Mechanisms of action in AWARE: A culturally informed intervention for 1.5- and 2nd-generation Asian American women.

Abstract

Young Asian American women have high rates of depression and suicidality; however, few interventions address the urgent need for culturally informed care. Asian Women’s Action for Resilience and Empowerment (AWARE) aims to be the first gender and culturally specific group psychotherapy intervention designed to improve mental and sexual health in Asian American women with trauma. This article specifically focuses on identifying the mechanisms of action that were responsible for improving mental health and well-being among those who participated in AWARE randomized controlled trial. Of the 435 women screened for the study, 63 Chinese, Korean, and Vietnamese women with histories of interpersonal violence were randomized into either the intervention (n = 32) or waitlist control groups (n = 31). Data from 16 posttrial focus group sessions were then thematically analyzed to explore the key themes and mechanisms of action of the AWARE intervention. Analysis revealed four cultural mechanisms that facilitated mental health improvements: psychoeducation on disempowering parenting, the reduction of mental illness-related stigma, community and relational building, and a heightened sense of empowerment. Results suggest that the AWARE intervention fosters Asian American women’s well-being on an individual level and encourages social engagement through culturally salient messages. Women in the study were able to expand their social support network, engage in activism, and develop an empowered connection to their community.

Analysis of Suicide After Cancer Diagnosis by US County-Level Income and Rural vs Urban Designation, 2000-2016

“…Numerous studies have demonstrated that social stigma, shame, and "saving face" often prevent Asian and Asian American individuals from seeking mental health care. [20][21][22][23][24] Meanwhile, the risk of suicide following cancer diagnosis among Hispanic persons was no different or potentially even lower compared with the general population, with a 37% lower risk in the highestincome counties. This finding may be partially explained by the Hispanic health paradox, a wellestablished epidemiologic finding that Hispanic people tend to have lower mortality rates compared with non-Hispanic people.…”

“…It is possible that cultural factors may be involved in this result. Numerous studies have demonstrated that social stigma, shame, and “saving face” often prevent Asian and Asian American individuals from seeking mental health care . Meanwhile, the risk of suicide following cancer diagnosis among Hispanic persons was no different or potentially even lower compared with the general population, with a 37% lower risk in the highest-income counties.…”

Review of third-wave therapies for substance use disorders in people of color and collectivist cultures: Current evidence and future directions.

“…AWARE is directed toward Asian American women who have experienced trauma (Rivera et al, 2019). AWARE covers a variety of health topics, including depression, suicidality, sexual risk behaviors, and substance use (Hahm et al, 2017; Rivera et al, 2019). It effectively teaches clients to utilize the mind–body connection that is rooted in many Asian cultures to create an environment and mindset that is more conducive to improving overall mental health (Hahm et al, 2017).…”

Guest editors’ introduction to the special section: Cultural adaptation of mental health interventions for Americans of East Asian descent.

“…In general, mechanisms are considered as causal links between treatment and outcomes. Rivera et al (2019) analyze 16 AWARE cohorts' postintervention focus group discussion after participants completed eight sessions of group psychotherapy. This study identified that the mechanisms of action that contribute to the improvement of mental health outcomes were four distinctive and culturally specific mediators: (a) psychoeducation on disempowering parenting, (b) the reduction of mental illness-related stigma, (c) community and relationship building, and (d) a heightened sense of empowerment.…”

“…The second article of this special section, Rivera et al (2019) explored the therapeutic mechanisms of AWARE intervention. Ideal psychotherapy research not only illuminates the efficacy or effectiveness of its intervention, but it also reveals the mediators of therapeutic change (Kraemer, Wilson, Fairburn, & Agras, 2002).…”