A culturally adapted family intervention for rural Pacific Island veterans with PTSD.

The Veterans Affairs mission to provide equitable, accessible, and patient-centered care necessitates that culturally appropriate interventions are available when cultural differences may jeopardize engagement in care. However, within the VA, wounded warriors residing in rural areas in the Pacific Islands have been offered interventions that were developed and tested using largely urban mainland populations. The objectives of this article were to (a) document the cultural adaptation of a cognitive-behavioral clinical intervention for use by rural Pacific Island veterans, and (b) report feasibility data for the intervention. The 5-stage Map of the Adaptation Process (assessment, selection, preparation, piloting, and refinement) was used to structure the work. The resultant intervention, called "Koa," is a multisession family psychoeducational program that integrates selected Pacific Islander values, beliefs, and healing traditions with an empirically based mainstream U.S. INTERVENTION: To pilot Koa, rural Pacific Island dyads (28 veterans and 28 family members) participated via video teleconference and completed pre- and post- intervention measures. Outcome data indicated that participants perceived the intervention to be highly acceptable, useful, and relevant. Relationship quality scores substantially improved postintervention as measured by the Dyadic Relationship Scale (95% CI [-10.97, -1.84], t(22) = -2.9, p = .008, d = -0.53 for veterans; 95% CI [-11.06, -2.47], t(21) = -3.28, p = .004, d = -0.68 for family members). Family caregiving burden also improved significantly. The positive results of this investigation support the development of culturally adapted mental health interventions for culturally distinct subgroups of veterans and their families. (PsycINFO Database Record

How self-enhancers adapt well to loss: The mediational role of loneliness and social functioning.

OBJECTIVE: The tendency toward unrealistically optimistic self-serving biases, known as trait self-enhancement, has been associated with both adaptive benefits and negative social consequences. This study explored these potential benefits and costs in the context of conjugal bereavement. METHOD: The study included 94 individuals who had experienced the death of a spouse 1.5-3.0 years prior. The sample (62 female, 32 male) ranged in age from 37 to 60 (M = 51.45, SD = 6.08). To examine benefits, we used relatively objective measures of overall adjustment: structured clinical interviews and ratings from participants' close friends and relatives. To examine social adjustment, we examined friends'/relatives' ratings of the quality of social interactions and the possible mediating roles of perceived loneliness and friend/relative ratings. RESULTS: Trait self-enhancement was uniformly associated with positive adjustment: relatively lower symptom totals, and friend/relative ratings of both overall better adjustment and better social adjustment. Self-enhancers' low loneliness was found to mediate reduced symptoms. Also, friends'/relatives' ratings of social functioning appeared to mediate self-enhancers' reduced loneliness. CONCLUSIONS: These findings provide further empirical data to challenge the longstanding assumption that inaccurate self-perception is inherently maladaptive. Authentic benefits may result from mistaken perceptions of oneself by influencing the experience of loneliness and how one is seen by close friends/relatives. Self-enhancement may be an adaptation that provides clinically relevant advantages.

Coping flexibility and complicated grief: a comparison of American and Chinese samples.

BACKGROUND: The ability to process a death and the ability to remain optimistic and look beyond the loss are both thought to be effective means of coping with loss and other aversive events. Recently, these seemingly contrary dimensions have been integrated into the idea of coping flexibility. METHODS: In this study, we assessed the ability of married and bereaved individuals in the United States and Hong Kong to use both coping approaches as operationalized by the trauma-focused and forward-focused coping scales of a previously validated questionnaire. We also calculated a single flexibility score. RESULTS: Bereaved participants reported greater trauma-focused coping ability than did married participants. However, bereaved participants meeting criteria for complicated grief (CG) reported less forward-focused coping than both asymptomatic bereaved and married participants. The CG group also showed less overall coping flexibility than the asymptomatic bereaved and married groups. Country was not a factor. CONCLUSION: Findings suggest that deficits in coping flexibility are indicative of pathology in bereaved individuals, and that this relationship extends across cultures. Limitations of the study and directions for future research are discussed.