From racial awakening to collective action: Asian Americans' pathways to activism and benevolent support during COVID-19.

OBJECTIVES: In response to increased anti-Asian discrimination and violence during the COVID-19 pandemic, this study examined pathways from discrimination experiences to own-group collective action in a diverse sample of 689 Asian Americans. METHOD: Informed by theories of ethnoracial identity, critical consciousness, and collective action and utilizing structural equation modeling, we examined the associations among discrimination, psychological distress, critical awareness and motivation (CAM) to resist racism, and two types of own-group collective action: political activism and benevolent support. Multigroup invariance tests also examined whether these associations differed by ethnic subgroup, immigrant generation, and age. RESULTS: Results supported our integrated model in which distress mediated the relationship between discrimination and CAM, and CAM mediated the relationship between discrimination and collective action. The structural pathways from discrimination to own-group collective action generally did not differ by ethnic subgroup and immigrant generation, although path coefficients for the effect of discrimination on distress did vary by age (p < .01). Further, discrimination did not appear to have the same catalyzing effect on CAM for South and Southeast Asians compared to East Asians. CONCLUSIONS: While anti-Asian discrimination was associated with both distress and engagement in collective action during the COVID-19 pandemic, group differences in mediational processes highlight the importance of disaggregating analyses to explore both similarities and differences in Asian Americans' responses to discrimination. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does Mindfulness Improve Intergroup Bias, Internalized Bias, and Anti-Bias Outcomes?: A Meta-Analysis of the Evidence and Agenda for Future Research.

Whereas mindfulness has been shown to enhance personal well-being, studies suggest it may also benefit intergroup dynamics. Using an integrative conceptual model, this meta-analysis examined associations between mindfulness and (a) different manifestations of bias (implicit/explicit attitudes, affect, behavior) directed toward (b) different bias targets (outgroup or ingroup, e.g., internalized bias), by (c) intergroup orientation (toward bias or anti-bias). Of 70 samples, 42 (N = 3,229) assessed mindfulness-based interventions (MBIs) and 30 (N = 6,002) were correlational studies. Results showed a medium-sized negative effect of MBIs on bias outcomes, g = -0.56, 95% confidence interval [-0.72, -0.40]; I(2;3)2: 0.39; 0.48, and a small-to-medium negative effect between mindfulness and bias for correlational studies, r = -0.17 [-0.27, -0.03]; I(2;3)2: 0.11; 0.83. Effects were comparable for intergroup bias and internalized bias. We conclude by identifying gaps in the evidence base to guide future research.

Factors Contributing to West Indian American Depression.

This study explored factors that mediate the relationship between subjective wellbeing and depression in a sample of West Indian American immigrants. An intersectional theoretical framework was used to identify the relative contribution of psychological stressors-perceived discrimination, financial strain and acculturative stress-that mediate the relationship between subjective wellbeing and depression. A geographically diverse sample was recruited by an online survey (N = 255), consisting of 138 men, 115 women, 173 Indo-West Indians and 82 Afro-West Indians. Path analysis was used to identify the relative contribution of psychological stressors. Acculturative stress and financial strain were both statistically significant predictors of depression. Financial strain was identified as the major mediator between subjective wellbeing and depression in West Indian Americans. West Indian Americans are vulnerable to financial strain and acculturative stress. These sources of psychological stress are important contributors to depression in the community. More research is needed to clarify these relationships.

Disaggregating the data: Diversity of COVID-19 stressors, discrimination, and mental health among Asian American communities.

Much of the public discourse as well as research regarding the negative impact of COVID-19-related anti-Asian discrimination has been conducted at the broad racial group level, yet data aggregation masks critical points of diversity among Asian Americans. We conducted an online survey of 620 Asian American adults in December 2020 and examined whether there were any demographic differences-including by ethnic subgroup and Chinese street race (being Chinese or being mistaken as Chinese)-in their experiences of COVID-19-related stress, direct and vicarious discrimination, and psychological outcomes. Our analyses found that younger age was correlated with higher reports of pandemic stress, discrimination, distress, and worry. Female and U.S.-born participants reported higher levels of pandemic stress and vicarious discrimination, but there were no gender or nativity differences in levels of direct discrimination. Being uninsured was also related to higher levels of pandemic stress, discrimination, and distress. East Asian Americans reported significantly lower frequencies of direct anti-Asian discrimination than did South Asian or Southeast Asian Americans, but the ethnic subgroups did not differ in their reports of vicarious discrimination. Of note, Chinese street race was not associated with either direct or vicarious discrimination. Separate hierarchical regression analyses for East Asian, South Asian, and Southeast Asian participants revealed that, regardless of ethnicity, racial discrimination significantly contributed to psychological distress and worry beyond the effects of pandemic stress. However, the three groups varied in the demographic indicators and COVID-19 stressors that were associated with psychological outcomes. Pandemic stress was more strongly associated with negative outcomes among South Asian Americans than East Asian and Southeast Asian Americans, and neither direct nor vicarious discrimination were associated with mental health among South Asian Americans. Direct discrimination, compared to vicarious discrimination, was a particularly robust predictor of both distress and worry among East Asian Americans. For Southeast Asian Americans, direct discrimination significantly predicted higher levels of distress, whereas vicarious discrimination predicted higher levels of worry. Vicarious discrimination was not significantly related to distress across ethnic subgroups. Results suggest that practitioners and policy makers would benefit from attending to these within-group differences in Asian Americans' experiences during the pandemic.

Rethinking Interpreter Functions in Mental Health Services.

Interpreters improve access to care for patients with limited English proficiency (LEP), but some studies have reported poorer cultural understanding, relationship quality, and patient satisfaction than with language-concordant care. Use of interpreter roles beyond linguistic conversion (clarifier, cultural broker, or advocate/mediator) may enhance interpreter-mediated care by improving cultural understanding and the therapeutic alliance. As reported in this column, pilot data on interpreter-mediated evaluations of 25 psychiatric outpatients with LEP support this position. The authors found that clarification of the interpreter's role and the session structure improved provider-interpreter collaboration, with two perceived benefits: improved assessment through elicitation of clinically relevant information and stronger therapeutic alliance through "emotion work." Strategies for effectively enhancing provider-interpreter collaboration are discussed.

A critical-cultural-relational approach to rupture resolution: A case illustration with a cross-racial dyad.

Ruptures are common in any therapeutic relationship and their successful resolution is associated with positive outcomes. However, therapist and client differences with regard to power, privilege, identity, and culture increase social and cultural distance, contributing to alliance ruptures and complicating the repair process. Informed by critical race theories, cultural psychological perspectives, and relational principles, we highlight how power, privilege, identity, and culture shape the development of ruptures and thus, how analyses of these dynamics should inform the process of repair. We present an expanded critical-cultural-relational approach to rupture resolution that emphasizes essential skills of critical self-awareness, wise affect, and anti-oppressive interpersonal engagement, and extends Safran and Muran's (2000) general rupture resolution model to emphasize a critical analysis of the rupture and repair processes. We illustrate our approach through a case presentation involving a rupture in a cross-racial dyad with themes of racism and classism.

Let Nature Take Its Course: Cultural Adaptation and Pilot Test of Taoist Cognitive Therapy for Chinese American Immigrants With Generalized Anxiety Disorder.

This report describes initial results from a multi-stage project to manualize and adapt an indigenous therapy, Chinese Taoist Cognitive Psychotherapy (CTCP), for dissemination in the United States context. Study aims were to (a) integrate cultural adaptation and implementation science frameworks to manualize and adapt the original intervention and (b) explore the feasibility, acceptability, and effectiveness of the modified intervention, renamed Taoist Cognitive Therapy (TCT), in a sample of Chinese immigrants with generalized anxiety disorder (GAD). Incorporating bottom-up and top-down adaptation approaches, we involved Chinese American clinician stakeholders and experts in Taoist philosophy, cognitive-behavioral therapy, and GAD to help identify cultural and contextual barriers and solutions to enhance treatment acceptability and implementation. Five treatment-seeking Chinese American immigrants (average age = 43.2 years) with a primary diagnosis of GAD completed 14-16 sessions of TCT. Two participants also had secondary diagnoses of major depressive disorder. Changes on primary measures of worry and anxiety were assessed for statistical and clinical significance using reliable change indices (RCIs; Jacobson and Truax, 1991) and comparisons to normative data. In this sample of patients with limited prior exposure to Taoism, results found evidence of feasibility and acceptability of the modified intervention, with strong endorsement of Taoist principles at termination. Statistically and clinically significant improvements in anxiety, worry, psychological inflexibility, and emotional avoidance were found only for the participants without comorbid depression. Results suggest that Taoist principles of acceptance and flexible adaptation to natural laws may be helpful to Chinese immigrants coping with anxiety. However, additional treatment modifications may be required to address the low self-efficacy and fatalism expressed among those with comorbid depression.

Discrimination as a frame-of-reference effect in overlapping friendship communities of ethnically diverse youth.

OBJECTIVES: To what extent is the frame of reference of overlapping friendship communities important for young people's feelings of discrimination and subjective well-being? That is, do youth feel better or worse to the extent that they feel less or more discrimination than their friends? METHOD: Participants (N = 898; Mage = 14.13; SDage = 3.37; 46% females; 46% Whites; 20% Indigenous; 34% other minorities) were high school students of three ethnically diverse, low socioeconomic status public schools in New South Wales, Australia. Cross-sectional data were collected to measure felt discrimination, mental health, subjective well-being, social support, and nominations of close friends. A state-of-the-art method of clustering links was used to identify overlapping friendship communities, and multiple membership multilevel models were run to examine whether community-level discrimination moderated the link between individual-level discrimination and well-being. RESULTS: When the community level discrimination was low, there was no well-being related cost or benefit of individual-level discrimination. But when the community-level discrimination was high, individuals in those communities who themselves felt low discrimination had better well-being than individuals who themselves felt high discrimination. CONCLUSIONS: We provide evidence for a frame-of-reference effect involving discrimination. Individuals' relative standing in their friendship communities with high group-level discrimination reliably predicted the individuals' well-being levels, regardless of ethnicity. The results highlight the importance of identifying overlapping friendship communities for understanding the dynamics of discrimination and well-being of ethnically diverse youth. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Inverting the power dynamic: The process of first sessions of psychotherapy with therapists of color and non-Latino white patients.

The present study is the first to apply Trawalter, Richeson, and Shelton's (2009) stress and coping framework to qualitatively examine interracial interactions in initial sessions of psychotherapy. The sample included 22 dyads: 15 therapists of color administering various treatment modalities to 15 treatment-seeking non-Latino White (NLW) patients and a comparison group of 7 intraracial (NLW-NLW) dyads. In Phase 1, videorecordings of the first session of treatment were analyzed using inductive thematic analysis (TA) to describe patient and therapist behaviors. In Phase 2, a deductive TA approach was used to interpret and cluster those dyadic behaviors according to Trawalter et al.'s (2009) framework. NLW patients paired with therapists of color made more efforts to bridge differences and more often questioned the therapist's professional qualifications compared with those matched with NLW therapists. Therapists of color made more self-disclosures than NLW therapists and maintained a more formal stance, compared with NLW therapists. The deductive TA operationalized 4 of Trawalter and colleagues' (2009) coping responses within a therapeutic framework. Findings highlight the ability of therapists' of color to engage positively with their NLW patients even in the face of challenges to their expertise and credibility. (PsycINFO Database Record

Racial/ethnic match and treatment outcomes for women with PTSD and substance use disorders receiving community-based treatment.

This study examined the relationship between racial/ethnic match and treatment outcomes for 224 women who participated in a clinical trial of group treatments for posttraumatic stress disorder (PTSD) and substance use disorders. Generalized estimating equations were used to examine the effect of client-therapist racial/ethnic match on outcomes. Results revealed racial/ethnic match was not significantly associated with session attendance. There was a significant three-way interaction between client race/ethnicity, baseline level of PTSD symptoms, and racial/ethnic match on PTSD outcomes. White clients, with severe PTSD symptoms at baseline, who attended treatment groups where they were matched with their therapist, had greater reductions in PTSD symptoms at follow-up than their counterparts who were racially/ethnically mismatched with their group therapist. Racial/ethnic match did not confer additional benefits for Black clients in terms of PTSD outcomes. Racial/ethnic match interacted with baseline substance use to differentially influence substance use outcomes at follow-up for all women. Clinical implications are discussed.

Ethnic minority clients' perceptions of the significance of race in cross-racial therapy relationships.

In this consensual qualitative research study, 23 ethnic minority clients were interviewed to assess perceptions of race in their recent therapy with a White therapist. Participants' responses were coded into an average of seven (out of 22) categories. The majority believed that White therapists could not understand key aspects of their experiences and subsequently avoided broaching racial/cultural issues in therapy. However, many felt that racial differences were minimized if the therapist was compassionate, accepting, and comfortable discussing racial, ethnic and/or cultural (REC) issues. A subgroup expressed positive expectancies of racial mismatch, and perceived disadvantages associated with racial matching. Results suggest that participants' constructions of race are multidimensional and support recommendations that therapists acquire skills for addressing racial perceptions that may impact the therapy relationship.

Correlations between self-reported symptoms and psychosocial factors of perpetrators with domestic violence in China: a population-based sample.

BACKGROUND: Domestic violence (DV) is not only a devastating societal problem, but also a severe medical and mental health problem worldwide. Our previous study has shown that perpetrators were with higher prevalence of self-reported symptoms than that of controls. This study based on our former large scale population-based samples is aimed to further explore the correlations between the symptoms and psychosocial factors of the perpetrators with DV. It was helpful to provide some insight into possible strategies for clinicians to reduce the symptoms of the perpetrators with DV in China. METHODS: From our former population-based epidemiological samples, 1098 households with a history of DV in preceding year, 318 perpetrators with DV were randomly selected. Face-to-face interviews were conducted. Symptom Checklist-90 (SCL-90) was administrated to check and classify the symptoms of perpetrators, Eysenck's personality questionnaire (EPQ), trait coping style questionnaire (TCSQ), life events scale (LES) and social supporting rating scale (SSRS) were administrated to evaluate the psychosocial factors of perpetrators. The correlation analysis was used to analyze the relationships between the symptoms and psychosocial factors of perpetrators of DV. RESULTS: The global and all subscale scores of SCL-90 were significantly positively correlated with EPQ-N, negative TCSQ and negative LES scores (P < 0.01). The global score of SCL-90 was negatively correlated with both objective and subjective SSRS (P < 0.01). The negative LES and negative TCSQ were significantly positively correlated with EPQ-N (P < 0.01). Negative TCSQ was significantly positively correlated with negative LES and negatively correlated with subjective SSRS (P < 0.01). CONCLUSIONS: The self-reported symptoms of perpetrators with DV were strongly correlated with their psychosocial factors, such as the neurotic personality, negative coping style, more negative life events and less subjective social supports. It suggested bio-psycho-socially oriented interventions were necessary to buffer the symptoms of perpetrators with DV.

Methodological challenges in treatment outcome research with ethnic minorities.

Treatment outcome research focused on ethnic minorities is critically needed to eliminate mental health disparities. Because the conduct of treatment outcome research with ethnic minorities is difficult and complex, we discuss key challenges and present some methodological options suited to provide answers to specific types of questions. We focus first on the randomized clinical trial (RCT) paradigm, reviewing specific challenges facing investigators conducting ethnically inclusive trials. We then highlight the promise of other methods of inquiry to expand the science on mental health treatment with ethnic minorities.

Beliefs about wife beating: an exploratory study with Lebanese students.

In recent years, there has been a growing interest in understanding the sociocultural contexts and risk factors for domestic violence in the Arab world. This study provides an analysis of the religious, legal, and familial contexts of domestic violence in Lebanon and assesses contemporary attitudes toward women and wife beating in a sample of 206 Lebanese university students. Gender, patriarchal attitudes, religion, childhood experiences with family violence, and mother's employment status were investigated as predictors of attitudes toward wife beating. Consistent with feminist theories of wife abuse, gender and attitudes toward women's roles emerged as the strongest predictors of beliefs about wife beating.

Prevalence and demographic correlates of intimate partner violence in Asian Americans.

This study provides the first national estimates of the prevalence and correlates of intimate partner violence (IPV) among Asian Americans. Population estimates are based on data from 1470 Asian Americans interviewed for the National Latino and Asian American Study. Interviews were conducted in English, Chinese, Tagalog, or Vietnamese. Results suggest that rates of IPV among Asian Americans are low compared to the general U.S. population. Minor violence victimization by a current intimate partner was reported by 10.2% of women and 12.0% of Asian American men. Notably, a greater proportion of participants admitted having perpetrated IPV than having been a victim. Predictors of IPV included younger age, higher SES, alcohol- and substance-use disorders, depression, ethnicity, and being U.S.-born. Results suggest the need for additional research to examine the interactions between gender, ethnicity, and acculturation to develop group-specific models of IPV risk and resilience within diverse Asian American groups.

Psychosocial and immunological factors in neurasthenia.

BACKGROUND: Neurasthenia is a disorder whose pathogenesis is still unknown. OBJECTIVE: The authors sought to examine the relationships between neurasthenia and possible psychosocial and immunological correlates. METHOD: A sample of 30 Chinese neurasthenic patients was compared with a matched sample of 30 control subjects for 1) the level of serum Epstein-Barr virus (EBV) gamma G immunoglobulin (IgG) and gamma M immunoglobulin (IgM); 2) scores on the Eysenck Personality Questionnaire (EPQ); 3) the Symptom Checklist-90; and 4) the Life Event Scale (LES); 27 of the 30 neurasthenia patients were treated with medication and psychotherapy for a 4-month period, with measures taken pre- and posttreatment. RESULTS: As compared with the control group, neurasthenic patients exhibited higher EPQ scores for neuroticism, higher levels of introversion, and a higher number of negative life events. Within the neurasthenia sample, scores for neuroticism and the SCL-90 Global Severity Index were significantly lower at follow-up than at baseline. CONCLUSION: As compared with control subjects, neurasthenia patients were characterized by greater neuroticism and introversion, and they reported a higher rate of negative life events. Moreover, the positive rate of EBV in neurasthenic patients was higher, which may be associated with higher EBV activation under states of stress.

Making cross-racial therapy work: A phenomenological study of clients' experiences of cross-racial therapy.

A phenomenological/consensual qualitative study of clients' lived experiences of cross-racial therapy was conducted to enhance our understanding of whether, how, and under what conditions race matters in the therapy relationship. The sample consisted of 16 racial/ethnic minority clients who received treatment from 16 White, European American therapists across a range of treatment settings. Participants who reported a satisfying experience of cross-racial therapy (n=8) were examined in relation to gender- and in most cases, race/ethnicity-matched controls (n=8) who reported an overall unsatisfying experience. Therapy satisfaction was assessed during the screening process and confirmed during the research interview. Therapy narratives were analyzed using consensual qualitative research to identify the client, therapist, and relational factors that distinguished satisfied from unsatisfied cases. Findings reveal substantial differences at the level of individual characteristics and relational processes, providing evidence of both universal (etic) as well as culture/context-specific (emic) aspects of healing relationships. Recommendations for facilitating positive alliance formation in cross-racial therapy are provided based on clients' descriptions of facilitative conditions in the therapy relationship.

Psychiatric disorders among foreign-born and US-born Asian-Americans in a US national survey.

BACKGROUND: Among Hispanics, Non-Hispanic Whites and Non-Hispanic Blacks studies have found lower risk for psychiatric disorders among the foreign-born than among the US-born. We examine the association of nativity and risk for psychiatric disorder in a national sample of the Asian-American (AA) population. METHODS: Data on 1,236 AAs from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) are analyzed using logistic regression and discrete time survival models to specify differences between the foreign-born and US-born in the lifetime occurrence of mood, anxiety and substance use disorders. RESULTS: Foreign-born AAs had significantly lower risk for all classes of disorder compared with US-born AAs (OR = 0.16-0.59). Risk for all classes of disorder was lowest for those foreign-born AAs who arrived in the US as adults. Among foreign-born AAs risk of first onset was lowest relative to the US-born in years prior to their arrival in the US and tended to rise to levels equal to that of the US-born with longer duration of residence in the US. CONCLUSIONS: Among AAs, risk for psychiatric disorders is lower among the foreign-born than among the US-born. The pattern of change in risk over time suggests that both the developmental timing and the duration of experience in the US contribute to increases in risk.

Shenjing shuairuo and the DSM-IV: diagnosis, distress, and disability in a Chinese primary care setting.

This study examines diagnostic concordance, symptomatology and disability among Chinese patients with shenjing shuairuo, ICD-10 neurasthenia, and DSM-IV diagnoses. Patients (N=139) with unexplained somatic complaints completed the Structured Clinical Interview for DSM-III (SCID), the Brief Symptom Inventory (BSI), and the Short Form 36 (SF-36). Shenjing shuairuo could be reclassified as DSM-IV undifferentiated somatoform disorder (30.6%) and somatoform pain disorder (22.4%); however, 44.9% did not qualify for a core DSM-IV diagnosis. Concordance of neurasthenia and shenjing shuairuo was significant (p < .001). Symptom distress and disability was similar to that reported by patients with somatoform and anxiety disorders. Within the Chinese context, shenjing shuairuo describes a heterogeneous group with clinically significant levels of disturbance and disability.

Prevalence and illness beliefs of sleep paralysis among Chinese psychiatric patients in China and the United States.

To investigate the prevalence and illness beliefs of sleep paralysis (SP) among Chinese patients in a psychiatric out-patient clinic, consecutive Chinese/Chinese-American patients who attended psychiatric out-patient clinics in Boston and Shanghai were asked about their lifetime prevalence, personal experience and perceptions regarding the causes, precipitating factors, consequences, and help-seeking of SP. During the 4-month study period, 42 non-psychotic psychiatric out-patients from the Boston site and 150 patients from the Shanghai site were interviewed. The prevalence of SP was found to be 26.2% in Boston and 23.3% in Shanghai. Patients with post-traumatic stress disorder (PTSD) or panic disorder reported a higher prevalence of SP than did patients without these disorders. Patients attributed SP to fatigue, stress, and other psychosocial factors. Although the experience has traditionally been labeled 'ghost oppression' among the Chinese, only two patients, one from each site, endorsed supernatural causes of their SP. Sleep paralysis is common among Chinese psychiatric out-patients. The endorsement of supernatural explanations for SP is rare among contemporary Chinese patients.