Despite compelling arguments for the dissemination of evidence-based treatments (EBTs), questions regarding their relevance to ethnically diverse populations remain. This review summarizes what is known about psychotherapy effects with ethnic minorities, with a particular focus on the role of cultural competence when implementing EBTs. Specifically, we address three questions: (a) does psychotherapy work with ethnic minorities, (b) do psychotherapy effects differ by ethnicity, and (c) does cultural tailoring enhance treatment effects? The evidence suggests that psychotherapy is generally effective with ethnic minorities, and treatment effects are fairly robust across cultural groups and problem areas. However, evidence for cultural competence is mixed. Ethnic minority-focused treatments frequently incorporate culturally tailored strategies, and these tailored treatments are mostly efficacious; yet support for cultural competence as a useful supplement to standard treatment remains equivocal at best. We also discuss research limitations, areas for future research, and clinical implications.

Objective: Evidence demonstrating treatment efficacy for ethnic minorities has grown in recent years; however, Asian Americans (i.e., of East Asian or Southeast Asian heritage) are mostly excluded from recent reviews. In this review we (a) synthesize the literature on mental health treatment effects for Asian Americans and (b) evaluate support for competing theoretical perspectives on cultural tailoring. Method: A literature search supplemented with other search strategies identified 21 randomized trials of mental health interventions for Asian Americans (n = 6,377 total participants). The meta-analysis was based on random-effects models. Results: Overall, results show that posttreatment effects were relatively large and significant (d = .75, SE = .14, p = .000). However, there was substantial heterogeneity across studies (ES range = −.04 to 2.61), with moderator analyses indicating that effects differed significantly by target problem, diagnostic status, and comparison group. Also, specificity of cultural tailoring was significantly associated with treatment outcomes, with treatments tailored specifically for Asian subgroups (e.g., Chinese Americans) showing the largest effects (d = 1.10), and those with no cultural tailoring or non-Asian tailoring (d = .25) showing the smallest effects. Conclusions: Findings suggest that mental health treatments are efficacious for Asian Americans and that cultural tailoring can enhance treatment outcomes. In general, these findings lend support to the cultural responsiveness hypothesis, although caveats are noted. Implications for psychotherapy research with Asian Americans are discussed, as well as methodological and conceptual challenges.

PurposeThroughout the past 50 years mental health services have aimed to provide and improve high quality inpatient care. It is not clear whether there has been improvement as service users and nursing staff have both expressed frustration at the lack of therapeutic activities. In particular, it may be that the changing levels of symptoms over the past 50 years may affect engagement with ward activities.MethodsEight wards in a health care trust in London serving an inner city and urban populations participated. Data were collected on participation in activities and 116 service users’ perceptions of acute care as well as clinical factors.ResultsLess time was spent participating in activities today than 50 years ago, while one quarter of service users reported taking part in no activities at all. Uptake of activities was related to more positive service user perceptions of the wards. Symptom severity did not impact the frequency of participation in activities, although those who took part in no activities at all had higher negative symptoms scores.ConclusionsService users’ uptake of activities was not related to the severity of their illness. This belies the belief that the acutely ill cannot take part in meaningful activities. This study supports the view that more therapeutic activities could be taken up by the acutely ill and are in fact appreciated.

The aim of this article was to systematically review the quality and efficacy of the current evidence for mindfulness-based interventions (MBIs) in patients with mild cognitive impairment (MCI), patients with dementia (PwD), and their caregivers. We identified 20 randomized controlled trials (RCTs) (11 for patients, 9 for caregivers) published in the last 15 years. Evidence suggested that MBIs are highly acceptable and credible treatments for patients with MCI, PwD and caregivers. Specifically, for PwD, the results indicated that the magnitude of post-treatment effects of MBIs are in the medium to large range for psychosocial outcomes, and in the small to medium range for cognitive functioning; however, treatment effects on dementia biomarkers were mixed, ranging from small to large, depending on the outcome measure. Findings also evidenced salutary effects of MBIs for caregivers of PwD, with post-treatment effects ranging from medium to large for caregiver stress and burden and large effects for quality of life, and mixed outcomes for cognitive functioning, with effects in the small to large range. However, confidence in these findings is relatively limited due to methodological limitations, especially in terms of poor consistency in intervention strategies, outcome measures, and other key criteria across studies. To better assess the value of MBIs for these populations and optimize treatment outcomes, we recommend further research with improved study methodology (e.g., multi-method assessment, universal criterion and outcome measures, use of active control groups, larger sample sizes, long-term follow-up) to replicate current findings and enhance our understanding of underlying treatment mechanisms of MBIs.

Previous studies have shown that multiple factors predict suicidal behavior in Asian Americans but have provided little guidance on how to rate the relative impact of these risks. To increase our understanding of suicide in Asian Americans, recursive partitioning analysis was used to identify risk factors most relevant to predicting suicidal behaviors and enhance the decision-making process of clinicians faced with clients presenting with multiple risk factors. Using a classification and regression tree (CART) and random forest analyses, we examined the role of previously identified correlates of suicidal ideation and suicide attempts in 2,095 Asian Americans from the National Latino and Asian American Study (Alegria et al., 2008). Random forest analysis showed that depressive and anxiety disorder were the best predictors of lifetime suicidal ideation, followed by family conflict and family cohesion. The model correctly classified lifetime suicidal ideation with moderate sensitivity (72%) and specificity (76%). CART analysis found that family conflict predicted suicide attempts in more than half of the individuals with suicidal ideation. Of those who reported low family conflict, 73% attempted suicide if they had low family support. Perceived discrimination was the next best predictor of suicide attempts (63%) when family issues were not a problem. Cross-validation of this model had moderate sensitivity (75%) but low specificity (39%). These findings highlight the importance of considering family relationship when assessing suicide risk in Asian Americans.