Running Head: Capstone<\/p>\n
Suicide Prevention for Hmong Adolescences with Depressive Symptoms
\nTable of Contents
\nPage<\/p>\n
Introduction 4
\nLiterature Review 7
\nDefining Suicide 7
\nSuicide Epidemiology 8
\nDefining Depression 10
\nDepression Epidemiology 11
\nSuicidality amongst Hmong Adolescents 13
\nHmong Suicide within Fresno: A Case Study 13
\nPrevious Interventions 16
\nSOS Suicide Prevention Program 17
\nCombined Cognitive-Behavioral Family Education Intervention 20
\nBicultural Effectiveness Training 22
\nProposed Intervention Approach 24
\nImplementation Strategy 24
\nPresentation of Theoretical Grounding for Proposed Intervention 26
\nCognitive Behavioral Therapy 26
\nNarrative Therapy via Constructionism 31
\nIntervention Hypothesis 33
\nDetail of Intervention 33
\nPresentation of Way Proposed Intervention Incorporates CRT 38
\nEvaluation Process 40
\nDescription of Measures 41
\nPage
\nEvaluation Protocol 44
\nPresentation of a Logic Model 45
\nReference 46
\nAppendix 55
\nFigure 1 55
\nFigure 2 56
\nFigure 3 56
\nFigure 4 57
\nStudent Satisfaction Survey 58
\nCBT Curriculum 62<\/p>\n
Introduction
\nThe term Asian American was a term first coined by Yuji Ichioka during the late 1960\u2019s in the advancement of bringing diverse Asian groups together (Kang, 2002). It has become an umbrella term used to describe American citizens who are of Asian descent. It is important to note that Asian immigrants who are not necessary American citizens will also get lumped under this umbrella term. According to Baruth and Manning (2003), there are almost 50 distinct Asian American ethnic groups that reside in the U.S. with an estimated total of 30 distinct languages spoken among this highly diverse group. Pacific Islander groups are also occasionally included within the umbrella term. Suicide rates are prevalent within this highly diverse population.
\nDespite suicide being ranked as the 11th most common cause of death in the U.S., it is ranked as the 8th most common cause of death amongst Asian Americans (U.S. Department of Health and Human Services, 2007). Bartels et al. (2002) reported that Asian American elders involved in the primary care system have the highest rates of death and suicide ideation (at 56.8%) when compared to other non-Asian elderly groups. In 2007, young Asian American adults had higher suicide mortality, as the combined suicide rate of Asian American males and females between the ages of 20 to 24 (12.44 suicides committed per 100,000 population) exceeded the combined rate of all other racial groups except for Native Americans (30.48 per 100,000) (CDC WISQARS Injury mortality Reports). This startling suicide rate can be correlated to the high suicide ideation rates of Asian American college students (Lam, 2009).
\nAccording to Lam (2009), Asian American students make up between 10 and 30% of the student population in the best American universities. Despite the academic achievement seen in this group, Asian American college students are more likely to attempt suicide than their European American counterparts at these educational institutions (Leong et al., 2007). Between May 2009 and July 2009, three Chinese American students at the California Institute of Technology (Caltech) have committed suicide (Lam, 2009). Other instances of college related suicide can be seen at Cornell University. Between 1996 and 2006 – Write a paper; Professional research paper writing service – Best essay writers, there were a total of 21 suicide related deaths reported at Cornell University. Out of the 21 victims, 13 of them were Asian students. This incident sparked the university to from a special Asian Campus Climate Task Force to investigate the high suicide rate, as Asian American students only make up 14% of the Cornell student body (Lam, 2009). The top three triggers in the formulation of suicide ideation reported among Asian American college students who had considered committing suicide in the past year were pressure to do well in academics, family conflicts, and financial issues (Wong, Brownson, & Schwing, 2009).
\nAsian American students are expected (and pressured) to excel in academics through expectations set forth by their parents. According to Chang (1998), these expectations can result in Asian American students becoming obsessive in striding for perfection. Perfectionism \u201crefers to a multidimensional phenomenon defined by excessive self-criticism associated with high personal standards, doubts about the effectiveness of one\u2019s actions, concerns about meeting social expectations (typically those of the parents), and an excessive focus on organization and neatness\u201d (Chang, 1998, p. 238). This behavior has been linked to risk of suicidal behavior, as seen in a study conducted by Hewitt, Flett, and Weber (1994) in which college students with perfectionistic tendencies reported being more suicidal (as cited in Chang, 1998). This behavior can be fostered by parents through rivalries of other parents as seen in Chin\u2019s (n.d.) account of her parent\u2019s academic expectation:
\nExcelling in our culture is based squarely on \u2018being better than someone else, preferably someone whose parents your parents can\u2019t stand.\u2019 I grew up being constantly compared and contrasted with other kids. And my favorite [quotes coming from my parents]: \u2018You scored a 99% on your test Why didn\u2019t you get 100%\u2019. We\u2019re just never good enough.\u2019 (Chin, n.d., para 8).<\/p>\n
Although more attention is being paid to this topic in the recent years, information about suicide within the Asian American community is still scarce among certain Asian groups such as Southeast Asians. Southeast Asians are Asian groups that originated from the following countries: Brunei Darussalam; Cambodia; Indonesia; Laos; Malaysia; Myanmar; Philippines; Singapore; Thailand; Timor-Leste; and Vietnam (United Nations Statistics Division, 2011). Suicide statistics mentioned above for Asian Americans has mainly reflected Asian groups (e.g. Chinese, Japanese, and Filipino Americans) who have been in the U.S. for an extended period of time (Leong, 2007). Despite the lack of statistical information for the newer Asian groups residing in the U.S., 70% of Asians in the U.S. are first generation Americans (Cheng et al., 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer).
\nSoutheast Asian groups that migrated into this country during 1970s and 1980s partially account for the high percentage of foreign-born Asians residing in the U.S (Lee, 1998). The vast majority of people within this group are refugees who have immigrated into the U.S. from Cambodia, Laos, Thailand, and Vietnam due to war conflicts such as the Vietnam War, Khmer Rouge conflicts, etc. Although there is a lack of research to convey the prevalence of suicide within Southeast Asian groups, there have been published studies indicating a high prevalence of Post-Traumatic Syndrome Disorder (PTSD) (which is a possible factor in triggering suicide) among this population (Hinton et al., 2004; Marshall et al., 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer; Oquendo et al., 2003).
\nWithin Southeast Asian groups such as the Hmong, intergenerational conflict can be identified as one of the key triggers of depression amongst adolescents, as various studies have indicated that a clashing of opposing cultures between Hmong parents and adolescents is a contributing factor for depression amongst Hmong adolescents (Boulden, 2009; Castillo & Phoummarath, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Juang et al., 2007; Lee et al., 2009; and Ying & Han, 2007). This type of conflict often exists within first generation Asian American families due to the acculturation differences between immigrant parents and their children (Cheng et al., 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer; Portes & Rumbaut, 2001). As it will be demonstrated in the Fresno case study below (on page 13), this clash of values within the family can cause a child to develop depressive symptoms and engage in suicidal behaviors if this conflict is not addressed promptly.
\nThe purpose of this capstone is to propose a school-based group intervention curriculum geared towards addressing intergenerational conflict amongst Hmong adolescents between ages 14 to 19. This curriculum was created in response to the string of Hmong adolescent suicides which occurred in Fresno, Ca between 1998 and 2002. Cognitive Behavior Therapy and Narrative Therapy will be used in assisting Hmong adolescents in developing coping skills in dealing with intergenerational conflict with their parents. In addition, through Hmong adolescents participating in the group sessions, it is hoped that a social support will be formed amongst them.
\nLiterature Review
\nDefining Suicide:
\nThe term \u201csuicide\u201d is used to describe the purposeful act of self-destruction of a human being by means of that person causing his or her body to cease life function. The act of committing suicide can be seen as a way to deal with a person\u2019s despair when they feel that they have exhausted all of their options in handling their predicament. This act can be triggered in a number of ways, such as hardships in the financial aspects of life, failed\/difficult relationships, and any undesirable life situations. Health related issues such as bipolar disorder, drug abuse, depression, schizophrenia, and alcoholism may also factor in as a reason for taking one\u2019s own life (Hawton and van Heeringen, 2009). While suicide is sometimes conducted as a means of political protest, this capstone will restrict its consideration to suicide reflecting difficulties with depression.
\nSuicide Epidemiology:
\nSuicide has become a leading contributor in the cause of death amongst various age groups and populations. An estimated total of more than 33,000 deaths as a result of suicide occur each year in the U.S., which equates to 91 deaths per day. Through the National Violent Death Reporting System, 16 states report that one-third of suicide victims were under the influence of alcohol. In addition, the use of heroin and prescription pain killers was found in 1\/5th of these deaths.
\nAs reported by the CDC (2009), the significance of suicide as a leading cause of death can vary amongst different age groups. Suicide was the third leading cause of death in 2009 for young adults between the ages of 15 to 24. It was estimated that for every successful suicide committed within this age group, there were approximately 100-200 attempts made. In a 2007 survey study, the CDC (2009) reported that 14.5% of high school students had given serious consideration in attempting suicide in the past 12 months. Of the students who were administered this survey, 6.9% had reported in having attempted suicide one or more times during the past 12 months. For older adults between the ages 25 to 34, suicide was the second leading cause of death (CDC, 2009). Moving up the age range from 35 to 44, suicide was the fourth leading cause of death. The prevalence of suicide can also be seen within elder adults, as the rate of suicide was 15.9 suicides committed per 100,000 people age 75 and over (CDC, 2009). In addition, CDC (2009) estimated for every four suicide attempts among persons aged 65 or older, there was one successful committed act.
\nFrom a gender perspective, suicide is the 17th leading cause of death for males and 16th for females (CDC, 2009). CDC (2009) data revealed that males are four times more likely to take their own lives as opposed to females, as 79% of all reported deaths by suicide in the U.S. having been committed by males. Although males are more likely to take their lives, females are about two to three times more likely than males to attempt suicide during their lifetime (CDC, 2009). The use of a firearm was attributed to 56% of all male related suicides. In contrast to males, poisoning was found to be the most common method for female (40.3%). The rate of suicide is highest for women within the ages of 45 to 54, while for males it is 75 and older (CDC, 2009).
\nSuicide is not only a social problem from a mental and physical health perspective, but also an issue from an economic standpoint. Suicide victims can incur a significant amount of direct and indirect monetary cost for society. According to Yang and Lester (2007), the direct costs incurred by the victim are associated with hospital cost and medico-legal cost (cost of autopsies and legal investigations). Indirect cost includes potential earnings (i.e. lifetime earnings) lost due to premature death and permanent disability. Estimates for indirect cost are determined by \u201cboth years of productive life lost and the corresponding estimated value of lifetime earnings\u201d (Yang & Lester, 2007, p. 352).
\nThe act of successful suicides can generate significant cost for society. In calculating the cost of suicide deaths that occurred during 1980, it was found that $4.2 billion were lost due to lost productivity. This loss of productivity comes to a loss of $260,691 per suicide victim (Yang and Lester, 2007). If this loss were to be converted to 2005 dollars, the cost of completed suicides is estimated to be $617,870. Yang and Lester (2007) gave an estimated total number of suicide deaths in 1980, which were 26,869 lives. From the estimated number of lives lost, total cost incurred by victims was $16.60 billion in 2005 dollars.
\nIt was estimated by Yang and Lester (2007) that the individual cost (for people within the age range of 15 to 24) of successful suicides in 1980 cost was $431,600 from lost lifetime earnings. By converting this estimated lifetime cost to yearly earnings, an estimated $10,400 per year of productive life expectancy to age 65 was lost. In addition to the lost lifetime earnings, each death also incurred an addition cost of $1,750 for medico-legal matters. The cost of lost lifetime earnings in 2005 dollars would be an estimated total of $1,022,950. For each teenage suicide, the cost in 2005 dollars would be $4,150 for each death.
\nUnsuccessful suicide attempts also incur heavy cost. These cost stems from the crucial medical care needed to treat the survivor, the possible psychological and psychiatric cost in dealing with the mental state of the person, and the \u201closs to the labor force during this period, incurring additional economic cost\u201d (Yang & Lester, 2007, p. 353). Yang and Lester (2007) provided some data collected from the accounting department at a small hospital in New Jersey. In 2001, 40 individuals were admitted into the hospital for attempted suicide. The reported average cost of the patients was $12,409, with the range cost being $1,811 to $61,803.
\nDefining Depression:
\nDepression can be defined from a simplistic standpoint as feeling blue, sad, miserable, and unhappy. From a clinical perspective, it is a mood disorder in which \u201cfeelings of sadness, loss, anger, or frustration interfere with everyday life for a significant period of time\u201d (National Center for Biotechnology Information, 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer, para 2). Beck (1995) defined depression in terms of cognitive content and processing styles wherein a person with depression may have a \u201cnegative view of themselves, the world, and the future\u201d (as cited in Vonk & Early, 2009, p. 243). It can be a debilitating and costly mental illness, as it can \u201cadversely affect the course and outcome of common chronic conditions, such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity\u201d (CDC, n.d., para 1). According to the DSM-IV-TR (American Psychiatric Association, 2000), symptoms of depression can include a combination of the following:
\n\u2022 Agitation, restlessness, and irritable mood
\n\u2022 a loss of interest or pleasure in activities that were once enjoyed
\n\u2022 Dramatic change in appetite, often with weight gain or loss
\n\u2022 Extreme difficulty concentrating
\n\u2022 Fatigue and lack of energy
\n\u2022 Feelings of hopelessness and helplessness
\n\u2022 Feelings of worthlessness, self-hate, and inappropriate guilt
\n\u2022 Thoughts of death or suicide
\n\u2022 Trouble sleeping or excessive sleeping<\/p>\n
This mood disorder can be trigger in variety of ways which can include difficulties in family or partnership, occupational stress, traumatic events, etc. This capstone will restrict its consideration to depression reflecting difficulties caused by family conflict via intergenerational conflict between Hmong adolescents and their families, as demonstrated in the Fresno case study below.
\nDepression Epidemiology:
\nDepression is the fourth leading cause of disability worldwide, as 121 million people worldwide are affected by this disorder (World Health Organization, n.d; National Institute of Mental Health, 2006 – Write a paper; Professional research paper writing service – Best essay writers). It is predicted that it will be the second leading cause of disability by 2020 (National Institute of Mental Health, 2006 – Write a paper; Professional research paper writing service – Best essay writers). Within the U.S., approximately 14.8 million adults (6.7 percent of the U.S. population) have depressive disorders (National Institute of Mental Health, 2006 – Write a paper; Professional research paper writing service – Best essay writers). Depression has a significant impact on people and society as 70 percent of psychiatric hospitalizations and 40 percent of suicides were attributed to this disorder (National Institute of Mental Health, 2006 – Write a paper; Professional research paper writing service – Best essay writers). The total cost of depression in U.S. during the year 2000 was an estimated total of $83 billion, which included the cost of treatment ($26 billion) and losses related to absenteeism, reduced productivity at work, and the value of lifetime earnings lost due to suicide-related deaths ($57 billion) (National Institute of Mental Health, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Greenberg et al., 2003).
\nAccording to the CDC (n.d.), the following groups were identified as being more prone towards having depression: people between the ages 45 and 64; women; people from ethnic groups; persons with less than a high school education; those previously married; individuals unable to work or unemployed; and persons without health insurance. Within a lifetime, depression will have affected 10 percent of men and 25 percent of women (National Institute of Mental Health, 2006 – Write a paper; Professional research paper writing service – Best essay writers). The prevalence of depression amongst women is higher than men, as they are 70% more likely to experience depression during their lifetime (Kessler et al., 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers; National Institute of Mental Health, n.d.). Depression can co-exist with other illness (anxiety disorders, alcohol\/substance abuse, and medical illnesses) that can either \u201cprecede the depression, cause it, and\/or be a consequence of it\u201d (National Institute of Mental Health, n.d., para 1).
\nAccording to SAMHSA\u2019s (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers) report, Major Depressive Episode among Youths Aged 12 to 17 in the United States: 2004 to 2006 – Write a paper; Professional research paper writing service – Best essay writers, the annual average of adolescents within ages 12 to 17 who had experienced at least one major depressive episode within the past year was 8.5 percent (2.1 million teens). There is a general pattern that can be seen on Figure 1 of the Appendix for the rate of past year major depressive episode, as the rates tend to increase from age 12 to 16 (SAMHSA, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). The report also indicated that 48.3 percent of adolescents surveyed reported being impaired in at least one of four domains (i.e. home, school\/work, family relationships, or social life) (SAMHSA, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers).<\/p>\n
Suicidality amongst Hmong Adolescents:
\nHmong Suicide within Fresno: A Case Study
\nThe Fresno Bee Newspaper compiled a special documentary story, Lost in America, in 2002, which featured stories of eight Hmong adolescents who committed suicide in Fresno, Ca between 1998 and 2002. In addition, the compilation story featured several other stories from other Hmong suicide victims and Hmong adolescents who had engaged in self-harm activities. This compilation was made in an effort to understand and explain the string of Hmong suicides committed during the 4 year period. This string of suicides became the center of attention for Fresno County, as these deaths had accounted for nearly half of the county\u2019s teen suicides during that time frame, despite the Hmong population being just 3% of the region\u2019s population (Fresno Bee, 2002).
\nVictims featured in the compilation had a variety of similar backgrounds and behavior patterns which may have contributed to their untimely deaths. All of the adolescents were children of refugees who immigrated into the U.S. after the end of the Vietnam War in 1975 (Fresno Bee, 2002). A majority of the victims had relationship conflicts with their parents. These conflicts were a result of the parent and children\u2019s values clashing with each other. One of the emphases in analyzing the lives of these victims were the victims\u2019 struggles in maintaining the two contrasting worlds that they lived in. These two worlds were living their life as a Hmong child under their parents and living their life as an American teenager outside of the home. These two worlds would come into conflict with each as Hmong adolescents must often choose between embracing the values of their parents or the values of their school peers to whom they have become accustomed. Through the clashing of values between the parent and child, the compilation of stories in this newspaper ultimately correlated the suicides to intergenerational conflict and a clashing of two different cultures. In order to gain a better understanding of this correlation within the Hmong community, one needs to understand the migration history of the Hmong, and the consequences of the migration on Hmong adolescents.
\nUnlike past immigrant groups who came into the U.S. to seek new found fortune, the Hmong people immigrated to the U.S. to avoid political persecution due to their involvement in the Vietnam War. Originally from Laos, the Hmong population was recruited by the U.S. to fight against communism during 1960-1975 (The Split Horn, n.d.). A total of 30,000 Hmong men participated in the effort. Towards the end of the conflict, the Hmong had to flee the country in fear of backlash from the communist regime. It has been estimated that one tenth to a half of the Hmong population was lost in the war (300,000 to 400,000 Hmong were living in Laos before the war) (The Split Horn, n.d.). Due to the forced migration, \u201cthe Hmong people have experienced tremendous acculturative shock upon resettlement in the late 1970s and 1980s and have continued to face multiple social, cultural, educational, economic, and institutional barriers and challenges\u201d (Lee et al., 2009, p. 549).
\nHmong immigrant parents have to contend not only with the cultural barriers of acculturating into the American mainstream, but also the new shifting dynamics of the culture between them and their children. Hmong children born in the U.S. are more \u201creadily and rapidly to acculturate to the mainstream American culture than their parents\u201d (Lee et al., 2009, p. 549). As a child develops their own identity and begins to become integrated into society, \u201cone of the normative tasks of adolescence involves developing a set of personal values, beliefs and behaviors\u201d (Juang et al., 2007, p. 966). Through their development, adolescents are much quicker in acquiring the values and behaviors of the new culture than their parents (Kao, 1999). This rapid rate of acculturation within children can cause \u201cintergenerational discrepancies in values and behaviors (dissonant acculturation)\u201d (Lee et al., 2009, p. 549). While dissonant acculturation is not a-typical among immigrant communities, the greater the cultural discrepancies, the greater the anticipated strain. In addition, it is possible that the accommodations to dissonant acculturation parents have to make may be more challenging for populations that had to relocate involuntarily.
\nIntergenerational conflict is a result of the clashing of values and behaviors between the Hmong immigrant parent and their first generation offspring. Communication between the two parties is conflicted, as the parents are more \u201clikely to retain the lifestyle, values, traditions, and customs of their homeland and less likely to uniformly adopt the mores of American society, particularly in regards to raising and socializing their children\u201d (Lee et al., 2009, p. 549). In contrast to their children, parents are highly selective in terms of choosing aspects of their lives that they are willing to acculturate and\/or assimilate.
\nBoulden (2009) notes that this selectiveness amongst the parents often leaves them \u201cill-equipped to guide or support the experiences of their children growing up in the U.S., thus creating this generational conflict within the Hmong community\u201d (p. 140). This conflict can cause an identity rift for Hmong adolescents, as they are force to choose between being \u201cHmong\u201d and \u201cAmerican\u201d. As communication between the parent and child becomes conflicted, children are more likely to \u201cshow an assortment of adjustment problems, including psychological distress, acting out behaviors and poor academic performance\u201d (Lee et al, 2009, p. 550). An example of how intergenerational conflict can lead an adolescent into destructive behaviors can be seen in the case of Melinda Lee, who is featured in the Fresno Bee\u2019s compilation report.
\nMelinda Lee (who fortunately is not one of the suicide victims) is a Hmong teenager who struggled with balancing her duties as a Hmong daughter and her longing of being an \u201cAmerican\u201d. At the age of 12, one of Melinda\u2019s duties as a Hmong daughter was waking up early in the morning at 5am daily to prepare breakfast for her family. During the weekdays, Melinda goes to school and comes back home by 5pm (this is her curfew) to start on her chores. Her parents\u2019 expectations for her are to clean the house, prepare meals, assist them, obtain an education, marry into a good family, and avoid shaming them. Despite her parent\u2019s expectations, Melinda longs to live the life of a normal American teenager (Fresno Bee, 2002). She reported often arguing with her parents over issues such as dating, clothes and the company that she keeps.
\nDue to the high expectations of her parents, she reported ditching her high school classes at least twice a month to spend time with friends at the mall. As result of her ditching school, her grades began slipping. Melinda elaborated, “I guess I was just so determined to live my own life. It’s so hard to live the life my parents want me to. I feel like if I get in trouble, it’s worth it\u201d (Fresno Bee, 2002, p. 64). She has reported having suicide ideation, as she has engaged in cutting herself with a razor blade and overdosing on pain relievers as her problems escalated.
\nPrevious Interventions:
\nTwo previous school-based interventions are analyzed in this section: 1) the SOS Suicide Prevention Program and 2) a combined cognitive-behavioral family education intervention for depression in children. In addition, a unique family intervention called Bicultural Effectiveness Training will be examined. In analyzing the components of each intervention, a Critical Race Theory (CRT) perspective will be taken in discussing the programs\u2019 strengths and weakness. Critical Race Theory (CRT) is a study of power in which it explicitly examines how societies organize themselves into hierarchies using race and other social identity categories (Delgado, 2001). In studying the dynamics of power, it seeks to \u201ctransform the relationship among race, racism, and power\u201d (Delgado, 2001, p. 2). CRT has built its theoretical foundations from critical legal studies and radical feminism (Delgado, 2001). CRT draws from \u201cEuropean philosophers and theorists, such as Antoino Gramsci and Jacques Derrida\u201d (Delgado, 2001, p. 4), as well as from the American scholars such as W.E.B. DuBois (Delgado, 2001). Furthermore, it draws from the civil rights movement and the concern for \u201credressing historic wrongs\u201d (Delgado, 2001). There are 6 basic tenets of CRT, which are as follows
\n1) Racism is \u201cordinary\u201d in which it is an experience infused into our everyday lives (Delgado, 2001).<\/p>\n
2) \u201cInterest convergence\u201d holds that certain groups within society will have an invested interest in maintaining the current systems of domination, as it works to their favor (Delgado, 2001).<\/p>\n
3) \u201cSocial construction thesis\u201d holds \u201cthat race and races are products of social thought and relations which are nether objective, inherent, or fixed\u201d (Delgado, 2001, p. 7)<\/p>\n
4) \u201cDifferential racialization\u201d holds that \u201cthe way dominant society racializes different minority groups at different times, in response to shifting social needs\u201d (Delgado, 2001, p. 8).<\/p>\n
5) \u201cIntersectionality and anti-essentialism\u201d holds that \u201cno person has a single, unitary identity\u201d (Delgado, 2001, p. 9).<\/p>\n
6) \u201cVoice of color thesis\u201d holds that those who have experienced oppression are able to \u201ccommunicate to their white counterparts matters that the whites are unlikely to know\u201d (Delgado, 2001, p. 9).<\/p>\n
SOS Suicide Prevention Program
\nThe SOS suicide prevention program is a school-based intervention targeted towards high school students (9th to 12th grade), as it blends 2 prevention strategies together (Aseltine & DeMartino, 2004). These 2 components are as follows: 1) structured curricula aimed towards raising suicide awareness amongst high school students; and 2) utilization of self-screening techniques for assessing depressive symptoms and other risk factors associated with suicidal behavior. The program materials consist of a video and discussion guide (Aseltine & DeMartino, 2004). According to Aseltine and DeMartino (2004), the video \u201cfeatures dramatization that depict the signs of suicidality and depression and the recommended ways to react to someone who is depressed and suicidal\u201d (p. 446). In addition, the video contains \u201cinterviews with real people whose lives have been touched by suicide\u201d (Aseltine & DeMartino, 2004, p. 446). The goals of this intervention are to: 1) \u201cincrease students\u2019 understanding and recognition of depressive symptoms in themselves and in others and by promoting more adaptive attitudes toward depression and suicidal behavior\u201d (Aseltine & DeMartino, 2004, p. 446); and 2) familiarizing students with self-screening techniques as to enable students to \u201cassess and evaluate the depressive symptoms and the suicidal thoughts they (or their peers) might be experiencing and prompts them to seek assistance when dealing with these problems (e.g. telling a school counselor)\u201d (Aseltine & DeMartino, 2004, p. 446).
\nAccording to Aseltine and DeMartino (2004), the main strengths behind the SOS prevention program is its simplicity and its appropriateness with targeting this age group. As highlighted by Aseltin and DeMartino (2004), the program does not require intensive training or extensive knowledge of specific therapeutic interventions (e.g. CBT). Additionally, the implementation cost of the program is low and \u201cdoes not unduly burden teachers, counselors, or administrative staff\u201d (Aseltine & DeMartino, 2004, p. 447). The program is age appropriate as it takes into account the adolescence developmental stage. Adolescents in this stage tend to place high value on their peer groups, as it \u201cbecomes the primary sphere of social involvement and emotional investment for most youths\u201d (Aseltine & DeMartino, 2004, p. 447).
\nDespite the highlighted strengths of this prevention program and its successful outcomes in significantly reducing self-reported suicide attempts (Aseltine & DeMartino, 2004), a flaw can be seen through the use of the CRT lens. Due to the program\u2019s focus on a single subordinate-group identity (i.e. adolescence), students who possess multiple subordinate-group identities maybe rendered \u201cinvisible\u201d (Purdie-Vaughns & Eibach, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). Although the focus of the program is on the adolescent\u2019s strength within their peer group, the program neglected to include their strengths from other intersecting identities (e.g. religious affiliations, ethnicity, etc.). The multiple and intersecting identities of students must be taken into account as they may have other support groups which they may potentially draw from for emotional support, which may prove to be more effective than their adolescent peer groups (e.g. family, religious group, cultural support groups, etc.). As such, a recommendation for this intervention would be the inclusion of the adolescent\u2019s multiple affiliations and identities.
\nIn applying this intervention for Asian American groups, program coordinators need to be aware of the concept of \u201cface\u201d, as it may affect the program\u2019s focus on the strengths of adolescent peer groups. \u201cFace\u201d is highly valued in Asian culture, as it is a \u201cmulti-faceted term, and its meaning is linked with culture, honor, and shame\u201d (Castillo & Phoummarath, 2006 – Write a paper; Professional research paper writing service – Best essay writers, p.7). According to Castillo & Phoummarath (2006 – Write a paper; Professional research paper writing service – Best essay writers), the concept of \u201csaving face\u201d is significant in the Asian culture as it is defined as \u201crefraining from public displays of disrespectful act towards others, or taking preventive actions so that an individual will not appear to lose face in the eyes of others\u201d (p.7). Within the Chinese culture, \u201clien\u201d is a related concept of \u201cface\u201d that \u201crefers to the confidence of society in a person\u2019s moral character\u201d (Castillo & Phoummarath, 2006 – Write a paper; Professional research paper writing service – Best essay writers, p.7). A loss of \u201clien\u201d would \u201cresult in a loss of trust within a social network\u201d (Castillo & Phoummarath, 2006 – Write a paper; Professional research paper writing service – Best essay writers, p.7). An example provided by Castillo and Phoummarath (2006 – Write a paper; Professional research paper writing service – Best essay writers) would be a student gossiping about someone cheating on a test. This would affect the student as their peers would potentially come to distrust them, as they sold out one of their peers. Trust amongst Asian American adolescents within their peer groups needs to be taken in consideration, as they may not be as willing to report to a school official or anyone outside of the social circle about a peer\u2019s depressive issues.
\nCombined Cognitive-Behavioral Family Education Intervention
\nThis intervention was conducted by Asarnow, Scott, and Mintz (2002) to address the rarity of approaches to family interventions in treating depressed youth. It is a 10 session combined cognitive behavioral and family education intervention for children. This intervention has 3 distinct features: 1) the inclusion of a family education sessions that \u201cencourage parents to support the learning that was achieved through the group sessions, and foster positive attitudes towards the skills emphasized in the intervention\u201d (Asarnow, Scott, and Mintz, 2002, p.222); 2) the intervention\u2019s consistency with \u201cMeichenbaum and Biemiller\u2019s (1988) emphasis on the importance of increasing levels of self-direction in moving from skill acquisition to mastery in CBT interventions\u201d (as cited in Asarnow, Scott, and Mintz, 2002, p.222); and 3) addressing comorbid symptoms\/discorders and adjustment problems observed among youth with depression with CBT techniques such as problem-solving and social skills training (Asarnow, Scott, and Mintz, 2002).
\nThe depression group would meet twice a week for the 10 sessions. For 9 sessions, the children are taught to handle their depression issues through utilizing CBT techniques. In addition, the children are also filmed practicing these techniques through vignettes. The filming of the sessions is for the purpose of the 10th session, which will be shown to parents in giving them a clear understanding of what took place during the sessions (Asarnow, Scott, and Mintz, 2002). The final session concludes with the inclusion of the child\u2019s parents. The strength of this intervention lies within this session, as the premise behind the final session is to not only give parents an overview of what occurred in the group sessions, but to encourage parents to help their child in nurturing their newly acquired skills (Asarnow, Scott, and Mintz, 2002). Additionally, this session gives the children a chance to feel good about themselves in what they have learned, as the children are given chance to teach the parents what they learned through the use of the filmed sessions (Asarnow, Scott, and Mintz, 2002). Asarnow, Scott, and Mintz (2002) report successes of this intervention as being signs of improvement in depressive symptoms, reductions in negative automatic thoughts, and less internalizing coping among the children.
\nDespite these successes, a CRT lens would suggest that additional consideration needs to be taken in fleshing out the parent\/child interaction activities for this intervention. If this intervention was implemented within Asian American groups such as the Hmong population, the parent\/child interaction component for the final session would need to be reworked. The acculturation levels between the child and parent would need to be examined, along with gauging the parent\u2019s language proficiency.
\nThere is a lack of understanding about the concepts of Western mental health within the Hmong communities amongst first generation Hmong immigrants (Gensheimer, 2006 – Write a paper; Professional research paper writing service – Best essay writers). This lack of understanding and the stigma that is attached to mental health can be seen through the use of a Hmong phase commonly used to identify mental health, \u201ctshuaj vwm\u201d (crazy medicine). Due to the surrounding stigma, Hmong parents may be less inclined to utilize mental health services. To address this obstacle, one method Castillo and Phoummarath (2006 – Write a paper; Professional research paper writing service – Best essay writers) suggested is the use of cultural brokering. This process involves exploring the following: \u201c1) the perceptions and values regarding the parents\u2019 and the adolescent\u2019s roles; 2) the adolescent\u2019s experience and behaviors in school; 3) the parents\u2019 experiences and concerns; and 4) the pressure of outside demands on both the parents and the adolescent\u201d (Castillo & Phoummarath, 2006 – Write a paper; Professional research paper writing service – Best essay writers, p. 13).<\/p>\n
Bicultural Effectiveness Training
\nAccording to Szapocznik et al. (1986), bicultural effectiveness training (BET) was developed under the center for Family Studies as a bicultural effectiveness training intervention to enhance bicultural skills within members of immigrant families. It is a specific intervention designed for the purpose of enhancing intercultural adjustment in Cuban American families, by ameliorating the acculturation-related stresses confronted by two-generation immigrant families. (Szapocznik et al., 1984). According to Szapocznik et al. (1984), this treatment intervention is a \u201cculturally sensitive intervention that targets on a specific problem area: intergenerational conflicts and conduct disorders in adolescents, either provoked or exacerbated by the stress of acculturation and cross-cultural adaptation\u201d (p. 317). The modality of this intervention is to \u201ccapitalize on certain features of culture conflict in order to ameliorate acculturative stress\u201d (p.317). By capitalizing on these features, it \u201cenhances adjustment in Cuban American families and reduces conduct disorders in adolescents\u201d (p.317) through the reduction of culture conflict and acculturative stress. In reducing culture conflict and acculturative stress, \u201cBET teaches family members that skills for effective functioning in different value contexts (cultural or otherwise) can be viewed as complementary and enriching to the individual\u201d (p. 317).
\nThis intervention consists of 12 lessons, which takes place in three phases. According to Szapocznik et al. (1984), phase 1 introduces the family involved in the treatment to concepts of \u201cbiculturalism, culture, culture conflict, family development and system theory\u201d (p. 333). These concepts are presented in \u201cvery simple form and in a language that is familiar to the family\u201d (p. 333). The essence of phase 1 is to create a shared worldview amongst the family.
\nPhase 2 of the intervention targets four specific areas: \u201c(a) Family Composition styles, (b) Family Relational styles, (c) Family Stress, and (d) Family Conflict\u201d (p. 333). For each of the areas, \u201ca common worldview is established, intergenerational conflict is detoured through culture conflict in order to displace the focus of the conflict from the intergenerational conflict\u201d (p. 333). The greatest emphasis in this phase is placed on forming crossed alliances between generations and cultures for each of the content areas (Szapocznik et al., 1984).
\nPhase 3 is the final step as it \u201cprepares the family to complete the BET sequence by establishing more firmly in the family a transcultural worldview, and by solidifying the gains made in both establishing culture as a common foe and fostering crossed alliances\u201d (p. 333). In addition, psycho-education is provided about mental health concepts and care (Szapocznik et al., 1984). This in turn will provide families with a \u201cpositive growth oriented view of mental health care\u201d (p. 333).
\nBy analyzing this intervention through a CRT lens, the strengths of this intervention lies within empowering parents and their children to explore and embrace each other\u2019s multiple and intersecting identities. Both the parent and child are brought closer to each other as the strategy behind BET is to \u201ccreate the conditions that allow individuals and their families not to feel torn by competing cultural or value allegiances\u201d (Szapocznik et al., 1984, p. 342). Differences between the two parties are instead embraced through utilizing \u201ctheir knowledge of each seemingly incompatible world to elicit the best from each cultural situation\u201d (Szapocznik et al., 1984, p. 342). By eliciting an ideal cultural situation between the two parties, BET is able to transition immigrant families from feeling caught two opposing worlds towards \u201can attitude similar to that which might be adopted by an ambassador to a foreign country: respect for one\u2019s own as well as the other\u2019s values and behavioral style; and an ability and willingness to bridge between two cultural worlds\u201d (Szapocznik et al., 1984, p. 342).<\/p>\n
Proposed Intervention Approach
\nThe proposed intervention is a CBT curriculum for suicide prevention among Hmong adolescents (ages: 14-19). The curriculum is aimed at addressing Hmong adolesents\u2019 depressive symptoms. The ideal location for this intervention would be the high schools at the Fresno United School District. The curriculum is adopted from Clarke\u2019s (2003) The Adolescent Coping With Stress Course; it is modified by the inclusion of elements of Narrative Therapy and attention to potential cultural issues that the students may have (e.g. intergenerational conflict and school issues).
\nImplementation Strategies:
\nThis intervention curriculum is meant to be used for the purposes of suicide prevention amongst Hmong adolescents who are exhibiting moderate to high levels of stress and depressive symptoms. The ideal location to put this intervention curriculum into use would be in high schools within the Fresno School District, since the city of Fresno has one of the largest Hmong populations in the U.S. (Lor, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). In order to recruit Hmong adolescents for this short-term intervention, it would be ideal to enlist the help of the Fresno School District. Upon receiving approval from the district, flyers would be made and passed out to all of the high schools to promote the program. The program would be promoted under the name \u201cStress Workshop for Hmong Students\u201d. The flyer would elicit attention from Hmong students by inquiring if they are feeling stressed out, and \u201cin need of a support system in learning ways to beat stress\u201d. Referrals can also be made by school counselors for students who have reported having signs of depression and\/or being stressed.
\nIn ensuring that this intervention is effective in treating the specified group as noted in this capstone, a screening process will be conducted to make certain that participants entering into the program are the ideal candidates for this curriculum. The screening process will consist of 2 phases. The first phase is the self-assessment in which students would screen themselves for signs of depression, anxiety, hopelessness and the student\u2019s coping skills through 4 different self-assessment tools as described below. The second phase is the clinician intake in which the treating clinician will interview the student using the Cultural Adjustment Difficulties Checklist (CADC) (as described below) in screening whether the source of the student\u2019s depression stems from dissonant acculturation.
\nStudents must meet the following criteria to be apart of the stress workshop: 1) student must show signs of depression, anxiety, hopelessness, and poor coping skills as indicated by the self-assessment tools during the first phase (described below in the Evaluation section); and 2) student must show that their depression is due to dissonance of acculturation within their family as indicated by the Cultural Adjustment Difficulties Checklist (CADC) during the second phase. For students who fail to meet the criteria listed (e.g. anyone who manifests with an anxiety disorder), those students will be screened out and referred to alternative services, at the school\u2019s counseling services, since this intervention is not designed for that level of intervention.
\nThe \u201cStress Buster Workshop\u201d will be held after school. Various workshops will be held within a classroom at each of the high schools, depending on the number of student recruits. The minimum number of students required for a high school to have its own workshop is 6. If however, recruitment is less than 5 at a particular high school, those students who are interested will be encouraged to attend the closest workshop at another high school to increase the number of participants.
\nPresentation of Theoretical Grounding for Proposed Intervention:
\nCognitive Behavioral Therapy
\nCBT is a collection of related techniques that are geared towards having cognition \u201cas the mediator of psychological distress and dysfunction\u201d (Vonk & Early, 2009, p. 242). These specific collections of techniques are from the contributions of both Behavior and Cognitive Therapy. Behavior Therapy (BT) was developed by Burrhus Frederic Skinner during the 1950\u2019s. BT was based upon various theories of learning (as will be discussed below), such as respondent (classical) conditioning, and operant conditioning (reinforcement\/punishment). A third type of learning is modeling (aka observational learning), in which a behavior is learned vicariously through the observation of someone else performing a behavior (Kirk & Clark, 1996). Mental illnesses were redefined as behavioral problems in Skinner\u2019s work, as they were \u201chypothesized to have arisen from faulty learning\u201d (Vonk & Early, 2009, p. 242). Achievements in BT were the reduction of aggressive and oppositional behaviors accompanying anxiety disorders (Vonk & Early, 2009). BT aims at facilitating clients\u2019 identification and modification of features of behaviors that may promote or worsen symptoms underlying a disorder, such as depression. Behavioral strategies can include: goal setting, activity scheduling, social skills training, and structured problem solving (Vonk & Early, 2009).
\nThe learning principles utilized in Behavior Theory include respondent (classical) conditioning, as established by Ivan Pavlov. This type of learning process was demonstrated through his experiments with dogs. In his experiment, he conditioned dogs to salivate when a bell was rung. Through enough trials to pair the bell with food, it was shown that an unconditioned response (salivation) can be made into a conditioned response by associating it with a conditioned stimuli (ringing of bell), as seen in Figure 2 in the Appendix (Kirk & Clark, 1996). The bell initially does not have any significance to the dogs, while the presence of dog food would have significance to the animal in which an overt behavioral response would be triggered (dog salivating). Prior to the pairing, the dog food was the \u201cunconditioned stimulus\u201d and the behavioral response of salivation as the \u201cunconditioned response\u201d (Kirk & Clark, 1996). If the bell (neutral stimuli) was paired with the salvation (unconditioned response), this would result in the bell becoming a conditioned stimulus. If the bell (conditioned stimulus) and dog food (unconditioned stimulus) were to be continually paired together, the dog would produce a behavioral response (salivating) in response to the ring of the bell through the association of the conditioned stimulus (bell) and unconditioned stimulus (dog food) (Kirk & Clark, 1996).
\nA second key learning principle is operant conditioning, as discovered through observations made by Thorndike, Tolman, and Guthrie (Kirk & Clark, 1996). In their observations, it was noted that the consistency of a particular behavior would be greater if there was a reward to follow along with the act. This observation is coined as the \u2018Law of Effect\u2019, which notes that the frequency of a behavior is dependent to the consequences, whether positive or negative (Kirk & Clark, 1996). If the behavior results in a positive consequence, the behavior is more likely to be repeated. If a negative consequence occurs instead, the behavior is less likely to be repeated. Operant conditioning involves changing of behaviors through the use of \u201creinforcement\u201d and \u201cpunishment\u201d. The use of \u201creinforcement\u201d and \u201cpunishment\u201d as a consequence can be either positive in which strengthens a behavior, or negative (weakens a behavior). Depending on which of the two is used, the consistency of a particular behavior is greater if there is \u201creinforcement\u201d, while vise-versa if there is punishment instead (Kirk & Clark, 1996). \u201cReinforcement\u201d can be positive or negative, as is \u201cpunishment\u201d (as in seen in Figure 3 in the Appendix). A behavior is more likely to occur if there is \u201cpositive reinforcement\u201d, in which a reward (e.g. getting praised) follows after the behavior. \u201cNegative reinforcement\u201d results in the increase of behavior through the \u201comission of an anticipated aversive event\u201d (Kirk & Clark, 1996). An example of \u201cnegative reinforcement\u201d would be a MSW student\u2019s anxiety level continually increasing until the student engages in the target behavior, such as finishing this assignment, thus lowering their anxiety level. \u201cPositive punishment\u201d involves the decreasing of a behavior through an aversive event, such as an electric shock. \u201cFrustrative non-reward\u201d results in a decreasing of behavior due to removal of an expected reward (e.g. reducing a child\u2019s television time following their bad behavior, causing a decrease in their bad behavior) (Kirk & Clark, 1996).
\nA third key learning principle for Behavioral Therapy is Bandura\u2019s work on observational learning, or modeling (Kirk & Clark, 1996). This type of learning involves an individual learning a particular behavior through observing another person (i.e. teacher) perform that behavior. This concept was further expanded though Bandura\u2019s model of self-regulation called \u201cself-efficacy\u201d (Kirk & Clark, 1996). The premise behind this model is \u201cthat all voluntary behavior change was mediated by subjects\u2019 perceptions of their ability to perform the behavior in question\u201d (Kirk & Clark, 1996, p.10). Another advancement included was the concept of self-control, which is \u201cbased on a three-stage model of self-observation, self-evaluation (setting standards), and self-reinforcement\u201d (Kirk & Clark, 1996, p.10).
\nCognitive Therapy (CT) was formulated through the efforts of Aaron Beck and Albert Ellis in the 1960\u2019s. The concepts of CT were based on the assumption that emotional and behavioral disturbances are not directly caused by a person\u2019s response to an experience but \u201cfrom the activation of maladaptive belief in response to an experience\u201d (Vonk & Early, 2009, p. 242). The focus of CT is on exploring and challenging an individual\u2019s negative assumptions and beliefs. Through exploring and contesting the negative idiosyncrasy of an individual\u2019s distorted cognitions, the cultivation of helpful and balanced thoughts would follow. The premise behind cognitive therapy is to empower an individual to come to the realization that they are capable of influencing their mood through identifying and changing their thought and beliefs.
\nWhen utilizing CBT in assessing and treating various emotional and behavioral disorders, Vonk and Early (2009) states that there are three elements of cognition to take into consideration: 1) actual content of thoughts; 2) core beliefs; and 3) maladaptive and ingrained styles of processing information, or cognitive distortions. The first element deals with automatic thought. Automatic thoughts in us a most visible when these thoughts \u201ccome into our minds immediately as life unfolds\u201d (Vonk & Early, 2009, p. 242). However, automatic thoughts that are invisible to us are thoughts that we refer to as rules or assumptions that influences how we act in response to our experience (Vonk & Early, 2009). An example given by Vonk and Early (2009) is the thought process of John. John may have an automatic thought in which he thinks to himself, \u201cI can\u2019t handle this situation\u201d after receiving feedback from his work. From his automatic thought, Vonk and Early (2009) points out that the rule John subconsciously made for himself may be \u201cI must be perfect at everything I do.\u201d
\nVonk and Early (2009) state that core beliefs are perceptions of one\u2019s self and the world that have been \u201cformed through early life experiences\u201d (p. 243). Beck notes that these core beliefs are maintained through \u201ca process of attending to information that is contrary to it\u201d (as cited in Vonk & Early, 2009, p. 243). An example of John\u2019s core beliefs is provided by Vonk and Early (2009). John experienced intense criticism from his father as a child and forms the core belief \u201cI am totally inadequate\u201d. As an adult, his core belief will cause him to be fixated at his flaws over his successes. At his work, John seems to discount his history of success in his career, and instead focuses on the few incidents he made a mistake.
\nThere are various types of cognitive distortions. Vonk and Early (2009) provide an example of distortion, along with a case example of John, in which his core belief is \u201che is inadequate.\u201d A type of distortion is catastrophizing, which is characterized by \u201cpessimistic beliefs about oneself, others, and the future, in which one assumes that the worst possible outcome will occur\u201d (Hassett et al, 2000, p. 2493). John in this case, may think to himself: \u201cIf my boss criticizes a piece of my work, I will lose my job, be unable to support my family, my wife will leave me, and I will end up homeless.\u201d
\nIn addressing the relevance of CBT for use in treating depression as a suicide prevention strategy, CBT is a structured psychotherapeutic intervention that is intended to empower individuals to lower symptoms of depression, and foster effective methods of dealing with hardships that contribute to their suffering (Blackburn & Davidson, 1990). Utilizing CBT techniques revolves around the following beliefs: 1) an individual\u2019s thought patterns and emotions are considered to be highly affected by their actions; and 2) an individual\u2019s emotions and behavior are influenced by their cognition (Neenan & Dryden, 2000; Wright, Basco, & Thase, 2006 – Write a paper; Professional research paper writing service – Best essay writers). Enabling individuals to begin the process of behavioral change is significant in utilizing CBT, as reflected through beliefs. In addition, CBT is an evidence based practice that has been shown to be effective in treating a wide range of medical and clinical disorders, including depression (Butler et al., 2006 – Write a paper; Professional research paper writing service – Best essay writers). Butler and colleagues (2006 – Write a paper; Professional research paper writing service – Best essay writers) methodologically rigorous meta analysis of 16 studies shows large controlled effect sizes found for CBT for unipolar depression, generalized anxiety disorders, panic disorders with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders.
\nNarrative Therapy via Constructionism
\nConstructionism\u2019s concepts originated from social psychology. Social psychology came about through studying various group interactions to observe how social identities are constructed and maintained (Payne, 2005). Although constructionism\u2019s concepts would not make a significant impact in social work until the 1990s, elements were already being incorporated through the utilization of role theory and communication studies out of psychology and sociology, respectively (Payne, 2005). Further incorporation of constructionism theories in social work began in the 1990s with the development of constructive practice theories. This development spurred from the creation of critical psychology, which was an integration of postmodernist and social construction ideas (Payne, 2005).
\nConstructive practice theories in social work are de Shazer\u2019s solution-focused therapy, White and Epston\u2019s narrative therapy, and O\u2019Hanlon\u2019s possibility thinking (Payne, 2005). These approaches focus on human interaction through use of language and understanding how individuals construct their social world (Payne, 2005). Through understanding the person\u2019s use of language and their social world construct, change can be initiated through reconstruction of the two. This review will focus on narrative therapy as the chosen approach to utilize in conjunction with CBT in this proposed intervention.
\nNarrative Therapy (NT) was initially developed in the 1980\u2019s by social workers\/family therapists Michael White and David Epston (Kelley, 2009). It was among one of the many ideas within the postmodern movement that \u201cchallenge the idea of absolute truth and grand theories that explain human behavior (aka modernism ideas)\u201d (Kelley, 2009, p. 273). Worldwide attention to NT was garnered in the 1990\u2019s corresponding to the development of constructive practice theories which became influential within clinical social work and family therapy (Kelley, 2009). White and Epston drew from ideas of constructivism and social constructionism in developing NT (Kelley, 2009). Constructivism places emphasis \u201con individuals\u2019 perceptions and cognitions as shaping their views of reality\u201d (Kelley, 2009, p. 273), as it is \u201caffirming, respects our capacity for development and helps people via promoting \u2018personal revolutions\u2019\u201d (Mahoney, 2003, p. 11). On the other hand, Social constructionism is \u201cfocused on the social and cultural narratives individuals internalize, taking them for granted as constituting \u2018reality\u2019\u201d (Kelley, 2009, p. 273). Clients are the focal point in NT, as it is believed \u201cthat people create stories of their lives to make sense of all their lived experience\u201d (Kelley, 2009, p. 273).
\nThe end goal of NT is to assist clients to look for other \u201ctruths\u201d within the \u201cstory lines around which they have organized their lives\u201d (Kelley, 2009, p. 273). This is done through assessing the plot, characters, and timeline in the presented storyline for meaning (Kelley, 2009). The means to assessing and finding new \u201ctruths\u201d in the client\u2019s story is through respectful listening, and avoidance of labels. Therapist plays the role of \u201cnon-expert, not knowing\u201d when listening to the client convey their story, as clients are the experts of their story (Kelley, 2009). The role of the therapist is not neutral, as they are partners with the client in breaking down the outcomes and consequences of the story (Kelley, 2009). In addition, therapist may \u201cchallenge the story through deconstruction and by assessing its origins\u201d (Kelley, 2009, p. 275). The use of labels in clients is avoided as clients themselves are not the problem, but rather are \u201cafflicted with a problem\u201d (Kelley, 2009, p. 275). An example conveyed here would be a person who has a mental disorder such as schizophrenia. The person here in NT would not be viewed as schizophrenic, but rather as \u201ca person suffering from a schizophrenic disorder\u201d (Kelley, 2009, p. 275). Labels maybe discarded entirely by some narrative therapists, as the classification of labels can serve to objectify and oppress people (Kelley, 2009).
\nIntervention hypothesis:
\nThe focus of this suicide prevention program is reducing depressive symptoms and stress amongst Hmong adolescences, ages 14 to 19. The program\u2019s intervention hypothesis states:
\nIf positive coping skills (e.g. being able to identify unrealistic thoughts) and peer support are provided to Hmong teen adolescences (ages 14 to 19) who have signs of depression, and if this is done in a culturally-competent manner attending to the role of acculturation strain, then we should see a reduction of depressive symptoms and stress, as well as in acculturation conflicts, in these participants.
\nDetails of intervention:
\nThe goals for this intervention are as follows:
\n1) For clients (Hmong adolescents) to develop positive ways of dealing with depression and stress as suicide preventive strategy.
\n2) For clients (Hmong adolescents) to develop positive ways of dealing with acculturation\/intergenerational conflict in reducing depressive symptoms.
\n3) For Hmong adolescents to become more aware of depressive symptoms and stress.
\n4) For the Hmong adolescents participating in the group to form a peer support within the group sessions and outside of session.
\nThe outcomes will be:
\n1) A reduction in depressive symptoms and stress as measured by The Beck Depression Inventory (BDI), The Beck Anxiety Inventory (BAI), The Beck Hopelessness Scale (BHS).
\n2) A reduction of acculturation\/intergenerational conflict as measured by Cultural Adjustment Difficulties Checklist (CADC).
\n3) An increase use of positive coping skills in dealing with depression and stress amongst Hmong adolescences as measured by the Self-Report Coping Scale.
\n4) An increase in knowledge of the signs of depression and stress
\nThese outcome objectives will be met through activities such as:
\n\u2022 A total of 13 group sessions will be provide for student in alleviating depressive symptoms and stress. The 13 group sessions will consist of 8 group CBT sessions for the purpose of providing psycho-education and assist in fostering positive coping strategies;
\n\u2022 5 group Narrative Therapy sessions to give students a chance to further develop their coping skills by developing implementation strategies through storyboarding.
\nThe key program tasks and activities within the group sessions will be replicating a preexisting short-term CBT group intervention model: Clarke\u2019s (2003) POD and TEAMS\u2019 The Adolescent Coping With Stress Course. This group intervention model contains eight 90 minute sessions (group capacity = 6 to 10 participants) that is geared towards preventing future occurrences of depression and stress in adolescents who maybe at risk. Along with utilizing this model, 5 additional sessions will be included to allow students as a group to practice their skills gathered from the adolescent stress course through two case scenarios (one assigned scenario and one scenario created by the student). These sessions incorporates elements of NT, as students get to construct a collective story of their struggles and issues within the case scenarios.
\nCBT is executively used in the first 8 session in order to adhere to Clarke\u2019s (2003) recommendation of \u201cdelivering contents for the program as laid out in the manual\u201d (p. x). Clarke (2003) stressed for therapist fidelity as Gillham et al. (2006 – Write a paper; Professional research paper writing service – Best essay writers) pointed out that \u201congoing therapist fidelity to a prevention program is associated with better outcomes\u201d (as cited in Clarke, 2003, p. ix). Despite Clarke\u2019s (2003) recommendation, he acknowledged that mental health and allied professionals have a long history of personalizing their therapy approach for a variety of reasons (i.e. better cultural fit). Additionally, the executive use of CBT is aimed towards fostering student awareness of depressive symptoms and stress and familiarizing them with positive coping skills of how to handle these symptoms on a general level. Once students become familiarized with the symptoms and techniques used to alleviate these symptoms, student will have a better understanding of dealing with their depression and stress, as they begin to explore their own situation with the incorporation of NT in later sessions.
\nClarke\u2019s (2003) The Adolescent Coping With Stress Course has a rigorous agenda set in place for group participants. All participants will receive a workbook which will be utilized throughout the sessions, as it contains worksheets for the activities of the sessions and homework for students to complete outside of the sessions. A brief description of the sessions are as follows (please refer to the Appendix for full specific details of each of the sessions): In session 1, activities will include the following: getting the students acquainted with each other and the program; giving an overview of stress and depression; goal setting; measuring student\u2019s mood via mood diary; and sharing activity in which 2 selected students for the week will bring in an object of significance to share with the group (sharing activity will occur on a weekly basis at the end of each session). Session 2 begins with setting guidelines for the group. After discussing the guidelines, the session will shift towards identifying negative thoughts. Session 3 will have students identify situations that make them sad and\/or stressed, and introduce them to techniques in increasing positive thinking.
\nSession 4 will allow students a chance to practice identifying unrealistic thoughts, along with providing strategies in modifying them into realistic thought. Session 5 is a continuation of session 4, as students\u2019 skills of identifying unrealistic thoughts is expanded by teaching them to identify underlying negative beliefs. Session 6 builds off of session 4 and 5 in having students continue with practicing how to identifying unrealistic thought A-B-C practice (A= identify \u201cActivating Event\u201d, B = Belief, C = Consequences). Session 7 moves students forward with teaching them how to interrupt unrealistic thoughts through the use of prompts and\/or reminders. Session 8 concludes with relapse prevention and teaching students in maintaining their gains.
\nAfter the conclusion of the eight sessions, the entirety of Clarks\u2019 existing curriculum, the NT group therapy component would begin. This component consists of five 90-minute group sessions in which students will have the chance, via storytelling, to practice the skills gained from the CBT portion within more specific life situations they face. The intervention utilized in these sessions draws upon Harper and Iwamasa\u2019s (2000) review of Costantino, Malgady, and Rogier\u2019s (1994) storytelling technique used with Puerto Rican adolescents. This storytelling technique involved utilizing pictures from the Tell-Me-A-Story (TEMAS) thematic apperception story to allow Latino youths within a group therapy setting to convey a collective story of the life situations that they face (Haper & Iwamasa, 2000). As the group formulated their story, the therapist would facilitate the group in analyzing their narrative and develop a strategy (i.e. finding health behavior and coping responses) in forming a resolution to the story. Upon figuring out the resolution to the story, the therapist would provide feedback for the group. Afterwards, the group would be filmed acting out the entire story. Once filming was complete, the group and therapist would gather together to watch the recorded story. The therapist would then provide feedback on the film (Haper & Iwamasa, 2000).
\nThe purpose behind the inclusion of the second phase of sessions is afford students a chance to work together as a group in conveying their stories and struggles with depression and stress through storyboarding. Within the storyboarding process, the group will develop strategic responses based on what was learned through the CBT sessions. For Session 9, students will be randomly divided into two groups to work on an assigned case scenario. The case scenario material will consist of a picture displaying a possible life situation that the students may face (see Figure 4 on Appendix for example of pictures that will be used). In Figure 4, there are two pictures that will be used. The \u201csad girl at school\u201d picture would be used to elicit any potential school problems that the student may be dealing with, while the \u201cparents and child arguing\u201d would elicit any potential relationship conflicts (e.g. acculturation issues) with their parents.
\nUpon receiving their case scenarios, the two groups would formulate a collective short-story based on the characters in the picture and the situation that the characters are in. Both groups are given freedom to interpret the picture as they see fit. Students would work on scripting a short-story for the characters based on their interpretations of the scenario picture. Students are viewed as the \u201cexperts\u201d in conveying their group story. The therapist would elicit the group\u2019s perspective about conflicts, behaviors, and coping responses from the story that they have scripted. The therapist during this time also would provide positive verbal reinforcement when group members describe the adaptive and healthy behaviors and attitudes used to solved the dilemma scripted in their story. While the therapist is eliciting the first group\u2019s perspectives and providing them with positive verbal reinforcement, the other group would sit in and listen to the feedback. The other group would then be asked by the therapist to provide feedback to the receiving group. Once the therapist is finished with the first group, the process is repeated with the second group.
\nThe storytelling process would then be carried over to session 10. In this session, both groups would then act out their story while being filmed. Each group would work separately in developing a 10 to 15 min short film based off the story that was scripted from the previous session. During the filming process, the therapist would be able to provide \u201cverbal reinforcement for appropriate responses (e.g appropriate confrontation of feelings, proper behavior, adaptive coping techniques)\u201d (Harper & Iwamasa, p. 41). The viewing of the group films would take place during the final session (session 13).
\nFor session 11 and 12, the students and therapist would repeat the same process from session 9 and 10. However, students would be reassigned into two new groups. This will allow for all participants to collaborate with different members not in their previous assigned group. There is no pre-assigned case scenario for this portion, as students will be instructed to construct a collective story based the life situations that they have come across which caused them to be depressed and\/or stressed. Clinicians will keep the group focused on acculturation-based strain with their families when the group is constructing their story. As with the session 9 and 10, students are afforded freedom in creating their collective stories. The therapist would again provide feedback and positive enforcement. Session 13 would be the final session, as the therapist and group would view the recordings together, which allows for the therapist to reinforce the skills learned for a final time (Harper & Iwamasa, 2000).
\nPresentation of way proposed intervention incorporates CRT:
\nThis proposed intervention seeks to address depression among Hmong adolescents, with attention to cultural factors (intergenerational conflict with parents due to acculturation), and lack of peer support. The addition of the second phase of treatment to Clarke\u2019s (2003) existing stress and depression course serves as a bridging tool to addressing issues specific to Hmong adolescents, while still adhering to Clarke\u2019s (2003) recommendation of fidelity to the curriculum. The 5 narrative therapy sessions of phase two were created under the consideration that social and environmental factors have an influence in how adolescents may perceive CBT interventions based their interactions with their surrounding social environment (Harer & Iwamasa, 2000). Graber & Brooks-Gunn (1995) noted that \u201cthe changes which occur in the biological, psychological, and social spheres of the adolescent’s life often form complex matrices of interconnections that both influence, and are influenced by, behavior\u201d (as cited in Harper & Iwamasa, p. 38). Bronfenbrenner\u2019s (1994) Ecological Models of Human Development points out that adolescents interact with a multitude of social system in their environment, \u201cranging from microsystems (immediate environment) such as school and family, and macorsystems (institutional patterns of culture) such as the economy, customs and bodies of knowledge\u201d (p. 37). The social context of these interactions may have \u201cgreater meaning and influence on minority adolescent\u2019s psychological development\u201d (Haper & Iwamasa, p. 38). Utilizing the Critical Race Theory (CRT) lens, issues of racism and discrimination play a significant role in shaping minority youth\u2019s understanding of the social context that is presented to them, as it is an experience that is incorporated into their daily lives and made \u201cordinary\u201d for them (Delgado, 2001).
\nElements of CRT were incorporated into the NT sessions with the focus of providing Hmong adolescents an opportunity to not only empower them to use their CBT coping skills, but to provide students with an opportunity to build a support group amongst each other through group work. Tenets of CRT are incorporated in the design of this session. The \u201cvoice-of-color\u201d thesis is incorporated, as it holds that people who have experienced oppression can speak about their experiences in ways that is unknown to those who have not experienced it (Delgado, 2001). This CRT tenet is integrated using Narrative Therapy, to allow the Hmong participants to draw commonalities of the social and cultural narratives that each have internalized as part of their reality. Students are able to share their stories through the case scenario to formulate a collective that best represents the group\u2019s experiences. It also provides students a chance to discuss issues of intersectionality with each other through the case scenarios. In discussing the case scenarios, group members may have a different interpretation of the scenario presented based on their multiple and intersecting identities. Members may relate their own experiences into the characters and the setting in the scenario. Through the possibility of students providing different outlooks on a case scenario, new perspectives of similar situations that the student may have faced (i.e. family conflicts) can be shared and new insight can be fostered.
\nEvaluation Process:
\nTo ensure that this intervention curriculum will yield the most favorable outcome, a program evaluation will be conducted. The rationale using a program evaluation is as follows: \u201c1) to assess the ultimate success of programs, 2) to assess problems in how programs are being implemented, or 3) to obtain information needed in program planning and development\u201d (Rubin & Babbie, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers, p. 306). Program evaluation protocols will be set into motion to assess the intervention\u2019s \u201cconcept, design, planning, administration, implementation, effectiveness, efficiency, and utility\u201d (Rubin & Babbie, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers, p. 306). A goal attainment model would used in the program evaluation for monitoring the outcome and efficiency of this intervention. An internally valid quasi-experimental design would be utilized as part of this model to rule out possible bias in the measuring process. As stated by Rubin and Babbie (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers), this model takes into consideration the program\u2019s goals, as they would be specified as the dependent variables. These variables would then be \u201cdefined in terms of measurable indicators of program success\u201d (p. 316).
\nA logic model, as seen in the following logic model section, is used as a graphical representation in depicting \u201cthe essential components of program\u201d (Rubin & Babbie, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers, p. 327). Rubin and Babbie (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers) states that a logic models illustrates how \u201cthese components are linked to short-term process objectives, specifies measurable indicators of success in achieving short-term objectives, conveys how the how those short-term objectives lead to long-term program outcomes, and identifies measurable indicators of success in achieving long-term outcomes\u201d (p. 327). As seen in the intervention\u2019s logic model, three types of outcomes (short-term, medium-term, and long-term) that are expected to be in terms of the goals that are set in executing this curriculum. By analyzing all three outcome types, the purpose of executing this intervention curriculum is for empowering Hmong adolescents to develop a healthy coping system in dealing with their depression. In developing a healthy coping system, Hmong adolescents would be able to reduce intergenerational conflict between them and their parents.
\nThe treating clinicians involved would act as monitors throughout the entire process of the intervention, which consist of the initial screening process, execution of the group sessions, and the post-screening process. This is done to ensure that the curriculum meets its projected goals. Collecting and compiling data and information is a crucial part of the evaluation process (Netting, Kettner, and McMurtry, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). According to Netting, Kettner, and McMurtry (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers), this involves tracking the performance of each participant in such a way to allow \u201cfor establishment of a baseline at the outset of the intervention and periodic measurement of progress\u201d (p. 388). As Netting, Kettner, and McMurtry (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers) elaborate, this involves using pretest and posttest to \u201cmeasure learning or a tracking of a single indicator such as a client being hired into a new job\u201d (p. 388).
\nDescription of Measures:
\nAs a part of screening process, students will take 3 self-assessment tests for students which will also serve as some pre-test measures:
\n\u2022 The Beck Depression Inventory (BDI) (Beck, Rush, Shaw, & Emery, 1979): a 21 item self-report inventory that has been extensively proven to be a reliable and valid measure of depression within both clinical and non-clinical populations (Beck, Steer, & Garbin, 1988).<\/p>\n
\u2022 The Beck Anxiety Inventory (BAI) (Beck, Epstein, Brown & Steer, 1988): a self-report tool consisting of 21 items which measures anxiety severity for the past week, including the day of completion. It is a reliable and valid measure that can be used in combination with the BDI, particularly for individuals with comorbid depression and anxiety (Beck & Steer, 1993)<\/p>\n
\u2022 The Beck Hopelessness Scale (BHS) (Beck, Weissman, Lester, & Trexler, 1974): a 20-item self report questionnaire consisting of true\/false questions regarding pessimism and hopelessness. The scores can vary from 0 to 20. Internal consistency of items is satisfactory (Cronbach\u2019s alpha = .88) (Steed, 2001)<\/p>\n
\u2022 Self-Report Coping Scale (Causey & Dubow, 1992): a 35 item decribing specific coping strategies. This scale ask the adolescent to indicate how they use each of these strategies within a given scenario (e.g. performing low in school) using a 5-point scale that ranges from never to always. This scale is based on the approach\/avoidance conceptualization of coping. Five scales have been derived based on factor analyses and include two approach scales (seeking social support, problem-solving) and three avoidance scales (distancing, internalizing, and externalizing). The internalizing scale assessed internalizing symptoms\/responses (depression and anxiety) and included items such as \u201cgo off by myself\u201d, \u201cworry about it\u201d, \u201ccry about it\u201d, \u201cfeel sorry for myself\u201d, and \u201cget mad at myself for doing something that I shouldn\u2019t have done”.<\/p>\n
These four measures will also be used post-test to measure whether the outcome objectives (reduction in depressive symptoms and stress; increase use of positive coping skills in dealing with depression and stress; and increase in knowledge of depression and stress) were met, at completion of the program and at a 6 month follow up.<\/p>\n
Another screening measure which also serves as pre-test measure is for dissonance of acculturation. This will also serve as a post-test measure for whether the outcome objectives (reduction of acculturation\/intergenerational conflict) were met, at completion of the program and at a six month follow up. Dissonance of acculturation will be measured with the following scale:
\n\u2022 Cultural Adjustment Difficulties Checklist (CADC) (Sodowski & Lai, 1997): a 59-item measure that was designed to analyze the acculturation-induced stresses of Asians in the U.S. The assessment has two subscales: Acculturative Distress (contains 35 items) and Intercultural Competence Concerns (contains 24 items). The assessment measures interpersonal problems due to contextual dissonance, alienation towards one\u2019s cultural reference group, and issues of self-efficacy in a white-dominant cultural context.<\/p>\n
Sodowsky and Lai (1997) specified \u201cacculturative distress\u201d as an indicator of the quality of adjustment in the country of resettlement, as it analyzes general and cultural stress. The purpose exploring these two aspects of stress is to assess whether the student feels caught between two cultures (Stoll & Johnson, 2007). General stress would be assessed through the \u201cstudent\u2019s academic concerns (e.g. feeling overworked, and performance anxiety), affect (i.e. sadness, guilt, anxiety, and anger), behavioral (i.e. drinking, procrastination, suicidal ideation and attempts, and violence), and psychosomatic symptoms (i.e. backaches, headaches, and stomachaches)\u201d (Stoll & Johnson, 2007, p. 628). Cultural stress measures \u201ccultural conflicts with the majority culture and one\u2019s own ethnic community or family, gender role confusion and feelings of discontent and anger toward either the majority culture or one\u2019s own culture or origin\u201d (Stoll & Johnson, 2007, p. 628).
\nIntercultural Competence Concerns in subscale 2 measures \u201cone\u2019s concern about social competence, academic and career competence, and cultural competence [i.e. the] pride in one\u2019s culture, perception of acceptance by White American or people from one\u2019s own cultural group, perception of the worthiness of one\u2019s contribution to both cultures and perception of one\u2019s adjustment to both cultures\u201d (Stoll & Johnson, 2007, p. 629). Sample items in this subscale include: \u201c\u2018Having pride in your own culture\u2019, \u2018Feeling accepted by White Americans\u2019 and \u2018Having friends among White Americans\u2019\u201d (Stoll & Johnson, 2007, p. 629).
\nEvaluation Protocol:
\nOnce the screening process is completed, participants will then be randomized to either the waitlist control group or intervention control group. A baseline will be created for each of the two groups. Assessment will also be conducted at two additional time points: 1) Posttest 1, after the intervention group has completed the intervention; and 2) Posttest 2, after the waitlist control group has completed the intervention.
\nDuring the posttest, the students would be reassessed by using the same measure as described above to see if there is a reduction in conflict with their parents and dissonance of acculturation, and if there is a increase in usage of positive coping skills. In addition, students will also fill out a client satisfaction questionnaire in which students will rate the effectiveness of the group in assisting them in fostering healthy coping strategies (please refer to the Appendix for satisfaction questionnaire). Furthermore, there will be a 6 month follow-up after the posttest process for each of the test groups, as the therapist and group coordinator would contact the participants to get an update of the student\u2019s progress and status in maintaining the progress that was made in the stress workshop.<\/p>\n
Presentation of a logic model:
\nIntervention Curriculum: Suicide Prevention for Hmong Adolescences with Depressive Symptoms Logic Mode<\/p>\n
Problem Statement: Reduction depressive symptoms amongst Hmong adolescences<\/p>\n
Goal: Providing Hmong adolescences with positive ways of managing their depression and reducing of acculturation\/intergenerational conflict<\/p>\n
Inputs
\nOutputs
\nOutcomes — Impact
\nActivities Participation Short Medium Long<\/p>\n
One MSW Staff Members<\/p>\n
Trained in CBT and Narrative Therapy<\/p>\n
Depression<\/p>\n
Intergenerational conflict with parents
\nCognitive Behavioral Therapy<\/p>\n
Narrative Therapy<\/p>\n
Group Therapy<\/p>\n
Address depression and stress caused by intergenerational conflict and school issues<\/p>\n
Identify positive two coping skills
\n13 sessions of group therapy<\/p>\n
2 hour per week<\/p>\n
10 high school participants (Hmong adolescents)<\/p>\n
Age range (14-19) years of age<\/p>\n
Reduction in depressive symptoms<\/p>\n
Learn coping skills<\/p>\n
Utilize positive coping skills<\/p>\n
Client demonstrates positive behaviors related to
\ntreatment process<\/p>\n
Reduced signs of depression<\/p>\n
Have positive ways of dealing with their depression<\/p>\n
A reduction of acculturation\/intergenerational conflict.<\/p>\n
Form a network of support amongst each other<\/p>\n
Assumptions External Factors
\nHmong adolescences will be able to learn new techniques
\nHmong adolescences will engage in treatment process
\nSocial\/ cultural context
\nGeographic constraints<\/p>\n
References
\nAmerican Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edition, text revisions). Washington, DC: Author.
\nAsarnow, J.R., Scott, C.V., & Mintz, J. (2002). A combined cognitive-behavioral family
\neducation intervention for depression in children: a treatment development study.
\nCognitive Therapy and Research, 26(2), 221-229.
\nAseltine, R.H., & DeMartino, R. (2004). An outcome valuation of the sos suicide prevention
\nprogram. American Journal of Public Health. 94(3), 446-451.
\nBartels, S. J., Coakley, E., Oxman, T. E., Constantino, G., Oslin, D., Chen, H., et al. (2002).
\nSuicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. American Journal of Geriatric Psychiatry, 10, 417-427.
\nBaruth, L.G. & Manning, M.L. (2003). Multicultural counseling and psychotherapy. (3rd ed.).
\nUpper Saddle River, NJ: Merrill Prentice Hall
\nBeck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring
\nclinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology,
\n56(6), 893-897
\nBeck, A. T., Rush, J., Shaw, B., & Emery, G. (1979): Cognitive theory of depression. New
\nYork: Guilford.
\nBeck, J. S., & Steer, R. A. (1993). Beck Anxiety Inventory manual. San Antonio, TX:
\nPsychological Corporation.
\nBeck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck
\nDepression Inventory. Twenty-five years of evaluation. Clinical Psychology Review, 8,
\n77-100.
\nBeck, A. T., Weissman, A., Kester D., & Trexler, L. (1974). The measurement of pessimism.
\nThe Hopelessness Scale. Journal of Consulting and Clinical Psychology, 57, 861-865,
\nBlackburn, I.-M., & Davidson, K. (1990). Cognitive Therapy for Depression and Anxiety: A
\nPractitioner’s Guide. Oxford: Blackwell Scientific Publications.
\nBoulden, W.T. (2009). Gay hmong: a multifaceted clash of cultures. Journal of Gay & Lesbian
\nSocial Services, 21(2), 134-150.
\nBronfenbrenner, U. (1994). Ecological models of human development. In International
\nEncyclopedia of Education, Vol. 3, 2nd Ed. Oxford: Elsevier.
\nButler, L. E., Harwood, T. M. (2000). Prescriptive Psychotherapy: A Practical Guide to
\nSystematic Treatment Selection. New York: Oxford University Press.
\nCastillo, L. G., & Phoummarath, M. J. (2006 – Write a paper; Professional research paper writing service – Best essay writers). Culturally-competent school counseling with
\nAsian American adolescents. Journal of School Counseling, 4(20). Retrieved from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/jsc.montana.edu\/articles\/v4n20.pdf
\nCausey, D., & Dubow, E. (1992). Development of a self-report coping measure for elementary
\nschool children. Journal of Clinical Child Psychopathology Review, 21(1), 47\u201359.
\nCenters for Disease Control and Prevention. An estimated 1 in 10 U.S. adults report depression.
\n(n.d.). Brief Article retrieved May 3, 2011 from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/cdc.gov\/Features\/dsDepression\/
\nCenters for Disease Control and Prevention, National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) {cited 2011 Mar 8}. Available from: www.cdc.gov\/ncipc\/wisqars
\nCenter for Disease Control and Prevention. (2009). Suicide Facts at a Glance. Retrieved from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/cdc.gov\/violenceprevention\/pdf\/Suicide-DataSheet-a.pdf
\nChang, E. C. (1998). Cultural differences, perfectionism, and suicidal risk in a college
\npopulation: Does social problem solving still matter Cognitive Therapy and Research, 22, 237-254.
\nCheng, J. K. Y., Fancher, T. L., Ratanasen, M., Conner, K. R., Duberstein, P. R., Sue, S., &
\nTakeuchi, D. (2010 – Essay Writing Service: Write My Essay by Top-Notch Writer). Lifetime suicidal ideation and suicide attempts in asian americans.
\nAsian American Journal of Psychology, 1, 18-30.
\nChin, J. (n.d.). Asian students, depression, and suicide: begin with the parents! Retrieved from http:\/\/chinspirations.com\/mhsourcepage\/asian-students-depression-and-suicide-begin-with-the-parents
\nClarke, G. (2003) The adolescent coping with stress course: adolescent workbook. Portland, OR: Kaiser Permenaente Center for Health Research.
\nCostantino, G., Malgady, R. G., & Rogler, L. H. (1994). Storytelling through pictures: Culturally
\nsensitive psychotherapy for Hispanic children and adolescents. Journal of Clinical Child
\nPsychology, 23, 13-20.
\nDelgado, R. and Stefancic, J. (2001). Critical Race Theory: An introduction. New York, NY: New York University Press.
\nFresno Bee. \u201cLost in America\u201d. August 11-27, 2002. Fresno Bee.
\nGensheimer, L. (2006 – Write a paper; Professional research paper writing service – Best essay writers). Learning from the experiences of hmong mental health providers.
\nHmong Studies Jounal, 7, 1-31.
\nGillham, J. E., Hamilton, J., Freres, D. R., Patton, K., & Gallop, R. (2006 – Write a paper; Professional research paper writing service – Best essay writers). Preventing depression among early adolescents in the primary care setting: a randomized controlled study of the Penn Resiliency Program. J Abnorm.Child Psychol, 34, 203-219
\nGraber, J. A., & Brooks-Gunn, J. (1995). Biological and maturational factors in development. In
\nV. B. Van Hasselt & M. Hersen (Eds.), Handbook of adolescent psychopathology: A
\nguide to diagnosis and treatment (pp. 69-101). New York: Lexington Books.
\nGreenberg, P. E., Kessler, R. C., Birnbaum, H. G., Leong, S. A., Lowe, S. W., Berglund, P. A., &
\nCorey-Lisle, P. K. (2003). The economic burden of depression in the United States: How did
\nit change between 1990 and 2000. Journal of Clinical Psychiatry, 64, 1465-1475.
\nHarper, G.W. & Iwamasa, G.Y. (2000). Cognitive-behavioral therapy with ethnic minority adolescents: therapist perspectives. Cognitive and Behavioral Practice, 7, 37-53.
\nHasseit, A.L., Cone, J.D., Patella, S.J., & Sigal, L.H. (2000). The role of catastrophizing in the pain and depression of women with fibromyagia syndrome. Arthritis & Rheumatism, 43(11), 2493-2500.
\nHawton, K., & van Heeringen, K. (2009). Suicide. Lancet, 373, 1372-1381.
\nHewitt, P.L., Flett, G.L. & Weber, c. (1994). Dimensions of perfectionism and suicide ideation.
\nCognitive Therapy and Research, 18, 439-460.
\nHinton, D.E., Pham, T., Tran, M., Safren, S.A., Otto, M.W., & Pollack, M.H. (2004). CBT for vietnamese refugees with treatment-resistant ptsd and panic attacks: a pilot study. Journal of Traumatic Stress, 17(5), 429-433.
\nJuang, L.P., Syed, M., Takagi, M. (2007). Intergenerational discrepancies of parental control
\namong chinese american families: links to faily conflict and adolescent depressive
\nsymptoms. Journal of Adolescence, 30(2007), 965-975.
\nKang, K.C. “Yuji Ichioka, 66; Led Way in Studying Lives of Asian Americans,” Los Angeles
\nTimes, September 7, 2002. Reproduced at ucla.edu by the Asian American Studies Center
\nKao, G. (1999). Psychological well-being and educational achievement among immigrant youth.
\nIn D. J. Hernandez (Ed.), Children of immigrants: Health, adjustment, and public
\nassistance (pp. 410\u2013477). Washington, DC: National Academy Press.
\nKelley, P. (2009). Narrative therapy. In A. R. Roberts (Eds.), Social workers’ desk reference (pp.
\n273-276). New York: Oxford University Press.
\nKessler, R. C., Merikangas, K. R., & Wang, P. S. (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). The prevalence and correlates of
\nworkplace depression in the national comorbidity survey replication. Journal of
\nOccupational and Environmental Medicine, 50, 381-390.
\nKirk & D. M. Clark Chapter 1: The development and principles of cognitive-behavioral
\ntreatments. In K. Hawton, P. M. Salkovskis, J. Kirk & D. M. Clark (Eds.). (1996).
\nCognitive Behavior Therapy for Psychiatric Problems: A Practical Guide. NY, NY: Oxford University Press.
\nLam, A. (2009, August 21). Asian americans\u2019 rising suicide rates. New America Media.
\nRetrieved from
\nhttp:\/\/news.newamericamedia.org\/news\/view_article.htmlarticle_id=c2b8f3a43bbe3e04
\n45f23274028d24a7
\nLee, R.M., Jung, K.R., Su, J.C., Tran, A.G.T.T., & Bahrassa, N.F. (2009). The family life and
\nadjustment of hmong American sons and daughters. Sex Roles, 60(2009), 549-558.
\nLee, S.M. Asian americans diverse and growing. Population Bulletin, 53(2), 1-44.
\nLeong, F.T.L., Leach, M.M., Yeh, C., Chou, E. (2007). Suicide among asian americans: what do
\nwe know What do we need to know Death Studies, 31, 417-434.
\nLor, Y. (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). Hmong political involvement in st. paul, minnesota and fresno, california.
\nHmong Studies Journal, 10, 1-53.
\nMahoney, M. (2003). Constructive psychotherapy: theory and practice. NY, NY: Guilford Press.
\nMarshall, G.N, Schell, T.L., Elliott, M.N., Berthold, S.M., Chun, C. (2010 – Essay Writing Service: Write My Essay by Top-Notch Writer). Mental Health of
\nCambodian refugees 2 decades after resettlement in the united states. Journal of
\nAmerican Medical Association, 294(5), 571-579.
\nNational Center for Biotechnology Information. Major depression. (2014: 2024 – Essay Writing Service. Custom Essay Services Cheap, February 14). Brief
\nArticle retrieved May 3, 2011 from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/ncbi.nlm.nih.gov\/pubmedhealth\/PMH0001941\/
\nNational Institute of Mental Health. Major depressive disorder among adults. (n.d.). Brief Article
\nretrieved May 3, 2011 from https:\/\/essays.homeworkacetutors.com\/write-my-essay\/nimh.nih.gov\/statistics\/1MDD_ADULT.shtml
\nNational Institute of Mental Health. Questions and answers about the NIMH sequenced
\ntreatment alternatives to relieve depression (STAR*D) study\u2014background. (2006 – Write a paper; Professional research paper writing service – Best essay writers,
\nFebruary). Brief Article retrieved May 3, 2011 from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/nimh.nih.gov\/trials\/practical\/stard\/backgroundstudy.shtml
\nNational Institute of Mental Health. What illnesses often co-exist with depression. (n.d.). Brief
\nArticle retrieved May 3, 2011 from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/nimh.nih.gov\/health\/publications\/depression\/what-illnesses-often-co-exist-with-depression.shtml
\nNeenan, M., & Dryden, W. (2000). Essential Cognitive Therapy. London: Whurr Publishers Ltd.
\nNetting, F.E., Kettner, P.M., & McMurty, S.L. (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). Social Work Macro Practice. Boston, MA: Pearson Education, Inc.
\nOquendo, M.A., Friend, J.M., Halberstam, B., Brodsky, B.S., Burke, Grunebaum, M.F., Malone,
\nK.M., & Mann, J.J. (2003). Association of comorbid posttraumatic stress disorder and
\nmajor depression with greater risk for suicidal behavior. American Journal of Psychiatry,
\n160, 580-582.
\nPayne, M. (2005). Modern Social Work Theory, 3rd Edition. Chicago, IL: Lyceum Books, Inc.
\nPortes, A., & Rumbaut, R. G. (2001). Legacies: The story of the immigrant second generation.
\nNew York: Russell Sage Foundation.
\nPuride-Vaughns, V., & Eibach, R.P. (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). Intersectional invisibility: the distinctive advantages
\nand disadvantages of multiple subordinate-group identities. Sex Roles, 59, 377-391.
\nRubin, A. & Babbie, E. R. (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). Chapter 13: Program Evaluation. Research Methods for Social Work, 6th Edition. (pp. 305- 334). Belmont, CA: Thomson Higher Education.
\nSodowsky, G.R., & Lai, E.W.M (1997). The cultural adjustment difficulties checklist. Antioch
\nNew England Graduate School, 40 Avon Street, Keene, NH. 03431-3516.
\nSpringer, D.W., & Tripodi, S.J. (2009). Assessment protocols and rapid assessment instruments
\nwith troubled adolescents. In A. R. Roberts (Eds.), Social workers’ desk reference, 2nd ed.
\n(pp. 242-247). New York: Oxford University Press
\nSteed, L. (2001). Further validity and reliability evidence for Beck Hopelessness scores in a
\nnon-clinical sample. Educational and Psychological Measurement, 61, 303-316.
\nStoll, K., & Johnson, P. (2007). Determinants of the psychosocial adjustment of southern
\nsudanese men. Joutnal of Refuee Studies, 20(4), 621-640.
\nSzapocznik, J., Rio, A., Perez-Vidal, A., Kurtines, W., Hervis, O., & Santisteban, D. (1986).
\nBicultural effectiveness training (BET): an experimental test of an intervention modality
\nfor families experiencing intergenerational\/intercultural conflict. Hispanic journal of
\nBehavioral Sciences, 8(4), 303-330.
\nSzapocznik, J., Santisteban, D., Kurtines, W., Perez-Vidal, A., & Hervis, O. (1984). Bicultual
\neffectiveness training: a treatment intervention for enhancing intercultural adjustment in
\ncuban american families. Hispanic Journal of behavioral Sciences, 6(4), 317-344.
\nThe split horn. (n.d.). Retrieved from https:\/\/essays.homeworkacetutors.com\/write-my-essay\/pbs.org\/splithorn\/story1.html
\nThe Substance Abuse and Mental Health Services Administration. Major depressive episode
\namong youths aged 12 to 17 in the United States: 2004 to 2006 – Write a paper; Professional research paper writing service – Best essay writers. (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers, May, 13). Brief
\nArticle retrieved May 3, 2011 from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/oas.samhsa.gov\/2k8\/youthDepress\/youthDepress.htm
\nUnited Nations Statistics Division. Composition of macro geographical (continental) regions,
\ngeographical sub-regions, and selected economic and other groupings. (2011, April 26).
\nBrief Article retrieved May 3, 2011 from
\nhttp:\/\/unstats.un.org\/unsd\/methods\/m49\/m49regin.htm
\nU. S. Department of Health and Human Services (2007). Health, United States, 2007. Retrieved
\nJanuary 29, 2009 from https:\/\/essays.homeworkacetutors.com\/write-my-essay\/cdc.gov\/nchs\/data\/hus\/hus07.pdf.
\nU.S. Department of Veteran Affairs. Epidemiology of ptsd. (2010 – Essay Writing Service: Write My Essay by Top-Notch Writer, June 15). Brief Article
\nretrieved December 12, 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/ptsd.va.gov\/professional\/pages\/epidemiological-facts-ptsd.asp.
\nVonk, M. E., & Early, T. J. (2009). Cognitive-behavioral therapy. In A. R. Roberts (Eds.), Social
\nworkers’ desk reference, 2nd ed. (pp. 242-247). New York: Oxford University Press
\nWong, Y. J., Brownson, C., & Schwing, A. E. (in press). Predictors of Asian American students\u2019
\nsuicidal ideation: A multi-campus, national study. Journal of College Student
\nDevelopment
\nWorld Health Organization. Depression. (n.d.). Brief Article retrieved May 3, 2011 from
\nhttps:\/\/essays.homeworkacetutors.com\/write-my-essay\/who.int\/mental_health\/management\/depression\/definition\/en\/
\nWright, J., Basco, M., & Thase, M. (2006 – Write a paper; Professional research paper writing service – Best essay writers). Learning Cognitive-Behavioural Therapy.
\nWashington: American Psychiatric Publishing Inc.
\nYang, B., & Lester, D. (2007). Recalculating the economic cost of suicide. Death Studies, 31,
\n351-361.
\nYing, Y. & Han, M. (2007). The longitudinal effect of intergenerational gap in acculturation on
\nconflict and mental health in southeast asian american adolescents. American Journal of Orthopsychiatry, 77(1), 61-66.<\/p>\n
Appendix<\/p>\n
Figure 1
\nSource: The Substance Abuse and Mental Health Services Administration (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers) Major depressive episode among youths aged 12 to 17 in the United States: 2004 to 2006 – Write a paper; Professional research paper writing service – Best essay writers
\nFigure 2
\nSource: (Kirk & D. M. Clark, 1996) Cognitive Behavior Therapy for Psychiatric Problems: A Practical Guide
\nFigure 3
\nSource: (Kirk & D. M. Clark, 1996) Cognitive Behavior Therapy for Psychiatric Problems: A Practical Guide
\nFigure 4
\nPictures that will be used for the case scenarios
\nSad girl at school<\/p>\n
Parents and child arguing
\nStudent Satisfaction Survey
\nThe purpose of this survey is to gather your impressions of how the group has assisted you in finding better ways of dealing with stress and depression. Please answer each item as best as you can. There is no right or wrong answer. All answers will be kept confidential. We are hoping that the information we get from this survey will help us understand how effective of the group is and how it can be improved. Thank you for completing this survey.<\/p>\n
Please mark each box (0) with a \uf0fb or \uf0fc
\n1. What school do you attend________________________________<\/p>\n
2. Grade:________<\/p>\n
3. Age:__________<\/p>\n
4. Gender
\n0 Female
\n0 Male
\n0 Transgender<\/p>\n
5. How did you learn about the group
\n0 Teacher
\n0 Counselor
\n0 Classmate
\n0 Other (please specify):__________________________________<\/p>\n
6. Do you believe that your participation in the group has helped you to develop better strategies in dealing with stress and depression
\n0 Yes
\n0 No
\n0 Somewhat
\n0 Don\u2019t know \/ not sure<\/p>\n
7. Has your group counselor been helpful in making sure you understand the material that is being taught
\n0 Yes
\n0 No
\n0 Somewhat
\n0 Don\u2019t know \/ not sure<\/p>\n
8. Would you recommend this group to your schoolmates
\n0 Yes
\n0 No<\/p>\n
9. Rate your favorite session from 1-10 (1 is your favorite, 10 is your least favorite):
\n___ Getting to Know Each Other
\n___Coping With Stress
\n___Stressful Situations and Thinking
\n___ Examining Negative Thinking
\n___ Is it Really About Me
\n___ Coping With Activating Events
\n___ Techniques for Stopping Unrealistic Thoughts
\n___ Stressful Events, Preventing the Blues
\n___ Storyboarding Activities
\n___ Filming a Story
\n___ Night at the Movies
\n10. What is positive self talk
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n11. What is positive thinking
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n12. How are unrealistic thoughts triggered
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n13. What is the A-B-C model
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n14. What are some of the steps you can take in \u201cjumping your hurdles\u201d
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n15. What are some ways you can \u201cget plugged in\u201d
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n16. Why is it important for you to \u201csee over the wall\u201d
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n17. If you could change any part of the program, what would it be
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\n______________________________________________________________________
\nThank you for your time and effort!!!!<\/p>\n
CBT Curriculum
\nSource: Clarke, G. (2003) The adolescent coping with stress course: adolescent workbook.<\/p>\n
Session 1 Agenda & Summary
\nI. GET-ACQUAINTED ACTIVITY
\nIn this section we\u2019ll introduce each other, and get to know the people you\u2019ll be meeting
\nwith other the next few months.<\/p>\n
II. WHAT IS STRESS
\nWe\u2019ll review stressful situations, how they make you feel, and what stress can lead to if it
\nisn\u2019t dealt with.
\nIII. WHAT IS DEPRESSION
\nOne of the most common effects of long-term stress can be depression. We\u2019ll review
\nhow everyday depression is different from serious depression, and possible causes for
\ndepression. We\u2019ll also introduce the Depression Spiral and a triangle figure showing how
\nyour mood and feelings are related to what you think and what you do.
\nIV. PERSONAL GOALS
\nWhat are you personal goals for this group
\nV. MOOD DIARY
\nYou\u2019ll learn how to keep track of your mood every day, in order to better understand
\nwhat helps you feel better, and what leads to stress and\/or sadness.
\nVI. PRACTICE ASSIGNMENT
\nEach session will involve some practice of the new skills at home, between group
\nmeetings.
\nV. SHARING ACTIVITY
\nYour therapist will share something about him or herself (a skill, hobby, talent, or
\ninterest). Each session, a different group member will do the same thing. This will help
\neveryone get to know one another better, as well as learn what is important for each of
\nus.
\nSource: Clarke, G. (2003) The adolescent coping with stress course: adolescent workbook.
\nSession 2 Agenda & Summary
\nI. REVIEW
\nWe\u2019ll review topics we discussed in Session 1, and the associated home practice.
\nII. GUIDELINES FOR THIS GROUP
\nWe\u2019ll review rules that we’d like everyone to follow in this group, so the group runs
\nsmoothly, and we can help each other out. If the group has other rules that everyone
\nagrees on, we\u2019ll add those to the list, too.<\/p>\n
II. IDENTIFYING NEGATIVE THOUGHTS
\nOur main approach to controlling stress and sadness is to examine our beliefs and
\nthoughts. Sometimes, we may \u201cmake things worse in our own head\u201d by thinking really
\nnegatively and unrealistically. Together, we will learn skills for challenging unrealistic
\nthoughts and forming realistic beliefs. Before we can test the accuracy of our thoughts
\nand beliefs, we must first become aware of them. We\u2019ll identify both positive and
\nnegative thoughts each of us has about ourselves and our life situation.<\/p>\n
III. FEELINGS ABOUT THE GROUP
\nAll group members will be asked to complete a questionnaire about how they feel about
\nthe other group members and the therapist. All of your answers are confidential!<\/p>\n
IV. MOOD QUESTIONNAIRE
\nYou\u2019ll be asked to complete a questionnaire about how you feel. This is similar to one
\nyou\u2019ve already filled out at your in-person interview. All of your answers are
\nconfidential!<\/p>\n
V. PRACTICE ASSIGNMENT
\nYou\u2019ll review your home practice for the next week. This includes keeping track of
\nnegative thoughts happening in the next week.
\nVI. SHARING ACTIVITY
\nOne of the group members will share something personally interesting \u2013 a
\nhobby, musical or artistic talents, or something else interesting to them.<\/p>\n
Source: Clarke, G. (2003) The adolescent coping with stress course: adolescent workbook.
\nSession 3 Agenda & Summary
\nI. REVIEW
\nWe\u2019ll review topics we discussed in Session 2, and the home practice.
\nII. IDENTIFYING ACTIVATING EVENTS
\nWhen you discover that you are thinking negatively, you will also need to figure out
\nwhat situation or event triggered the negative thoughts. We call these situations
\nACTIVATING EVENTS, because they \u201cactivate\u201d or trigger the negative thoughts.
\nWe\u2019ll spend time trying to identify the most important activating events for each group
\nmember.<\/p>\n
III. INCREASING POSITIVE THINKING
\nIt’s good practice to think realistic and positive thoughts about others and about
\nourselves. In this exercise, each group member will come up with 1 or 2 positive
\nstatements about the other group members, and share these. You\u2019ll take these
\nstatements home so you can read them again later.<\/p>\n
IV. PERSONAL GOALS, REVISITED
\nWe\u2019ll check in with each group member: what personal goals do you have for this
\ngroup<\/p>\n
V. PRACTICE ASSIGNMENT
\nYou\u2019ll review your home practice for the next week. This includes keeping track of
\nyour daily mood, and your negative thoughts happening in the next week.<\/p>\n
VI. SHARING ACTIVITY
\nOne of the group members will share something personally interesting \u2013 a
\nhobby, musical or artistic talents, or something else interesting to them.<\/p>\n
Source: Clarke, G. (2003) The adolescent coping with stress course: adolescent workbook.
\nSession 4 Agenda & Summary
\nI. REVIEW
\nWe\u2019ll review topics we discussed last session, and the home practice.
\nII. PRACTICE IDENTIFYING UNREALISTIC THOUGHTS
\nWe\u2019ll spend time looking for unrealistic thinking in example cartoons, and in our real lives. We\u2019ll talk about exaggerations: noticing one wrong thing and then believing that
\nEVERYTHING is wrong. We\u2019ll also practice uncovering the WHOLE belief, or
\nUNDERLYING belief. It often requires more \u201cdigging\u201d and thinking about the underlying MEANING of your thoughts.<\/p>\n
III. CHANGING UNREALISTIC THINKING to REALISTIC THINKING
\nOnce you have identified unrealistic automatic thoughts and the underlying beliefs, you now can begin to examine their accuracy and come up with more realistic alternatives, or
\ncounter thoughts. The basic approach is to EXAMINE YOUR OWN THOUGHTS\u2014and put them to a sort of test. Instead of blindly accepting that all your thoughts are true, you \u201ccheckout\u201d just HOW TRUE your thoughts really are\u2014examine the evidence. If they aren’t true, or possibly aren\u2019t true ALL THE TIME, then they may be unrealistic. We have a list of 6 Helpful Questions to ask (see page 4.3) to uncover whether a belief is realistic or unrealistic. We\u2019ll then practice coming up with more realistic alternative thoughts and beliefs to challenge the unrealistic thoughts that lead us to feel sad, irritable, angry or tense. Your workbook refers to them as Counter thoughts.<\/p>\n
IV. PRACTICE ASSIGNMENT
\nYou\u2019ll review your home practice for the next week. This includes keeping track of your daily mood, and your negative thoughts happening in the next week. Use the 6 Helpful Questions to test whether the beliefs are realistic or unrealistic.<\/p>\n
V. SHARING ACTIVITY
\nOne of the group members will share something personally interesting \u2013 a hobby, musical or artistic talents, or something else interesting to them.<\/p>\n
Source: Clarke, G. (2003) The adolescent coping with stress course: adolescent workbook.
\nSession 5 Agenda & Summary
\nI. REVIEW
\nWe\u2019ll review topics we discussed last session, and the home practice.
\nII. DISCOVERING UNDERLYING NEGATIVE BELIEFS
\nIt’s often easier to recognize unrealistic thinking when we can identify the whole thought. The whole thought is called the BELIEF. These are the beliefs that are below the surface (like the tip of the iceberg, or the inner layer of an onion). In this section we will practice finding the whole belief that is behind the immediate thought that occurs to us.<\/p>\n
III. IS IT REALLY ABOUT ME
\nSometimes when we react to a particular Activating event, we have a negative thought that involves someone or something else, but not ourselves. If nonpersonal thoughts make us feel down, they may be PERSONAL THOUGHTS IN DISGUISE \u2013 personal beliefs underlying the nonpersonal thoughts. In this section we’re going to look at nonpersonal negative thoughts to see why they might make us feel negative or down.<\/p>\n
IV. PRACTICE ASSIGNMENT
\nContinue to record your negative thoughts, activating events, and realistic, positive
\ncounterthoughts.<\/p>\n
V. SHARING EXERCISE
\nOne of the group members will share something personally interesting \u2013 a hobby, musical or artistic talents, or something else interesting to them.<\/p>\n
Source: Clarke, G. (2003) The adolescent coping with stress course: adolescent workbook.
\nSession 6 Agenda & Summary
\nI. REVIEW
\nWe\u2019ll review topics we discussed last session, and the home practice.
\nII. MORE A-B-C PRACTICE or SOURCES OF BELIEFS
\nIn this section the group will either:
\na. Practice using the A-B-C method to identify and test unrealistic thoughts, and
\ncreate counterthoughts, or
\nb. Identify the sources of unrealistic beliefs: from TV, radio, movies, friends,
\nparents, and other places. Does this make it harder to challenge unrealistic beliefs
\nwhen many other important people in your life believe the same thing Which
\napproaches work best when trying to change to a new, more realistic way of
\nthinking that is different from the beliefs of people around you<\/p>\n
III. USING PROBLEM SOLVING TO COPE WITH ACTIVATING EVENTS
\nSometimes our reaction and beliefs about a problem situation are realistic. We aren\u2019t making things any worse by how we think about them. In these situations, it can be helpful to use problem solving skills to try to change out circumstances. We\u2019ll practice the three problem solving steps:
\n1. Brainstorm. Think of as many solutions as you can, even silly ones.
\n2. Pros and cons. Evaluate which solution is the \u201cbest.\u201d Make a list of the advantages and disadvantages of each solution.
\n3. Try and try again. Try it out and decide if it worked. If not, go back to brainstorming.<\/p>\n
IV. PRACTICE ASSIGNMENT
\nYou\u2019ll review your home practice for the next week. This includes keeping track of your
\ndaily mood, and your negative thoughts happening in the next week.<\/p>\n
V. SHARING ACTIVITY
\nOne of the group members will share something personally interesting \u2013 a hobby,
\nmusical or artistic talents, or something else interesting to them.
\nSource: Clarke, G. (2003) The adolescent coping with stress course: adolescent workbook.
\nSession 7 Agenda & Summary
\nI. REVIEW
\nWe\u2019ll review topics we discussed last session, and the home practice.
\nII. TECHNIQUES FOR INTERRUPTING UNREALISTIC THOUGHTS
\nDuring the last few sessions, we’ve been working on ways to counter or argue with
\nnegative and unrealistic thoughts. In this session, we\u2019ll learn some additional techniques
\nwe can use to interrupt negative thinking (remember \u201cDon’t Respond\u201d as a choice for
\ncoping with Activating Events).<\/p>\n
These are very different techniques \u2013 not related to challenging unrealistic thinking.
\nHowever, some people find them useful because they are quick and easy. We like to
\nthink of these as additional \u201ctools\u201d in your toolbox of techniques to deal with negative or
\nunrealistic thoughts. They include:
\na. Thought stopping.
\nb. The rubber band technique.
\nc. Setting aside some \u201cworrying time\u201d for negative thoughts
\nIII. USING A-B-C IN YOUR LIFE
\nIn this section, we review how you can make the A-B-C methods work for you in your
\neveryday life. We will discuss what could go wrong, how negative thoughts might sneak up on you, and what you can do to prevent these problems from getting worse.
\nIV. PROMPTS or Catch Up
\nIn this section we will either:
\na. Try to identify prompts, or reminders, to use the A-B-C method in everyday life,
\nor
\nb. Catch up with any other exercises that were missed earlier<\/p>\n
V. PRACTICE ASSIGNMENT
\n1. You\u2019ll review your home practice for the next week. This includes using at least one of
\nthe three Thought-Stopping techniques between now and next session. Each day, try to
\nfill out an A-B-C form when you catch yourself thinking a negative thought or when you
\nstart feeling depressed.
\nVI. SHARING ACTIVITY
\nOne of the group members will share something personally interesting \u2013 a hobby,
\nmusical or artistic talents, or something else interesting to them.<\/p>\n
Source: Clarke, G. (2003) The adolescent coping with stress course: adolescent workbook.
\nSession 8 Agenda & Summary<\/p>\n
I. EMERGENCY PLANNING<\/p>\n
We\u2019ll start this session by working on plans to deal with both big and small stressors.
\nThis will involve thinking ahead about how you might use the skills you\u2019ve learned to
\nhelp yourselves during stressful times. What are the major stressful events that might
\naffect you in the near future Which ones might set-off negative thoughts for you and
\nlead to feeling down How will you deal with these<\/p>\n
II. MAINTAINING YOUR GAINS<\/p>\n
In order to prevent depression, try to build the techniques into your daily life so that you
\ncan deal with everyday hassles effectively. What hassles (small, irritating situations) are
\nmost likely to happen for you How you can remind yourself to use these skills on a
\ndaily or weekly basis What kind of reminders work best for you<\/p>\n
III. QUESTIONNAIRES<\/p>\n
We\u2019ll ask everyone to fill out two questionnaires: one about your mood (similar to the
\none that you completed before) and another about your satisfaction with our program and
\nother medical care you may have received.<\/p>\n
IV. LAST SHARING ACTIVITY<\/p>\n
One of the group members will share something personally interesting \u2013 a hobby,
\nmusical or artistic interests, or something else interesting to them.