International university students often experience acculturative stress, and culturally appropriate techniques to manage stress are needed. This randomized trial tested the effects of group assertiveness training, private expressive writing, their combination, and a wait-list control on the acculturative stress, affect, and health of 118 international students at an urban, American university. Interventions were conducted at the start of a semester, and assessments were conducted at baseline and the end of the semester. Group assertiveness training was rated positively by students and led to lower negative affect, whereas expressive writing was less well received and led to higher homesickness and fear, but also higher positive affect. The combined intervention had no effects, perhaps because the two components negated each other. It is concluded that group assertiveness training improves emotional adjustment of international students, but expressive writing has mixed effects and needs further development and study.Keywords assertiveness training; expressive writing; international students; acculturative stress; randomized clinical trial Undergraduate or graduate education can be stressful, particularly for international students who sojourn to study in another country. Unlike native students, international students need to develop bicultural competence, or second culture acquisition, as they maintain their own values while adjusting to the practical, interpersonal, and emotional challenges encountered in the host country (Mori, 2000;Noh & Kaspar, 2003;Poyrazli & Grahame, 2007;Zahi, 2002). As a result, many international students experience acculturative stress, which is a physiological and emotional reaction to a new environment that has unfamiliar cultural values, customs, and expectations (Berry, 2005), and such stress may contribute to the increased incidence of mental and physical health problems found among international students (Ryan & Twibell, 2000).International students in the U.S. increasingly coming from cultures that espouse communal or interdependent goals, such as India and China, rather than individuality, which is more Shedeh Tavakoli-Moayed and George P. Parris, Department of Counselor Education. Mark A. Lumley, Alaa M. Hijazi, and Olga M. Slavin-Spenny, Department of Psychology. Shedeh Tavakoli-Moayed is now at Argosy University, Chicago, Illinois. Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/cou. commonly found in Western students. As a result, many international students tend to av...

Background and purpose Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches. Methods Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment. Results On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls. Conclusions Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from emotional expression versus emotional reduction approaches to chronic pain.

Research on emotional disclosure should test the effects of different disclosure methods and whether symptoms are affected differently than post-traumatic growth. We randomized 214 participants with unresolved stressful experiences to four disclosure conditions (written, private spoken, talking to a passive listener, talking to an active facilitator) or two control conditions. All groups had one 30-minute session. After six weeks, disclosure groups reported more post-traumatic growth than controls, and disclosure conditions were similar in this effect. All groups decreased in stress symptoms (intrusions, avoidance, psychological and physical symptoms), but disclosure did not differ from control. We conclude that 30 minutes of disclosure leads to post-traumatic growth but not necessarily symptom reduction, and various disclosure methods have similar effects. Research on the effects of disclosure should focus on the benefits of growth as well as symptom reduction.

Acculturative stress is a common experience for international students and is associated with psychological and physical problems. In a previous study, the authors reported that two stress reduction interventions—expressive writing (EW) and assertiveness training (AT)—had limited overall benefits among international students at an American University. The current analyses of data from that study investigated whether individual differences moderated the effects of EW and AT. Results indicate that greater acculturative stress at baseline predicted greater improvement from both interventions, compared with control. Women benefited more from AT than EW, except that EW improved women’s physical symptoms. Men benefited more from EW than AT. Students with limited emotional awareness and expression tended to benefit from both interventions, relative to control. Finally, nation of origin cultural differences generally did not predict outcomes. It is concluded that the benefits of EW and AT and can be enhanced by targeting these interventions to specific subgroups of international students.