Editor’s Note: In our last post about multicultural competency, we explored the pitfalls that currently detract from our ability to deliver culturally salient, non-ethnocentric psychological services to clients, and how overcoming these pitfalls to provide such services can improve mental health in a broader sense. This week, we offer you potential avenues to do this: the recommendations of Janice Ya Ken Cheng, PhD, and Stanley Sue, PhD, contributors to this year’s Mindfulness and Acceptance in Multicultural Competency: A Contextual Approach to Sociocultural Diversity in Theory and Practice, edited by Akihiko Masuda, PhD. The following is adapted from their chapter entitled “Addressing Cultural and Ethnic Minority Issues in the Acceptance and Mindfulness Movement,” and explores how mindfulness- and acceptance-based therapeutic practice can better address minority issues.
Despite increased attention to diversity issues, ethnic minorities are still underrepresented in the field of psychology. Baseline knowledge on the effectiveness of treatments for ethnic minority groups is limited. Although initial research of the applicability of acceptance- and mindfulness-based treatments to ethnic minority clients has been encouraging, much more innovative studies are needed.
First, the effectiveness of acceptance- and mindfulness-based treatments should be evaluated with individuals from diverse, underserved backgrounds. Much more attention should be paid to how well data and theories from one context apply to another; in other words, researchers should explicitly describe the samples in a way that readers determine to whom the findings can be applied. In cases where treatments are only tested with limited populations, researchers and clinicians should not assume findings can be generalized to all populations unless they are empirically tested. Finally, there should be true desire to include diverse populations in clinical research in order to improve mental health care for minority clients.
Second, the processes underlying effective treatment using acceptance and mindfulness approaches should be identified. Are principles associated with acceptance and mindfulness more consistent with certain cultures or cultural patterns?
Third, evidence suggests that psychotherapeutic interventions are enhanced when they are culturally modified to meet the needs of diverse client populations (Griner & Smith, 2006; Smith, Domenech Rodriguez, & Bernal, 2011). For example, such modifications in treatment can involve a method of delivery (responding to the ethnic language of clients, varying the style of interaction, or providing a cultural context for interventions) or the introduction of certain content in treatment (integrating ethnic cultural issues in the therapeutic interaction, discussing ethnic community supports, etc.). Discovering the kinds of cultural modifications that may be beneficial in acceptance and mindfulness therapy is a critical task.
Fourth, in addition to randomized controlled trials, a range of alternative research strategies should be considered when studying the feasibility and effectiveness of a treatment. For example, community-based participatory research (CBPR) involves collaboration between community members and researchers and often utilizes qualitative methods—including focus groups, in-depth interviews, and ethnographies—to generate valuable baseline knowledge for the development of an intervention. CBPR is particularly useful in providing a deeper understanding of structural and cultural factors affecting mental health care and empowering community members to engage in all aspects of the study. Furthermore, single treatment open trials (STOTs) and single case design experiments (SCDEs) can provide preliminary evidence of the feasibility and effectiveness of a treatment prior to investing in a costly RCT (see Lau, Chang, & Okazaki, 2010, for a discussion of alternative strategies).
Finally, recruitment and retention of ethnic minority students, faculty, and staff are important. Undergraduate and graduate programs should offer courses in ethnic minority research and diversity issues. Training programs should expose trainees to clients from diverse backgrounds. Increasing the heterogeneity and participation in psychology will serve to increase the number of perspectives from and overall commitment to different cultural groups.
Cheng and Sue believe that by engaging in the above mentioned tasks we are in a better position to address the fundamental issues related to the practice of psychological science in general and the application of acceptance- and mindfulness-based therapies in particular.
Look out for the next post in our series about multicultural competency, in which we'll explore how mindfulness-, acceptance- and compassionate-based therapeutic interventions can be utilized to reduce shame and stigma among a subset of sexual minorities living with HIV.
Griner, D., & Smith, T.B. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43, 531-548. doi: 10.1037/0033-3184.108.40.2061.
Lau, A.S., Chang, D.F., & Okazaki, S. (2010). Methodological challenges in treatment outcome research with ethnic minorities. Cultural Diversity and Ethnic Minority Psychology, 16, 573-580. doi: 10.1037/a0021371.
Smith, T., Domenech Rodriguez, M.M., & Bernal, G. (2001). Culture. Journal of Clinical Psychology, 67, 166-175. doi: 10.1002/jclop.20757,
Yan Cheng, J. K., & Sue, S. (2014). Addressing cultural and ethnic minority issues in the acceptance and mindfulness movement. In A. Masuda (Ed.), Mindfulness and acceptance in multicultural competency (21—37). Oakland, CA: New Harbinger Publications.