FINAL EXAM STUDY GUIDE ASAM

Direct Experiences

• experienced by the individual (i.e military combat, violent personal assault, kidnapping/torture, incarceration, auto accidents, diagnoses of illnesses)

Witnessed Events

• traumatic stressors like injury or death of another person the individual witnessed (i.e war stories, observing violent assault, seeing deceased, learning about life-threatening events)

Stressors of Resettlement for Refugees

• learning a new language, customs, and values

• resettlement in regions with limited avenues for social support

• major shifts in family member roles/structure

• employment difficulties

• financial stress

Age of Children During Migration

• immigration experiences depend on the child’s age

VERY YOUNG INFANTS

• no memory of native country, camps, or the journey

6MONTHS-2YEARS

• unique experience

• some have faint memories of journey

• easy adjustment

12MONTHS-3YEARS

• period of rapid language acquisition (may be disrupted by trauma)

3-10YEARS

• memories of native country, war, and the journey

• learn english as second language

• experiences of trauma and change can be dealt with verbally

9-15YEARS

• time for identity confusions for adolescents

PTSD

disorder that develops through exposure to:

• traumatic event

• severely oppressive situation

• cruel abuse

• natural or an unnatural disaster

SYMPTOMS

• flashbacks

• avoiding emotional experiences

• reduced ability to feel emotion

• excessive arousal/exaggerated startle response

• inability to sleep

• difficulty with memory and concentration

• impulsive behavior

MDD

• significant depressive episode and depressed characteristics, lethargy, hopelessness

• for at least 2 weeks (GAD - 6months)

SYMPTOMS

• depressed mood most of the day

• reduced interest or pleasure in activities that were once enjoyable

• significant weight loss or gain/appetite

• trouble sleeping/sleeping too much

• fatigue

• feeling excessively worthless/guilty

• issues thinking, concentrating, or decision making

• recurring thoughts of death or suicide

Cognitive Behavioral Therapy

• emphasis on individual’s cognitions or thoughts as the main source of abnormal behavior and psychological problems

• reducing self-defeating thoughts; self-efficacy

• behavioral therapy: emphasis of changing behavior; reinforcing statements

• get individuals to recognize errors in thinking/challenge accuracy of automatic thoughts

Culturally Cognitive Behavioral Therapy (CBT)

• identify cultural group/cultural & social history

• specify language of the group

• identify key demographic variables

• explain PTSD & MDD to enhance understanding

• make person feel heard/understood

• help decrease feelings of isolation

Narrative Exposure Therapy (NET)

• form of treatment for individuals suffering from “complex and multiple trauma”

• small group settings

• objective: share story or narrative about one’s experiences that doesn’t only revolve around the experienced trauma (i.e life events, positive elements of one’s life)

• unconditional understanding, active listening, and empathy from therapist

OUTCOME

• patient gains understanding of their life/experiences/interrelated emotional stress

• patient is able to see the overall picture of their behavioral patterns in the present

Holland’s Theory of Types (1985)

work environment being a good match for one’s personality = happiness and satisfaction with job

Realistic: drawn to the outdoor, tools and machines, mechanics/building

Investigative: analytical, mathematical, scientifically inclined, researching & problem solving

Artistic: creative, unconventional, self expression, originality

Social: cooperative, helping others, altruistic, communicative

Enterprising: management, persuasion, financial reward, power/status/wealth

Conventional:

The Strong Interest Theory

• career assessment tool

• identifies which of the 6 best describe a person’s style

• find a fit between personality preferences and work environment preferences

Academic/Career Stressors on A.A

• parental expectation

• fear of underperformance

• issues with family financial support

• “fear of “falling through the cracks”

• race barrier in career fields

Family/Culture Influences on EDU/Career

Family Expectation

• strong educational background

• prestigious career choice

• stability for the future

Obligation Towards Family

• taking care of family

• providing financial support

Cultural/Community Influence

• collectivistic ideologies

• acting as a community role model

Influence of Ethnic Identity

Integration (Bicultural) Identity

• willingness to take native culture into consideration

• more likely to choose similar paths as counterparts from individualistic backgrounds

Assimilation Identity

Separationist Identity

• likely to view occupational stereotypes as valid

• career choices influenced by parental pressures

Expectations of the Individual

• autonomy

• development of social skills

• time for self-discovery

• opportunities to explore different sides of one’s racial/ethnic identity

Cultural Dissonance

tensions experienced due to incongruence between

• the student’s exposure to different racial and ethnic experiences at home/community

• new cultural information that they encounter in their college environment

Elements of Culturally Engaging Environments (Campus)

• physical cultural connections

• transformational cultural connections

• culturally validating connections

• humanized educational environment

• proactive educational environments

• opportunities for meaningful cross-cultural environments

Culturally Engaging Environments Continued

Physical Cultural Connections

Transformational Cultural Connections

opportunities given to students to:

• spread awareness about issues affecting their community

• participate in service-learning opportunities

• engaging in community work to help address challenges facing their community

Culturally Validating Environments

• having educators and staff validate the cultural backgrounds and identities of diverse students

• foster awareness of the stereotypes affecting the AAPI community/their impact

• encouraging meaningful interactions and dialogue among students to allow them an opportunity to bring forth their life experiences

Humanized Educational Environments

Culturally Engaging Environments Continued

Proactive Educational Environment

Opportunities for Meaningful Cross-Culture Engagement

• creating opportunities for different cultures to interact

• allowing for interethnic and interracial interactions to enhance empathetic dialogue exchange

• critical assessment of topics involving racism and race

• recognizing the racial climate within AA navigating academic and career choices

Eating Disorders

extreme disturbances in eating behavior

• from eating very little → a great deal or vice versa

Anorexia Nervosa

an eating disorder that involves relentless pursuit of thinness through starvation

• weight less than 85 percent of what is considered for age and height

• intense fear of gaining weight

• distorted body image

• thinning of bones, hair, low bp, constipation

• life-threatening complications to heart and thyroid

• highest mortality rate of any ED

• obsessive thoughts about weight and compulsive exercise

Bulimia Nervosa

an eating disorder in which an individual consistently follows a binge-and-purge eating pattern

• eating binge and then purge by self-induced vomiting or the use laxatives

• preoccupied with food while having a strong fear of becoming overweight

• being depressed or anxious

• generally occurs within a normal weight range, hard to detect

• chronic sore throat, kidney problems, dehydration, gastrointestinal disorders, dental problems

Binge-Eating Disorder (BED)

characterized by recurrent episodes of consuming large amounts of food during which the person feels a lack of control over eating

most common of all ED

Eating Disorders Among AA

AA women:

• 0.12% for anorexia

• 1.42% bulimia

• 2.67% the binge eating disorders

• 4.17% for “any binge eating”

Understanding ED Among AA

• disordered eating is usually a hidden concept and can be seen as a way to be able to have control over one’s life; silent protest

• prevalent of a sense of powerlessness and hopelessness that translates through disordered eating

• guilt for not meeting others’ expectations and for the disordered behavior as well

• thoughts lead to a “vicious cycle” which may culminate into depression, mood
  swings, anxiety, and isolation

Psychological Consequences

AA women experience:

• pressure to push aside the “perpetual foreigner” image

• pressure to adopt the western beauty standards to
  achieve success and inclusion in the predominant society

Influence of AA Body Image: Sociocultural

Sociocultural Factors

• body image satisfaction may depend on whether they adhere to western or asian values

• AA Women: “myth of transformation” = losing weight means economic and interpersonal increase in social status

• AA Men: “Adonis Complex”, ideal physical shape has become increasingly muscular

Influence of AA Body Image: Interpersonal Experiences

• parents become more tangible factors

• theorists hypothesize over-intrusive parenting leads to body image dissatisfaction

• high parental/societal expectations lead to perfectionism, self-consciousness, and body image dissatisfactions and EDs

Individual Characteristics

• actively rejecting identity: denigrate or be embarrassed of racial characteristics with asian heritage, vulnerable to low self-esteem

• strongly identify with their ethnic identity: feel like their unique self sets them apart from other ethnic groups

• achieved ethnic identity: global self-acceptance/appreciation of features they have and don’t have

CBT For Eating Disorders

Stage 1

• client education

• determines a collaborative approach

• begins regular eating

Stage 2

• identifying hurdles to progress

• work on altering the treatment plan as needed

Stage 3

• strong working phase

• aim to disrupt “maintaining mechanisms” of the ED

Stage 4

• future planning that includes relapse prevention

Facilitating a Healthy Body Image

• beware of sociocultural message about weight an body image

• detracting from the narrow focus on physical appearance

• learn importance of setting boundaries with family/close friends and relationships

• focusing on a sense of holistic wellness and balance

3 Criteria (Psychopathology/Clinic Issues)

• not typical/culturally expected behavior: atypical or out of the ordinary behaviors

• dysfunction: behavior that interferes with one’s ability to function effectively in the world

• personally distressful:

Ethical Standards in Therapy

• competent treatment

• informed consent

• confidentiality

• appropriate interactions

Cultural Values and Mental Health

Individual Barriers to Seeking Help

Cognitive Barriers

• conceptions of mental illness and labelling the process is an obstacle

• only considered an issue if psychotic, dangerous, and disruptive behaviors exist (personal problems/emotional distress aren’t considered significant)

• AA seek help from primary physicians for psychological problems

Value Orientation Behaviors

• collectivistic contradiction with western psychotherapy which encourages open communication and is individually focused

• conflict between allocentric (focus on interests and concerns of others) and egocentric (focused on interests and concerns of the self before others)

Physical Barriers

• economic: working multiple jobs, lack of childcare

• geographic: distance and transportation issues

Different Types of Therapy: Individual

• one-on-one counseling between the counselor and the client

• individual works through the personal issues they have been facing

• helps in changing people “cognitively, affectively, and behaviorally”

• difficulty adjusting to mainstream culture, incidents of racism and discrimination, parenting struggles, conflicts with family members, abuse, employment insecurities, grief
  and loss

Different Types of Therapy: Couples

Asian Americans may seek relationship counseling due to:

• cultural differences within a partnership

• communication difficulties

• intergenerational conflicts between parents or in-laws

• gender role differences

• job stress

• child rearing disagreements

• concerns regarding the mental health of their significant other

• maintain an unbiased outlook, co-therapists may also be used in couples therapy.

Different Types of Therapy: Family

a possible option utilized by AA to deal with the intergenerational conflict within the family structure/some possible issues:

• education (academic expectations)

• struggles with role reversal

• autonomy versus family obligation

Different Types of Therapy: Group

• information

• universality

• altruism

• experiencing a positive family group

• development of social skills

• interpersonal learning

Defense Mechanisms

automatic, subconscious strategies used as protection against emotional pain, stress, and anxiety (AA are more likely to use defensive mechanisms to manage stress and anxiety)

• denial: negative existence of mental health struggles

• avoidance: distracting oneself with other tasks

• minimization: invalidation of mental health concerns (self or others)

• repression: prevents anxiety-producing material from entering consciousness

Changes to Western Approach to AA Healing

emphasize family consensus, focusing on factors that would enhance
harmony and peace among the family:

• be respectful in speaking of the wisdom of elders

• positive reframe of questions/statements

• to not embarrass family members in front of each other and the therapist

• provide client with respect

Adopting a Bicultural Approach

treatment providers should be aware of:

• multicultural training

• interethnic variations among Asian Americans and Pacific Islanders

• one’s own stereotypes/myths they hold about the AAPI community

• actively work on ridding of the stereotypes/myths

• socioeconomic status of individuals from the AAPI community (to provide more cost-effective
  treatment options)

• diversity of experiences of clients (i.e., refugees, victims of racism)

• underdiagnosis and misdiagnosis

Article Notes

• Asian Americans remain one of the least studied racial/ethnic groups in eating disorder research

• rates of disordered eating among Asian Americans appear similar to or slightly lower than other groups

• underreporting is likely due to stigma, lower mental health service use, and assessment tools developed primarily with White populations

• exposure to Eurocentric beauty standards (e.g., thinness, light skin, specific facial features) contributes to body dissatisfaction among Asian Americans, often focused on facial features, height, and body proportions rather than weight alone.

• perfectionism, acculturative stress, bicultural pressures, and objectification

Article Notes Cont.

• Asian Americans present with more subclinical or atypical eating disorder symptoms, less fat phobia, lower BMI, fewer compensatory behaviors, and greater focus on somatic complaints or facial/body-part dissatisfaction

• standard eating disorder assessments may not fully capture culturally specific symptoms, and stigma or emotional restraint may lead to minimization or indirect expression of distress

• collectivism, interdependent self-construal, family harmony, stigma, and culturally rooted beliefs about food and mental health can affect help-seeking, disclosure, treatment goals, and engagement

• the authors recommend adapting evidence-based treatments (e.g., CBT, FBT) through cultural competence, flexibility, family involvement, attention to stigma, and an intersectional, individualized approach rather than rigid Western models

Traumatic Stressors

• witnessed or directly experiences events that involve either the threat or actual death/serious injury to oneself or others

Barriers to Getting Mental Health Help

• shortage of bilingual/bicultural mental health providers

• lack of confidence in western psychological services

• family prohibitions against seeking professional help

• fears of shame and stigma

• feelings of isolation