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Psyc 411 > Nov 20 & 25 Lecture > Flashcards

Nov 20 & 25 Lecture Flashcards

1
Q

what is feminist therapy video

A

field of psychology does lots of harm to certain groups of people - especially those who are targeted in multiple ways

ie. due to race, class, gender, sexuality, size, ability

in 1960s - women psychologists infused feminism and psychology

^ goal is to subvert the patriarchy and advance equality and social justice for people of all genders/backgrounds

^ way to be able to see systems that are impacting your lives, relationships and ultimately mental health

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2
Q

key tenets of feminist theory video

A
  1. de-expert
  2. reframe
  3. de-pathologize
  4. advocacy
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3
Q

de-expert: key tenets of feminist theory video

A

therapists are here to collaborate with clients

there to co-discover their truth

doing this together, pulling from patient before adding anything from themselves

they’re always equal (regardless of things like age gaps)

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4
Q

reframe: key tenets of feminist theory video

A

intrapersonal view > societal view

^ recognize society’s role in health and wellness

intrapersonal view = deficiency related, you’re at the root of your prroblems

societal view = how has society/oppression/injustice affected your mental health?

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5
Q

de-pathologize: key tenets of feminist theory video

A

start to question the DSM-5

why do we have to use labels anyways? who does the DSM-5 serve?

the key factors that help with client outcomes aren’t dependent on diagnosis - regardless of diagnosis, outcomes are dependent on the client-therapist relationship

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6
Q

reading on feminist therapy - what’s the primary goal?

A

empowerment

seeing self as ‘active agent in personal, interpersonal, and political contexts’

^ links to self-determination theory

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7
Q

reading on feminist therapy - empirical evidence…

A

empirical evidence > different parts have promising evidence (esp impact of increasing client empowerment)

overall, little research on treatment outcomes when therapist incorporates feminist therapy orientation into whatever evidence-based treatment is being conducted

MORE WORK NEEDED

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8
Q

liberation psychology

A

purpose is to “change people so they can change the world”

promote indigenous cultural healing and activism/emancipation into mainstream therapy

nonreligious and non-denomenational, but leans into spirituality present among oppressed communities
^ values of interconnectedness, solidarity, transformation

radical humility & empathy

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9
Q

purpose of liberation psychology

A

to change people so they can change the world

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10
Q

liberation psychology promotes…

A

indigenous cultural healing

activism/emancipation into mainstream therapy

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11
Q

liberation psychology is nonreligious and non-denominational, but…

A

leans into spirituality present among oppressed communities

values of interconnectedness, solidarity, transformation

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12
Q

liberation psychology - radical humility & empathy

A

OPEN conversations about POSITIONALITY and POWER DIFFERENTIALS in life and between therapist and client

help develop CLIENT CRITICAL CONSCIOUSNESS and accompany clients as they connect with cultural strengths and work toward personal and collective liberation

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13
Q

summary: feminist and liberation therapy

A

broad theoretical orientations (approaches to therapeutic process)

not incompatible with ‘mainstream’ evidence-based practices, but these practices will likely require more adaptation to be more inclusive of systemic-level influences

both focused on power, privilege and oppression as contributors to struggling

reconnecting with various aspects of identity, becoming aware of inequalities, narratives, and taking concrete action are proposed as healing mechanisms

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14
Q

evidence-based psychosocial interventions for ethnic minority youth: the 10 year update - INCLUSION CRITERIA

A
  1. representation: at least 75% of participants were ethnic minorities
  2. OR effects evaluated using subgroup analyses with subset of ethnic minorities
  3. OR evaluated whether ethnic minority status moderated the outcome(s)

65 studies included

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15
Q

evidence-based psychosocial interventions for ethnic minority youth: the 10 year update - DESIGN AND METHODS INCLUSION CRITERIA

A
  1. group design: study involved a randomized controlled design
  2. independent variable: intervention was manualized or logical equivalent
  3. population: specified problems based on clearly delineated/exclusion criteria
  4. dependent variable: reliable and valid measures used to ascertain outcomes
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16
Q

evidence-based psychosocial interventions for ethnic minority youth: the 10 year update - of the 65 studies identified…

A

27 studies focused on Hispanic/Latino youth

19 studies focused on African American youth

1 study focused on Asian American youth

18 studies focused on multiethnic youth

NONe focused on Native American youth

MORE HIGH-QUALITY RESEARCH NEEDED

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17
Q

how many well-established programs exist among Ethnic-Minority Youth?

A

only FOUR

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18
Q

the 4 well-established programs among ethnic minority youth

A
  1. cognitive and behavioural interventions for anxiety in latinx children (caveat: if no consideration given to cultural-contextual factors, program compromised)
  2. multisystemic therapy (MST) for disruptive behaviours among black adolescents
  3. family-based interventions for disruptive behaviours among Latinx children & teens
  4. family-based interventions for substance use problems among Latinx children & teens
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19
Q

what is MST?

A

therapists work in the home, school and community

are on call 24/7 to provide caregivers with tools they need to transform the lives of troubled youth

research demonstrates that MST reduces criminal activity and other undesirable behaviour

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20
Q

MST reduces…

A

criminal activity and other undesirable behaviour

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21
Q

MST ecological model

A

sees the child as inside a big environment

child is surrounded by:
- family
- peers
- school
- neighbourhood
- community/culture

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22
Q

cultural adaptation

A

program modifications that are culturally sensitive

tailored to a cultural group’s traditional world views

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23
Q

cultural adaptation requires…

A
  1. moving beyond changing surface structure to CHANGING DEEP STRUCTURE
  2. understanding CULTURAL NUANCE
  3. CULTURAL COMPETENCE
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24
Q

cultural adaptation: can adapt…

A

program content

or program delivery

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25
Q

sources of misfit model looks at…

A
  1. sources of mismatch
  2. program validation group(s)
  3. current consumer group
  4. actual or potential mismatch effect
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26
Q

sources of misfit model: sources of misfit

A

group characteristics:
a) language
b) ethnicity
c) SES
d) urban-rural context

program delivery staff:
a) type of staff
b) staff cultural competence

admin/community factors:
a) community consultation
b) community readiness

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27
Q

sources of misfit model: actual or potential mismatch effects

A
  1. consumer inability to understand program content
  2. conflicts in beliefs, values, norms
  3. insufficient social resources and culturally different life experiences
  4. lesser or different program delivery skills and perspectives
  5. limited awareness of/insensitivity to cultural issues
  6. absence of community “buy in”, community resistance, low participation
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28
Q

why are mental health services under-utilized in black populations?

A
  1. FINANCIAL (but still under-utilize when insurance covers)
  2. CULTURAL BARRIERS (stigma, seen as weakness, prohibition on sharing)
  3. STIGMA OF MENTAL ILLNESS
  4. ALTERNATIVE RESOURCES (church, primary care)
  5. LACK OF INFO or KNOWLEDGE
  6. MISTRUST OF MENTAL HEALTH CARE SYSTEM
  7. FEW BLACK PRACTITIONERS (4% psychologists in US)
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29
Q

standing in the gap - distance between clinicians and clients

A

distance between clinic and clients:

  1. diagnosis and symptom focus
  2. lack of focus/lack of therapist understanding of structural factors impacting client
  3. lack of self disclosure
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30
Q

standing in the gap - cultural relevance

A

“as we enter a new decade on research and especially practice concerning Black youth, it appears there still remains a GAP BETWEEN the PHILOSOPHICAL PRESCRIPTIVE on the one hand (what theory and research says) and the PRACTICE on the other (what practice does)”

“what does it mean to incorporate culture in the clinical context? what should be said or done differently to move traditional practice from a typically monocultural, mainstream framework toward a culturally relevant framework?”

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31
Q

more practice recommendations

A
  1. assess clients’ and their caregivers’ experience with racial stressors, racial socialization practices, and racial identity
  2. assess spiritual beliefs
  3. be cautious that various ethnic and cultural groups exist within the greater Black racial categorization - you don’t want to stereotype
  4. explore common barriers to session attendance
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32
Q

goals tailoring treatments

A
  1. increase engagement
  2. decrease drop-out
  3. increase satisfaction
  4. increase relevance
  5. increase treatment effectiveness
  6. address specific issues
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33
Q

cultural relevance

A
  1. LINGUISTIC STYLE

a) storytelling
b) call & response
c) signification - art of insult when speaking humorously, sarcasm come backs, jokes

  1. SPIRITUALITY and RELIGION
  2. HUMAN CONNECTION

a) genuineness, culturally grounded

  1. MOVEMENT - communication tool
  2. RACIAL/CULTURAL SOCIALIZATION
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34
Q

Africentric treatments: application of Nguzo Saba Principles

A
  1. umoja (unity)
  2. kujichagulia (self-determination)
  3. ujima (collective work and responsibility)
  4. ujamaa (cooperative economics)
  5. nia (purpose)
  6. kuumba (creativity)
  7. imani (faith)
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35
Q

Nguzo Saba Principles: umoja

A

unity

to strive for unity in family, community and race

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36
Q

Nguzo Saba Principles: kujichagulia

A

self-determination

to define ourselves, create for ourselves, and speak for ourselves

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37
Q

Nguzo Saba Principles: ujima

A

collective work and responsibility

to build and maintain our community together

and make our sisters’ and brothers’ problems our problems

and to solve them together

38
Q

Nguzo Saba Principles: ujamaa

A

cooperative economics

to build and maintain our own businesses and to profit from them together

39
Q

Nguzo Saba Principles: nia

A

purpose

to make our collective vocation the building and developing of our community

40
Q

Nguzo Saba Principles: kuumba

A

creativity

to do always as much as we can and in the ways we can to leave our community more beautiful and beneficial than we inherited it

41
Q

Nguzo Saba Principles: imani

A

faith

to believe with all out heart in our people, our parents, our leaders and the righteousness and victory of our struggle

42
Q

afrocentric worldview

A

values, beliefs and behaviour of people of African descent

  1. spirituality
  2. collectivism (cooperation)
  3. time orientation
    ^equal importance of past, present, future - time flexibility
  4. orality
  5. sensitivity to affect and emotional cues
  6. verve and rhythm, creative behaviour
  7. balance and harmony with nature (balance of mental, physical, spiritual states)
43
Q

TF-CBT

A

trauma-focused CBT

  • short term evidence-based trauma treatment
  • cognitive behavioural strategies to address PTSD and trauma-related depressive and anxiety symptoms & behaviour problems
  • 9 intervention components - PRACTICE
44
Q

CBT triangle

A

triangle in the middle: TRIGGERING EVENT

3 boxes surrounding it:
1. THOUGHTS
2. BEHAVIOURS
3. EMOTIONS

45
Q

CBT triangle: thoughts

A
  1. words you tell yourself
  2. internal dialogue

eg. “I’m never going to be good enough”

46
Q

CBT triangle: behaviours

A
  1. your actions
  2. what you do

eg. procrastination, comparing yourself to others, avoiding

47
Q

CBT triangle: emotions

A

how you feel

eg. frustrated, hopeless, sad

48
Q

TF-CBT traditionally does NOT address…

A
  1. racial trauma
  2. cultural factors that may influence engagement and persistence in treatment
49
Q

adding ERS to TF-CBT can…

A
  1. help youth PROCESS and COPE with racially charged traumatic experiences
  2. help with MANAGEMENT of racialized stressors that may ADD to IMPAIRMENT and COMPOUND upon ‘general’ trauma experiences
  3. improve TREATMENT ENGAGEMENT by increasing cultural relevance
50
Q

PRACTICE - first part

A

part of TF-CBT

PRAC: Coping skills

  1. Psycho-education and parenting
  2. Relaxation
  3. Affective expression and modulation
  4. Cognitive coping
51
Q

PRACTICE - second part

A

part of TF-CBT

T:

  1. Trauma narrative and processing

ICE:

  1. In vivo exposure
  2. Conjoint sessions
  3. Enhancing safety
52
Q

summary - treatment in black populations

A

think about barriers to access and engagement in treatment

afrocentric principles (afrocentric worldview, Nguza Saba)

integration of ERS into existing mental health treatments

^ no great data on these yet, but is hopefully coming

53
Q

CBT with Latino populations

A
  1. PROVIDING POSITIVE REINFORCEMENT

^ helping parents praise positive behaviours

  1. SHAME vs GUILT

^ addressing cognition in adolescents regarding family

  1. UNDERSTANDING CONTEXT OF IMMIGRATION

^ educational experiences
^ rules and consequences
^ family conflict

54
Q

family based CBT for Latino families

A
  1. empower parents
  2. pleasant activity planning
  3. discuss rule setting and expectations
55
Q

empower parents: family based CBT for Latino families

A

teach them skills

discuss feelings of failure

56
Q

pleasant activity planning: family based CBT for Latino families

A

using family

increasing trust in family

57
Q

discuss rule setting and expectations: family based CBT for Latino families

A

explicate rule setting - giving authority to parents

help teens form expectations in context of family

58
Q

meta analysis of culturally adapted substance use interventions for Latinx adolescents - QUESTION

A

what is the effectiveness of culturally adapted treatments for Latino adolescents made to treat substance use?

59
Q

meta analysis of culturally adapted substance use interventions for Latinx adolescents - STUDY CHARACTERISTICS 1

A

analyzed findings from 10 studies of interventions intended to prevent/reduce substance use in Latinx adolescents

7 studies were randomized controlled trails

3 studies were quasi-experimental design studies

60
Q

meta analysis of culturally adapted substance use interventions for Latinx adolescents - STUDY CHARACTERISTICS 2

A

10% of interventions were delivered to a group of adolescents

30% were one-on-one

control group was non-adapted version 40%, attention/placebo 10%

70% addressed substanced use through education or skills training

40% included parents

half in school settings

mean sessions = 12

mean duration = 12 weeks

61
Q

meta analysis of culturally adapted substance use interventions for Latinx adolescents - CHARACTERISTICS OF CULTURAL ADAPTATIONS

A
  1. CULTURAL VALUES
  2. CONTENT
  3. LANGUAGE
  4. DELIVERY
62
Q

cultural values: characteristics of cultural adaptations

A

incorporating cultural values to intervention context

ie. respeto, familismo

90% did this

63
Q

content: characteristics of cultural adaptations

A

making changes to intervention content

ie. using actors of colour, telenovelas

60% did this

64
Q

language: characteristics of cultural adaptations

A

providing the intervention in English and Spanish

40% did this

65
Q

delivery: characteristics of cultural adaptations

A

changing the nature of the therapeutic service delivery

ie. family members are included in the recruitment, engagement, or retention of participants

20% did this

66
Q

meta analysis of culturally adapted substance use interventions for Latinx adolescents - RESULTS

A
  1. very small effect at POST-TEST (right when intervention ends) - Latinx teens in culturally adapted interventions generally did ONLY VERY SLIGHTLY BETTER than control groups

^ G = .06

  1. effect of intervention at LATER FOLLOW-UP - POSITIVE EFFECT of culturally-adapted intervention on substance use outcomes

^ G = .26

67
Q

underutilization of care in Asian populations - cultural barriers

A
  1. privacy
  2. avoidance of shame and stigma
  3. reliance on other sources of help
  4. individual versus collectivist goals
  5. acculturation
  6. model minority myth
68
Q

even compared to other minoritized groups, Asian populations…

A

utilize mental health care FAR LESS and have LESS POSITIVE ATTITUDES towards seeking psychological help

69
Q

school-based mental health prevention at a high school…

A

AA youth less likely to utilize SBMH compared to other ethnic minority youth

70
Q

East Asian groups often clash in values…

A

with Western models of psychotherapy

ie. Western models often emphasize the EXPLORATION OF EMOTION as a solution to problems, which often doesn’t align with EAA practices

71
Q

EAAs with stronger internalized model minority beliefs…

A

also have less positive help-seeking attitudes

72
Q

EAA cultural values

A
  1. avoidance of shame
  2. hierarchical relationship
  3. deference to authority
  4. collectivism - keeping things within the family
  5. emotional self-control
  6. conformity to norms
  7. filial piety
  8. humility
  9. family recognition through achievement
73
Q

south asian youth and families - mental illness seen as…

A

a “moral failure” or “characterological weakness”

74
Q

south asian cultural values…

A

COLLECTIVISM and CONFORMITY

COURTESY STIGMA: family members can become victims of the same devaluation experienced by the individual with the mental illness due to their association

75
Q

south asian groups - collectivist values are associated with…

A

higher stigmatizing attitudes

76
Q

south asian youth/families are more likely to present with…

A

somatic complaints

77
Q

south asian youth/families: more culturally acceptable to…

A

seek spiritual remedies like:

prayer

complementary/holistic medicine

78
Q

what does literature say about effectiveness of psychology tx with Asian groups?

A

meta analysis of 21 randomized control trials of mental health interventions including people of East or Southeast Asian descent

(very little research on South Asians)

on average, tx close to 1SD better than control

79
Q

2 MODERATORS - what does literature say about effectiveness of psychology tx with Asian groups?

A
  1. treatments with most amount of CULTURAL TAILORING (ie. made for specific Asian subgroups) worked the best

^ followed by treatments generally tailored for minorities, and then by un-tailored treatments

  1. thought group might work better than individual treatment given context and collectivist beliefs, but INDIVIDUAL and GROUP TREATMENTS worked EQUALLY WELL
80
Q

MODERATOR TAKEAWAY - what does literature say about effectiveness of psychology tx with Asian groups?

A

the more specific the cultural adaptation for specific Asian ethnicities, the better the treatment outcomes

regardless of group or individual therapy modality

81
Q

intergenerational & historical trauma (treatment for Indigenous populations)

A

history of displacement, disenfranchisement, genocide

colonization

residential schools

forced assimilation

82
Q

residential schools

A

family and community disruption

confusion of parenting and punitive institutional practice

impaired emotional response

physical and sexual abuse

loss of knowledge, language, tradition

systemic devaluing native identity

83
Q

implications for interventions (treatment for Indigenous populations)

A
  1. need to establish TRUST
  2. reducing historical trauma response and increasing RE-ATTACHMENT TO HERITAGE cultural values
  3. discuss ETHNIC SIMILARITIES/DIFFS
  4. acculturation
  5. allow extended fam and other valued persons into therapy
  6. STRENGTHS-BASED
  7. respect silence
  8. honour and respect for culture
  9. EXAMINE HISTORICAL CONTEXT
  10. encourage physical health
  11. enhance coping
  12. reduce isolation and enhance connection
  13. PROMOTE POSITIVE CULTURAL IDENTITY & CONNECTIONS
  14. reduce generational divides
84
Q

“what are the best practices for psychotherapy with Indigenous peoples in the US and Canada? a thorny question”

A
  1. very large diversity across NA indigenous people
  • cookie cutter recommendations have some utility but aren’t a panacea
  1. very few RCTs and pre-post treatment studies of evidence based treatments
  • mostly effective but mostly focused on substance abuse/alcohol use
  1. culturally adapted treatments exist, but are small in numbers
  • important tools esp when adaptations are done at deeper level to align intervention with values and practices of group
  1. traditional healing and community-led cultural interventions are key
  • process of implementation may be slow and support structures for these may vary
85
Q

mindfulness based interventions INTRO

A

systemic review of 9 studies of mindfulness-based interventions for indigenous people

total n = 135 (very small)

86
Q

mindfulness based interventions RESULTS etc

A

generally positive mental health effects

high feasibility

participants were satisfied with these programs and thought they helped them reconnect to their group’s traditional beliefs

87
Q

culturally adapted digital interventions

A

large semi-recent increase in digital interventions

  • convenient for users
  • cheap
  • flexible (may reduce mental health care access barriers)
  • often ‘one size fits all’ but may benefit from cultural tailoring
88
Q

impacts of culturally adapted digital mental health interventions SETUP

A

12 randomized studies (more included in broader view)

most involved ‘deep’/thorough cultural adaptation, including:

a) language translation
b) modification of audio/visual content
c) inclusion of culturally salient messaging

89
Q

impacts of culturally adapted digital mental health interventions RESULTS

A

overall, effects of these interventions were LARGE and POSITIVE relative to controls

cultural adaptation of digital interventions is important and can be a good way to serve harder to reach minoritized populations

90
Q

when working with people from marginalized backgrounds, be careful of…

A

ESSENTIALISM: idea that people inherently have specific attributes based on their cultural group membership

don’t assume - ask people about cultural identity, history, beliefs, values that may be impacting them

91
Q

DSM-5 cultural formulation interview

A

some questions to guide work with people from marginalized backgrounds

“for you, what are the most important aspects of you background/identity?”

“are there any aspects of your background/identity that make a difference to your [problem]”

“are there any aspects of your background or identity that are causing other concerns or difficulties for you?”

Psyc 411 (25 decks)

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