian values. A mission for the group has been created as well as protocols for community engagement to ensure all projects that work with the Waimānalo Pono Research Hui are ethically sound and grounded in the community's preferences, cultural knowledge, and lived experiences. Our community members continually report that the Waimānalo Pono Research Hui has positively transformed their perception of and willingness to engage in research. Similarly, university students and academic researchers express how much their knowledge about working with communities has grown and inspired them. Creating spaces for communities and researchers to build authentic relationships and engage in ongoing conversations can promote culturally grounded and community‐driven research and programming.     

Measuring Sense of Community Responsibility in Community‐Based Prevention Coalitions: An Item Response Theory Analysis

Research on sense of community (SOC) has traditionally been approached from a resource perspective. Recently, however, research on the experience of SOC has evolved to include a related but distinct construct of sense of community responsibility (SOC‐R), or feelings of accountability for the well‐being of a community. This study applied item response theory to examine the psychometric properties of a SOC‐R scale used in an evaluation of community‐based substance abuse prevention coalitions. Data were collected in 2017 from coalition members (analytic sample = 309) in the northeastern United States. Findings indicate that the scale was reliable, unidimensional, and functioned well, particularly at low and moderate levels of the construct. The addition of two items intended to capture higher levels of the construct improved the scale's functioning at higher levels of SOC‐R. The adapted SOC‐R scale was also shown to have moderately strong relationships with conceptually relevant variables, including SOC, coalition participation, number of roles performed in the coalition, and engagement in community action activities. These findings provide empirical evidence to support the reliability and validity of the SOC‐R scale, and have critical implications for our conceptualization of the SOC construct, its measurement, and for the evaluation of community‐based prevention interventions.     

The Latent Threat of Community Violence: Indirect Exposure to Local Homicides and Adolescents’ Mental Health in Colombia

This study examines the relation between adolescents’ indirect exposure to local homicides and mental health disorders and post‐traumatic stress disorder (PTSD) symptoms. We employ a sample of 300 adolescents ( representative for Bogotá, Colombia, and geocoded data on violent crimes recorded by the national police. Findings show that one SD increment in local homicides is associated with increments by 0.17 SD in the mental health disorder index and a 0.14 SD increase in the PTSD score index, even after accounting for adolescents’ direct exposure to violence. The estimated effect for PTSD was larger for adolescents’ who were directly exposed to violence and for those living in multidimensionally poor households, whereas no detectable effects were found for adolescents who perceived their residential neighborhood as relatively safe.     

The “Place” of Place‐Based Pedagogy in Teaching Religion: Brooklyn and Its Religions

Place‐based pedagogy offers students a distinctive way to be attentive to a particular expression of a given religion while enabling them to minimize generalizations on the basis of that experience. Place‐based pedagogies decenter the traditional classroom as the sole locus of learning and emphasize the value of learning within varied spatial frameworks including undeveloped natural environments and built environments in rural, suburban, or urban communities. This article, set in Brooklyn, New York, is a case study of place‐based teaching in an urban context. “Brooklyn and Its Religions” is a course that provides students with a place to explore diverse expressions of Judaism, Christianity, and Islam. The article describes the course and analyzes students' field reports in two settings to demonstrate the value of place‐based learning for studying religion in Brooklyn.     

Aging and decision‐making competence: an analysis of comprehension and consistency skills in older versus younger adults considering health‐plan options

Older adults need to maintain strong decision‐making capabilities as they age. However, we know little about how age‐related physical and psychological changes affect older adults' judgment and decision processes. This paper reports the results of research comparing older versus younger adults' performance on evaluation and choice tasks about health‐plan options. In particular, comprehension and consistency in judgments (across separate versus joint evaluation contexts) were examined. Results indicated that increasing age was related to greater comprehension errors and inconsistent preferences, even when covariates (education, income, gender, self‐perceived skill and health, decision style, and attitude toward delegation) were taken into account. Discussion of the results emphasizes difficulties in interpreting the meaning of age differences in performance on decision tasks and the need for research that ascertains the seriousness of the consequences of age differences in real‐life tasks. The implications for providing decision‐aiding interventions for older adults are highlighted. Copyright © 2002 John Wiley & Sons, Ltd.     

Reducing Disparities in Cancer Screening and Prevention through Community‐Based Participatory Research Partnerships with Local Libraries: A Comprehensive Dynamic Trial

Reduction of cancer‐related disparities requires strategies that link medically underserved communities to preventive care. In this community‐based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped‐wedge sequence. Population‐level outcomes included self‐reported screening adherence and smoking cessation, based on street intercept interviews. Event‐history regressions (n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities.     

Transforming Social Regularities in a Multicomponent Community‐Based Intervention: A Case Study of Professionals’ Adaptability to Better Support Parents to Meet Their Children's Needs

This paper presents an in‐depth case study of the dynamic processes of mutual adjustment that occurred between two professional teams participating in a multicomponent community‐based intervention (CBI). Drawing on the concept of social regularities, we focus on patterns of social interaction within and across the two microsystems involved in delivering the intervention. Two research strategies, narrative analysis and structural network analysis, were used to reveal the social regularities linking the two microsystems. Results document strategies and actions undertaken by the professionals responsible for the intervention to modify intersetting social regularities to deal with a problem situation that arose during the course of one intervention cycle. The results illustrate how key social regularities were modified in order to resolve the problem situation and allow the intervention to continue to function smoothly. We propose that these changes represent a transition to a new state of the ecological intervention system. This transformation appeared to be the result of certain key intervening mechanisms: changing key role relationships, boundary spanning, and synergy. The transformation also appeared to be linked to positive setting‐level and individual‐level outcomes: confidence of key team members, joint planning, decision‐making and intervention activities, and the achievement of desired intervention objectives.     

Beyond the Belmont Principles: A Community‐Based Approach to Developing an Indigenous Ethics Model and Curriculum for Training Health Researchers Working with American Indian and Alaska Native Communities

Individuals responsible for carrying out research within their diverse communities experience a critical need for research ethics training materials that align with community values. To improve the capacity to meet local human subject protections, we created the research Ethics Training for Health in Indigenous Communities (rETHICS), a training curriculum aligned within American Indian and Alaska Native (AI/AN) context, culture, and community‐level ethical values and principles. Beginning with the Belmont Report and the Common Rule that defines research with human subjects (46 CFR 45), the authors convened three different expert panels (N = 37) to identify Indigenous research values and principles common across tribal communities. The resulting culturally grounded curriculum was then tested with 48 AI/AN individuals, 39 who also had recorded debriefing interviews. Using a thematic analysis, we coded the qualitative feedback from the expert panel discussions and the participant debriefings to assess content validity. Participants identified five foundational constructs needed to ensure cultural‐grounding of the AI/AN‐specific research training curriculum. These included ensuring that the module was: (a) framed within an AI/AN historical context; (b) reflected Indigenous moral values; (c) specifically linked AI/AN cultural considerations to ethical procedures; (d) contributed to a growing Indigenous ethics; and (e) provided Indigenous‐based ethics tools for decision making. Using community‐based consultation and feedback from participants led to a culturally grounded training curriculum that teaches research ethical principles and procedures for conducting research with AI/ANs. The curriculum is available for free and the community‐based process used can be adapted for other cultural groups.     

Extensions and Mechanisms of Mindfulness‐based Cognitive Therapy: A Review of the Evidence

Mindfulness‐based cognitive therapy (MBCT) was originally developed to prevent depressive relapse and recurrence and has also been widely extended to new patient populations and target problems over the last 14 years. We provide a comprehensive review of this literature, examining the strength of the evidence base for specific populations and target problems and identifying questions for future research to address. Specifically, we review studies addressing the use of MBCT for depressive disorders (prevention of depressive relapse and treatment of residual and current depressive symptoms), the use of MBCT in the treatment or management of other mental disorders (bipolar disorder, anxiety disorders, mixed anxiety and depression symptoms, disordered eating, personality disorders, and psychosis), and the use of MBCT in behavioural medicine contexts. Additionally, we discuss the extension of MBCT during specific developmental periods, like childhood, pregnancy and post‐partum, and adult caregiving, and, finally, we address the use of MBCT among clinical health‐care providers. In the second section, we review hypothesised mechanisms of change in MBCT and reflect on implications for theories of how MBCT works in the application to various patient populations and target problems. We also consider research addressing active ingredients and what is known about the “dosage” of meditation practice. We conclude with a summary of recommendations for future research.