Personal Relevance of Psychotherapy for Asian Americans

Anxiety, Behavior, Stress

Problem-Solving Therapy, Online App, MindBoba

Using a three-armed design the investigators will test whether participants in the Mindboba online application experience significantly greater improvements as compared to participants in the active control (online app based on Cognitive Behavioral Therapy) and participants in the business-as-usual control. The outcome measures are self-reported social problem-solving, self-efficacy, stress, depression, anxiety, attitudes towards seeking mental health, and knowledge.

The intervention, Personal relevance of psychotherapy for Asian Americans: A mHealth problem-solving intervention to reduce stress, is designed 1) to increase the use of mental health services by a population that uses them at one third the rate of Whites,and 2) to develop a personally-relevant approach to stress-reduction. Practical and cultural barriers inhibit the use of mental health services by Asian Americans including a lack of fluency in English amongst specific subpopulations, insufficient health literacy, and stigma surrounding mental illness which stems from Asian American cultural beliefs shared across subpopulations. To this end the investigators developed MindBoba a mHealth (mobile health) application that is systematically adapted to be culturally relevant to select Asian American subpopulations based on Problem-Solving Therapy (PST). To ensure client engagement, psychotherapy should provide relevant, immediate, and tangible benefits. Personally relevant, evidence-based interventions have the potential to increase the reach and impact of mental health services-especially as conventional, evidence-based interventions have not worked to eliminate mental health disparities among ethnic minority groups. Personally relevant interventions can reduce disparities by increasing engagement, and greater engagement makes mental health services more effective. An external problem-solving orientation is culturally responsive to Asian values. It focuses on the problem, allowing the client to feel more comfortable in treatment, rather than on cognitive reframing, which can elicit an aversive reaction if the client is unprepared to make internal shifts and feels blamed when asked by the therapist to do so. By approaching personal issues as external problems to solve, as opposed to a personal disease to manage, Asian Americans can effectively save face, a particular concern. PST is effective for reducing psychopathology, such as depression and other psychological difficulties. Research has shown that Asian Americans report greater perceived relevance of PST, as well as greater activation of self-processing, in the medial prefrontal cortex compared to Cognitive Behavioral Therapy (CBT). The MindBoba intervention's content is innovative, it integrates external problem-solving and goal-setting through the use of PST. By focusing on stressful problems in the real world, PST offers a more personally relevant approach for many Asian Americans-particularly those concerned about saving face. Mindboba was culturally adapted for this group systematically. Culturally adapted strategies may include providing cultural-clinical bridges through a comprehensive therapy orientation, focus on stigma reduction, integration of cultural metaphors and symbols, and use of cultural and philosophical teachings. The final evaluation of intervention efficacy will be conducted via a randomized controlled trial with 360 Asian American participants. Over 14 weeks (1 week for pretest + 12 weeks for intervention + 1 week for posttest), the investigators will assess whether, compared to a business-as-usual (BAU) or an active control (AC), implementation of the full PRoP-AA intervention: (a) increases social problem-solving, (b) increases participant self-efficacy, (c) decreases stress and depression, (d) increases motivation to engage with the intervention, (e) improves attitudes towards seeking mental health help, and (f) increases knowledge.

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United States