Week 10: Culture and mental health

Question 1

Culture resposiveness hypothesis

Answer 1

Therapies developed for white ppl

Most clinicians white

Maybe do not consider culture:
Values ignored
Client discomfort and poor engagement
Drop out and treatment failures

So treatments must be culturally sensitive

Prof had assumed mental heath treatments do not work as well for minorities

Question 2

Are treatments effective with ethnic minorities?

Answer 2

In a meta analysis effect sizes for treatments with ethnic minorities hover around .5 (medium)

Varies by disorder:
Most effective = anxiety, schiz, trauma
Least = misc and substance abuse

Much diversity in terms of what is shown to be effective. Many seem to work with minorities. Modality does not matter

Culturally sensitive hypothesis says some should be more effective than others (e.g. family/group should be better as this brings the culture into the room)

Data says it does not matter

Are they effective: Overwhelmingly yes

Question 3

Are treatments equally effective for white and non-white people?

Answer 3

Data is mixed

Most show no consistent differences for ethnicities

15-25% show effects favoring minorities

There is a lot of data saying the effects are equal and some saying the effects are better

62% say no effects
12% favor whites
17% favor minorities

Summary: NO consistent ethnicity effects

Question 4

Does cultural tailoring enhance outcomes for minorities?

Theoretical background

Answer 4

General reasons to consider culture

• Implicit bias against outgroups is the norm and this effects judgement and behavior
• Interatrial interactions are tiring
• Majority/minority groups often have different perception if opportunity and discrimination

USC vs UCLA

• join one, be anti-other
• minimal group effect
• part of who we are as humans

Clinical reasons to consider culture

Stigma
-Greater stigma about mental health in minorities
-EXP one story mental, one story physical
Had ptps do stigma measures
Mental = more stigma in Asians but not whites
Indeed stigma is stronger in Asians

Help seeking is different in some ethnicities
-Some groups do not go to mental health services
-Different things predict mental illness in minorities
Perceived discrimination
Multiple forms of discrimination
Among immigrant populations, they have different views to their kids on acculturation and gender roles

Drop out is higher in some populations (like black Americans)

Differences in pragmatic treatment barriers

Question 5

Does cultural tailoring enhance outcomes for minorities?

What is culturally responsive treatment (CRT)?

Answer 5

No uniform view
Many frameworks
Is a label used for any treatments that tries to make them better for minorities.

Question 6

Does cultural tailoring enhance outcomes for minorities?

Evidence

Answer 6

2008 Meta Analysis review

• Most ethnic minority treatments are already tailored
• This is the norm now
• Clinicians already do this

in 10 meta analyses
-Culturally tailored was better than no treatment, placebo and TAU but this does not say if it is better than the generic form of the treatment for minorities

In a study on spider phobia in Asians, the more tailored, the better

Most ROboust Study
Take RCTs pf culturally adapted versions and compare them with RCTs of generic version of the same therapy
10 RCTs did this
Overall .1 effect size
No difference

Question 7

5 things so far

Answer 7

• Therapies generally work for minorities
• In lab and real world (lower effect in real world)
• There are lots of evidence based treatments
• Play therapies can work fine
• Minorities and euro Americans seem to benefit equally
• Overall, cultural tailoring does not seem to add much

Question 8

Does Culture Matter?

5 things

Answer 8

Yes but it is complex

(1) Clinicians already adapt their therapy to cultures
-Do not need a special measure, already doing it
Might already be being done

(2) Equifinality
Minorities might get tot eh same place via a different route
In MST, usually people struggle and their perceived difficulty gets worse mid therapy then better at the end. This is what is seen with white ptps but not black, they have the opposite pattern

(3) CRT effects may vary as a function of acculturation status
In the case of the Asian spider phobia study, the higher in Asian American the ptp was, the higher the effect
Was tweaked to make it adaptive and performed better for everyone than self-help

(4) CRTs can hurt as well as help
Some studies show better effects, some worse
Added, they give /1
Maybe reactivity, cultural content might evoke a negative reaction in some participants
You may also get less active ingredient if you focus on culture by distracting from core change mechanisms
e.g. tweaked Pennebaker’s expressive writing task in black youth with violence histories

G1 normal expressive writing
G2 Come up with something that talked about violent xp (does not have to be written)

Kids loved G2 but it was less effective
Potentially less fear activation and therefore, less processing

(5) Effective CRTs may challenge conventional notions of what matters when addressing diversity
In phobia XP
Asked ptps whether they thought they were in cultural group or generic group
All thought generic group
Was super subtle (but seemed to work)
Might not need to be explicit to get results