An evaluation of the feasibility and acceptability of sister circles as an anxiety intervention for pregnant Black women.

BACKGROUND: Black women and their infants face heightened health risks during pregnancy, labor, and delivery that, for many, cost them their lives. Such health risks during this critical period are linked to increased rates of anxiety among Black pregnant and postpartum women. Black women also endure racism when seeking support from mental health and healthcare providers, which further contributes to pregnancy and postpartum-related anxiety. Evidence on sister circles has demonstrated that this indigenous form of healing may provide Black pregnant and postpartum women with the support and skills needed to cope with stressors associated with mental and physical health concerns and racism. OBJECTIVE: Our study aimed to evaluate the feasibility and acceptability of the Birthing Beautiful Babies Sisters Offering Support, a sister circle cognitive behavioral therapy-based stress and anxiety intervention for Black pregnant and postpartum women. DESIGN: Our study employed a mixed-methods framework. METHODS: Descriptive analyses, paired samples t-test, and open and selective coding were conducted. We utilized the following measures: Penn State Worry Questionnaire-Abbreviated, Kessler Psychological Distress Scale, Pregnancy-Related Anxiety Scale, focus booklet, and focus group discussion. RESULTS: Participants reported experiencing moderate levels of worry and distress and low levels of pregnancy-related anxiety prior to the start of the Birthing Beautiful Babies Sisters Offering Support intervention. Eighty women participated in Birthing Beautiful Babies Sisters Offering Support. Eleven focus groups were conducted to assess their experience. Participants reported a perceived increase in their knowledge about panic attacks and stress and ability to manage stressors effectively. They found that all completed activities contributed to their development and application of skills. They reported they enjoyed Birthing Beautiful Babies Sisters Offering Support because of the supportive environment, openness, and emphasis on sisterhood. Participants provided helpful feedback about the structure and flow of the intervention. CONCLUSION: Limitations of the present study and future directions are discussed.

Hair Cortisol Concentration and Perceived Chronic Stress in Low-Income Urban Pregnant and Postpartum Black Women.

Black women are more likely to experience short- or long-term health consequences from their labor and delivery and die from pregnancy-related causes than White women. Similarly, infants born to Black women also have heightened health risks. Developing research suggests that a contributing factor to Black health disparities may be maternal chronic stress. A widely used biomarker for chronic stress is hair cortisol concentration (HCC). Few prior studies have explored the HCC of pregnant Black women or comprehensively examined perceived chronic stress in this population. Using a mixed-methods focus group framework, we assessed HCC and perceived chronic stress among low-income pregnant and postpartum Black women. Four focus groups were conducted (N = 24). The mean HCC for our pregnant Black participants was greater than pregnant White women in reviewed published studies. The high levels of stress evidenced at all pregnancy stages indicate that many of these women are experiencing chronic stress, which can contribute to higher Black maternal morbidity and mortality rates, and possibly infant mortality rates. From the open coding of the focus group transcripts, 4 themes emerged: chronic stress, experiences of racism, experiences of trauma, and negative thinking. Selective coding based on these themes revealed cumulative experiences of chronic stress, various traumatic experiences, and frequent encounters with racism. Negative thinking styles were observed across the 4 focus groups. More studies of HCC and perceived stress among pregnant Black women are encouraged. Findings suggest the need for tailored multi-level interventions given the layers of stressors present in this population.

Evaluation of the Effectiveness of a Musical Cognitive Restructuring App for Black Inner-City Girls: Survey, Usage, and Focus Group Evaluation.

BACKGROUND: Research on mobile health (mHealth) app use during adolescence is growing; however, little attention has been paid to black adolescents, particularly black girls, who are generally underresearched and underserved in psychological intervention research. Cognitive restructuring is an important tool in anxiety and fear management and involves two parts: (1) recognizing and deconstructing erroneous thoughts and (2) replacing negative anxiety and stress-provoking thoughts with positive thoughts. In our work with black adolescent females, we found that cognitive restructuring is a difficult skill to practice on one's own. Thus, drawing upon the importance of music in the black community, we developed the Build Your Own Theme Song (BYOTS) app to deliver a musical form of the technique to middle-school black girls. OBJECTIVE: Our aim in this mixed methods study is to evaluate the effectiveness of the BYOTS app. We hypothesize that participants will expect the app to be effective in reducing negative thoughts and that the app will meet their expectations and data generated from the app will demonstrate a reduction in negative thinking and anxiety. METHODS: A total of 72 black or biracial seventh- and eighth-grade adolescent females were enrolled in Sisters United Now (SUN), an eight-session culturally infused and app-augmented stress and anxiety sister circle intervention. Before using the BYOTS app, girls completed the Multidimensional Anxiety Scale for Children 2 and the App Expectations Survey. Usage data collected from the app included an assessment of negative thinking before and after listening to their song. After completion of the intervention, focus groups were held to gather qualitative data on participants' app experience. RESULTS: Results using paired sample t tests indicated negative thinking was significantly lower at day 7 than day 1 (t31=1.69, P=.05). Anxiety from preuse to postuse of the app was also reduced (t38=2.82, P=.004). Four effectiveness themes emerged from the focus groups: difference in behavior and temperament, promoted calmness, helpfulness in stressful home situations, and focused thinking via the SUN theme song. CONCLUSIONS: The BYOTS app is a useful tool for delivering musical cognitive restructuring to reduce negative thinking and anxiety in an underserved urban population. Changes were supported both quantitatively and qualitatively. Participants, their peers, and their family noted the difference. Findings support expanding the research to black girls of various socioeconomic statuses and geographic diversity. Currently, the app augments SUN, a culturally relevant intervention. Future research will explore BYOTS as a stand-alone app.

Assessing the Effects of the Acting White Accusation Among Black Girls: Social Anxiety and Bullying Victimization.

One of the most harmful accusations one Black adolescent can hurl at another is the acting White accusation (AWA). The AWA is an attack against an individual's ethnic/racial identity and many have described it as a bullying experience. Those who experience the AWA frequently and are bothered by it might perceive the accusation as bullying for these reasons, and peer victimization has been associated with several negative outcomes including social anxiety. The present study examines the relationship between the acting White accusation, bullying victimization, and social anxiety. Thirty-one Black females between the ages of 10 and 18 years served as participants in the study. The findings indicated that all participants reported receiving the accusation at least once in their lifetime. The results also indicated that bother experienced when receiving the accusation was positively associated with social anxiety, while both bother and frequency of the accusation were positively associated with bullying victimization. These findings suggest that adolescents interpret the accusation as a negative evaluation. Additionally, the more an adolescent experiences the accusation and the more bothered he or she is by it, the more victimized they feel.

The acting White accusation, racial identity, and anxiety in African American adolescents.

Acting White is one of the most negative accusations an African American adolescent can receive from another. The accusation can either be made directly or indirectly. Research suggests that receiving the accusation may create distress for some African American adolescents. The current study examined the relationship between experiencing the acting White accusation, racial identity, and anxiety among African American adolescents. High school students completed the Multigroup Ethnic Identity Measure (MEIM), the Multidimensional Anxiety Scale for Children (MASC) and the Acting White Experiences Questionnaire (AWEQ). Results indicated that adolescents who both directly and indirectly experienced the AWA reported higher anxiety than those who only indirectly experienced the AWA. Additionally, adolescents who reported experiencing more indirect aspects of the accusation or being "bothered" more by the accusation reported higher levels of anxiety. Findings suggest that the acting White accusation may be a culturally relevant factor influencing anxiety among African American adolescents.

Sister Circles as a Culturally Relevant Intervention for Anxious African American Women.

Research on anxiety treatment with African American women reveals a need to develop interventions that address factors relevant to their lives. Such factors include feelings of isolation, multiple roles undertaken by Black women, and faith. A recurrent theme across treatment studies is the importance of having support from other Black women. Sister circles are support groups that build upon existing friendships, fictive kin networks, and the sense of community found among African Americans females. Sister circles appear to offer many of the components Black women desire in an anxiety intervention. In this article, we explore sister circles as an intervention for anxious African American women. Culturally-infused aspects from our sister circle work with middle-class African American women are presented. Further research is needed.

In the company of my sisters: sister circles as an anxiety intervention for professional African American women.

BACKGROUND: Sister circles have been used within African American communities to raise awareness about physical health. The possibility exists that sister circles could be used to educate and teach women strategies about managing anxiety and panic. In this paper we examine professional Black women's conceptualization of panic attacks and other related anxiety issues. Then, we explore the feasibility of sister circles as a psycho-educational anxiety intervention for African American professional women. METHODS: Four focus groups (n=37) were conducted. Focus group interviews were transcribed and were coded into three categories: (a) a major theme; (b) a minor theme; or (c) an off-topic comment. Specifically, we generate information regarding the key content and research components of a sister circle for African American female professionals. RESULTS: Focus group members saw a distinct difference between anxiety and panic. The number of African American women who experienced was seen as low. Women felt sister circles were a nice vehicle for helping African American women manage their anxiety and panic. Confidentially was a key component. Sister circles for anxiety and panic were seen as a natural outgrowth of African American women's professional networks. LIMITATIONS: Limited data were collected on participant's anxiety levels. CONCLUSIONS: Overall, sister circles were seen as feasible interventions for African American professional women. The data from the focus groups were used to enhance the development of a sister circle intervention for anxious professional African American women.

Trichotillomania symptoms in African American women: are they related to anxiety and culture?

Trichotillomania (TTM) is a little understood disorder that has been underresearched in the African American community. Furthermore, the incorporation of cultural factors into TTM research has virtually been ignored. Existing data from an African American college student population suggest TTM is associated with high levels of anxiety. In this study, we explored anxiety symptoms and cultural hair messages in an African American female community sample with TTM symptoms. We predicted high levels of TTM severity and impairment would be associated with high level of anxiety symptoms. We also predicted that cultural messages about hair will influence both TTM and anxiety symptoms. In this telephone study, 41 African American females participated in interviews about their TTM. TTM impairment and severity was positively correlated with general anxiety symptoms as measured on the Symptom Checklist 90-Revised (SCL 90-R(®) ). Severity was also positively correlated with obsessive-compulsive symptoms. Given the significance of hair for African American women, we also explored the childhood cultural messages receive about hair. Over half the sample received at least one cultural message about hair. Although many women received the same message, the value they placed on the message differed. Messages received about hair were not associated with TTM severity or impairment. The association among obsessive-compulsive symptoms and hair messages approached significance. Results highlight the importance of assessing anxiety comorbidity and culture with African American TTM samples. Little is known about TTM in African American samples. Existing research indicates this population seeks TTM help from their hairdressers. Among college students, a significant correlation has been found for anxiety as measured on the Beck Anxiety Inventory and TTM. To the best of our knowledge, this is the first paper to examine cultural messages about hair in an African American sample. In addition, rather than looking at college students, this research is conducted with a community sample of mostly professional African American women. The use of the SCL-90-R(®) specific anxiety dimensions demonstrates the relationship with TTM severity and impairment.

Affective states and racial identity among African-American women with trichotillomania.

Affective correlates of hair pulling were investigated in a sample of 43 African-American women with trichotillomania. The relationship among affective correlates and dimensions of racial identity was also examined. Via phone interview, participants completed the hair-pulling survey on which they rated the intensity of 10 different affective states across three different points in the hair-pulling episode (before, during and after). Participants also completed the Multidimensional Inventory of Racial Identity, which assesses racial identity across the dimensions of centrality, regard and ideology. Univariate analyses identified the feelings of being bored, happy, anxious, guilty and relieved as reflecting a time difference. Negative correlations were found among the racial identity dimension of private regard and the affective correlates of happy and relief that were experienced during and after pulling. Negative correlations were found between the racial identity dimension of humanist ideology and relieved affect as well as humanist ideology and relieved affect during a pulling episode. In light of the results, the importance of understanding and assessing cultural factors in the affective experience of African-American women with trichotillomania is discussed.