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«The Mediating Effect of Acculturation on the Effectiveness of Culturally Adapted Cognitive Behavioral Therapy with Mexican Americans Suffering From ...»

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Graves (1967) later presented the concept of psychological acculturation which refers to the changes an individual goes through in the culture contact situation. This dissertation focuses on the acculturation process at the psychological level as acculturation is examined as it relates to individual response to treatment for depression.

Another concept that is found in contemporary literature on acculturation is the concept of situational acculturation. Trimble (1989) proposes that the changes that take place during the acculturation process depend on the persons’ situation. Mendoza (1984) suggests that people can acculturate at various rates in different areas of their life (i.e.

religion, dress, customs).

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unilinear unidimentional process to a more multilinear, multidimensional process. Berry and his colleagues (1986) propose that the course of adaptation an individual goes through is comprised of two orthogonal processes: (a) adaptation to the norms of the new culture and (b) maintenance of the norms of the indigenous culture. Kim and Abreu (2001) term the second process enculturation to describe the process of being socialized into and retaining one’s indigenous cultural norms. The acculturation process can happen in different ways for different members of the same ethnic group. Sue (2005) writes that acculturation cannot be understood without considering the person’s environment and the person-environment match. Trimble (2005) adds the concept of situational acculturation and points out that people will acculturate differently depending on their circumstances.

Marsiglia and Kulis (2009) contribute the importance of considering the impact of social class, power and prestige on the acculturation process. Furthermore, they pose the example of how a White middle-class young person has the option of adopting the dress and language of Mexican American or African American classmates, while the minority group member may find it necessary to adopt such aspects of the mainstream culture in order to advance academically and professionally.

The study of acculturation has evolved to an understanding that there may be different elements of a person’s culture of origin and the host culture at any given time (an orthogonal view of acculturation). This means a person’s acculturation should not be described in degree or level because doing this implies it is a unilinear process (Berry, 2005). Cuellar and his collaborators (1995) discuss the orthogonal measure of acculturation in which acculturation is plotted on four quadrants. By doing this, an individual’s acculturation can be seen as having a wide range of cultural characteristics

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culture. These authors to captured the orthogonal measure of acculturation by modifying the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II). The modified scale measures the presence of cultural aspects that a person possesses simultaneously from the Mexican culture and the U.S. mainstream culture.

THEORETICAL FRAMEWORK OF THE ACCULTURATION PROCESS

Bronfenbrenner’s ecological framework (1979) is useful in explaining the acculturation process. In this framework, the individual is seen as influencing and contributing to the environmental context in a systemic, reciprocal manner (Songtang, 1996). In this theoretical perspective environment is defined as any event or condition outside the person that either influences or is influenced by the developing person (Bronfenbrenner & Couter, 1983). Interactions, according to Bronfenbrenner, are the exchanges that take place between an active human organism and the persons, objects, and symbols in its immediate environment, which become progressively more complex and are reciprocal in nature (Bronfenbrenner, 1994).

The acculturation process involves exactly what Bronfenbrenner describes in the ecological framework. For Mexican Americans, more specifically this occurs when they immigrate or are born into families of Mexican origin. The individual then begins to interact with the environment and this reciprocal process takes place. The individual then participates in the process of deciding which values, ideas, or behaviors they will internalize from their environment. As the individual internalizes more of the values, ideas, or behaviors of the host environment, they become more like the host environment, and thus more acculturated.

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perspective. One of his recent additions is the concept of ecological niches. By ecological niches, he refers to “particular regions in the environment that are especially favorable or unfavorable to the development of individuals with particular personal characteristics” (p.194). The concept of ecological niches fits well with the argument that evidence-based practices should be culturally adapted to create an environment that is favorable for Mexican American individuals to develop. The idea is that culturally adapting interventions creates an environment that is favorable for the development of Mexican Americans who possess particular cultural characteristics.

Alex Gitterman and Carel Germain (1976) wrote about the ecological perspective as it relates to the social work profession in the Life Model. Their work proposed that social workers focus equally on the individual clients and the environments they inhabit.





These two authors proposed that all forms of life strive toward a goodness-of-fit with their environment and that people and their environments are interdependent and complementary (Germain & Gitterman, 1979). The goodness-of-fit argument is highly aligned with current views on acculturation that are moving towards including environmental factors in assessing the impact of acculturation on mental health.

Nonetheless, the Life Model sets part of the foundation for understanding the question that this dissertation sets to answer: Does culturally adapting evidence-based practices make a difference for people of color? More specifically, does culturally adapted cognitive behavioral therapy result in different outcomes for Mexican Americans suffering from depression based on their acculturation?

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Several modes of acculturation are identified in the literature. Assimilation is a mode of acculturation that is described as being a process in which individuals lose their original cultural identity as they acquire a new identity in a second culture (Berry, 1980;

LaFromboise, Hardin, Coleman & Gerton, 1993). Others have referred to this as a “cultural shift” (Mendoza & Martinez, 1981). Integration as defined by Berry (1980) refers to developing a bicultural orientation that successfully integrates cultural aspects of the acculturating group and the host group, making the individual feel a sense of identification and comfort with both groups. Separation or “cultural resistance” (Mendoza & Martinez, 1981) is a mode of acculturation in which the individual chooses not to identify with another cultural group and to retain a separate ethnic identification.

Lastly, marginalization, as presented by Park (1928) and Stonequist (1937), is a state in which individuals give up their original cultural identity and then discover that they are rejected by the group to which they are acculturating.

Measures of Acculturation The debate about which elements should be explored when defining the acculturation process has grown throughout the years. As a result, researchers have been criticized for measuring acculturation based on a single proxy variable such as language preference, place of birth, social preference, or preference in food and music. Critics state that the impact of factors such as immigration experience, discrimination, socioeconomic and educational factors should also be explored (Chun, Organista, Marin, 2002). At this time the instruments that are available to measure acculturation have very narrow measures in place. Some examples are the Hispanic Background Scale which measures language use, the Bicultural Involvement Questionnaire which measures language

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the Cultural life Styles Inventory which measures social preference and the Behavioral Acculturation Scale which measures preferences in food and music (Chun et al., 2002).

The Acculturation Scale for Mexican Americans-II (ARSMA-II) was used in this dissertation study. The ARSMA-II is a validated instrument that measures acculturation

orthogonally. The ARSMA-II measures acculturation by measuring four dimensions:

language preference and use, ethnic identity, customs, and social affiliations (Cuellar, Maldonado, & Arnold, 1995). The psychometric properties of this scale will be described later.

Literature on the relationship between acculturation and mental health points to higher acculturated individuals having a higher incidence of psychiatric disorders (Escobar et al., 2000; Vega et al., 1998). The same is found in the substance abuse literature that looks at the relationship of acculturation level and incidence of drug use (Gil et al., 2001; Vega & Gil, 1998; Vega et al., 1998). These findings support the argument that culture may play a role as a protective factor for some minority groups and that some individuals become more susceptible to depression, anxiety, drug use, and negative expectations of the future as they become more acculturated (Vega & Alegria, 2001). This dissertation study adopts this idea as it proposes that acculturation influences how Mexican Americans respond to treatment for depression.

Acculturation of Mexican Americans in El Paso This dissertation is relevant and timely because the population of people of Mexican descent continues to grow in large numbers and the influx of people from Mexico will continue because of the close proximity of Mexico to the United States. The impact of acculturation on Mexican people is very important because Mexican people

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United States. El Paso is an ideal place to conduct this research because of the predominance of people of Mexican descent. The purpose of this dissertation study is to examine the impact acculturation has on how well Mexican Americans respond to mental health treatment, more specifically Cognitive Behavioral Therapy.

COGNITIVE BEHAVIOR THERAPY

Major Assumptions The group of therapies known as cognitive therapies (CT) and cognitive behavioral therapies (CBT) are based on the notion that thinking plays a role in the etiology and maintenance of some mental disorders (Hollon & Beck, 2004). The various interventions that fall under these two groups of therapies such as cognitive therapy (CT;

Beck, 1991), rational emotive therapy (RET; Ellis, 1962), stress inoculation training (SIT; Meichenbaum, 1985), and problem-solving training (PST; D’Zurilla & Goldfried,

1971) are so similar that they are known by most under the general rubric of CBT (Hollon & Beck, 2004). The main difference in all of these approaches is how much emphasis is placed on cognitions rather than on behavioral interventions.

Aaron Beck’s CT also known as CBT is the intervention under examination for this study. Beck developed this approach in the 1960’s when he began to suspect that his patient’s problems stemmed from distorted interpretations of events. Beck developed his theory of therapy based on the patterns of thinking and behaving expressed by his patients. Beck wrote, in his early writings (Beck, 1979) that he believed people have a source of data available to them that helps them define and cope with psychological problems. He asserted that people are able to use basic common-sense strategies to deal

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help outside themselves to either learn or regain these common-sense strategies.

Beck found that “automatic thoughts” are present in mental processes and that these thoughts can become a source of problems when they become distorted. Beck wrote that the sources of automatic thoughts are the self-monitoring and self-instruction that takes place in every person’s mind (Beck, 1979). Self-monitoring involves the way people monitor their thoughts, wishes, feelings, and actions. At times this self-monitoring can lead to maladaptive reactions when people over monitor themselves or have a deficit in self-monitoring. Self-instructions involve verbal messages directing behavior.

Problems arise when self-instructions become over mobilized and are manifested in a preoccupation with a wide range of “shoulds". In addition, the theory proposes that “automatic thoughts” are based on underlying schemas which are “deep cognitive structures that enable an individual to interpret his or her experiences in a meaningful way” (Persons, Davidson, & Tompkins, 2001).

Automatic thoughts can also result from what Beck calls “anticipations”. People may anticipate that something bad is going to happen or may try to predict others’ reactions. These anticipations can also turn into a source of distress for some people.

Related to this are what Beck calls “rules” which he describes as internal signals that guide how people react to specific situations. These “rules” guide overt actions and form the basis for specific interpretations, expectations and self-instructions (Beck, 1979).

A third component of Beck’s theory is that there are public and private meanings that people attach to situations or objects. Public meanings are the formal and objective definitions of an event that do not have any personal significance or connotation attached to them. Private meanings are attached when people judge that situations or objects have

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emotions.



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