Anu Asnaani’s research while affiliated with University of Utah and other places

The South Asian diaspora is one of the largest racial/ethnic diasporas in the world. Limited psychological research and practice have focused on the traumatic experiences of South Asian individuals in this diaspora, and even less work has examined how these traumatic experiences are inextricably linked with historical and ongoing colonial context; migration and displacement; and intersectional identity based on religion, race, gender, nationality, and more. Additionally, scant research has focused on tangible solutions to these grave gaps in mental health care—how to best disseminate and implement culturally congruent interventions, enhance policy for trauma‐informed work, and best attend to the culturally informed needs of South Asian mental health trainees. This narrative review examines the current psychological literature on trauma among South Asian individuals in the diaspora from a translational perspective. We review (a) South Asian history using a trauma‐focused lens, (b) the types and prevalence of traumatic experiences, (c) trauma interventions, (d) trauma‐related dissemination and implementation efforts, and (e) trauma‐informed policy initiatives. We note from the outset that due to the limited work on the diaspora, much of this review inadvertently also reviews extant work on trauma among South Asians residing in South Asia, which is distinct but related to diasporic experiences. Recommendations for the traumatic stress field, community members and lay providers, and implications for the training of South Asian students preparing for careers in mental health are discussed.

Despite advances in understanding emotion regulation (ER) flexibility (e.g., flexibly using ER strategies to meet situational demands), there is heterogeneity in conceptualizations. To address this, we provide a unifying operationalization for ER flexibility and a person-specific ER flexibility framework. We define ER flexibility as the ability to continuously monitor the effectiveness of chosen ER strategies to meet one's goals for a situation and to adjust strategies, as needed, in response to changes in internal states (e.g., affect, beliefs about emotions) and external contextual demands (e.g., regulatory goals, situational factors/demands). This paper discusses existing ER flexibility frameworks, their empirical research, and potential limitations. We then present our person-specific ER flexibility framework. We highlight methodological applications, future research directions, and limitations.

Latinos experience disproportionate rates of obesity and related conditions like type 2 diabetes, which are projected to increase (Mohebi et al., 2022). Standard interventions for these issues often fall short due to individual-focused approaches and the lack of culturally sensitive definitions of health that include emotional, physical, political, and social domains (Gutierrez Chavez et al., 2022; Ritchie et al., 2020). Multilevel and multidimensional research efforts, integrating social justice-informed orientations, psychotherapy science, and behavioral medicine, are crucial for addressing these health inequities (Asnaani, 2023; Collins et al., 2018; Rodriguez Espinosa & Verney, 2021). Additionally, critically analyzing researcher and participant roles is essential to avoid perpetuating systemic racism (Cook et al., 2023). This article highlights the need for a paradigm shift in psychotherapy research by (a) describing Latino families’ eating patterns and coping strategies for emotional distress through focus groups in the community and (b) illustrating the process behind the community-partnered development of a culturally responsive mindfulness-based health intervention. Importantly, this research approach emphasizes liberation psychology theory in the exploration of structural influences affecting health (Martín-Baró, 1996). While mindfulness techniques are feasible in this population (Cotter & Jones, 2020), Latino communities may not be amenable to the current presentation of mainstream psychological science interventions. Our research paradigm informed the conceptualization of mindfulness techniques through both clinical science and critical lenses. Thus, this study argues for reconceptualizing the definition of a successful psychotherapy study to include community engagement and liberatory principles, making the potential for big needle jumps in addressing health inequities incalculable.

Background The National Diabetes Prevention Program (National DPP) is an evidence-based lifestyle intervention successfully disseminated across the United States. Some adaptations have been made to address real-world needs, including during the COVID-19 pandemic. This study aims to qualitatively describe adaptations Lifestyle Coaches made in response to the pandemic. Methods Between May and June 2021, Lifestyle Coaches (n = 300) from organizations across the United States answered open-ended survey questions about adjustments implemented during the pandemic. Survey responses were descriptively coded and codes were grouped into categories. Results Nearly all coaches transitioned the format of their class from in-person to remote delivery (93.0 %; n = 279). Other commonly-reported strategies included adjusting contact with participants (48.0 %; n = 144), increasing support for participants (36.7 %; n = 110), and tailoring materials (28.3 %; n = 85). Conclusions Maintaining these adaptations may address barriers to engagement in the National DPP and improve access to the program. Increased support for emotional symptoms and ensuring a patient-centered approach to care are particularly promising strategies.

Objectives Quality of life (QOL) is a multidimensional construct including emotional well‐being, life satisfaction, and physical health. Individuals with posttraumatic stress disorder (PTSD) consistently report low QOL, highlighting the importance of assessing the effectiveness of first‐line PTSD treatments (e.g., exposure‐based therapies) on QOL. This meta‐analysis examined the efficacy of exposure therapy for PTSD on QOL compared to control conditions (e.g., waitlist, medication, treatment‐as‐usual) at posttreatment and follow‐up (ranging from 1 month to 2 years). Methods Building on a previous meta‐analysis of exposure‐based therapy for PTSD, we searched PsycINFO and Medline in December 2021, July 2022, and March 2023 to include randomized controlled trials of exposure‐based treatments for adult PTSD assessing QOL. We screened 295 abstracts for initial eligibility; 20 articles met inclusion criteria and were included (N = 2729 participants). Risk of bias was evaluated using the Cochrane Risk of Bias tool 2.0. Results At posttreatment, exposure‐based therapies showed a medium effect on QOL relative to control conditions (k = 25, g = 0.67). This effect was not observed at follow‐up for the small subset of studies with follow‐up data (k = 8, g = 0.16). At posttreatment, effect size varied significantly as a function of the control condition (p < .0001). There were no differences in QOL effects across exposure therapies at posttreatment or follow‐up (p = .09). Conclusion Exposure therapy was associated with greater improvement in QOL compared to control conditions at posttreatment. Exposure was not superior to control conditions at follow‐up, and the longer‐term impact of exposure on QOL is unclear. The implications of these findings are discussed, along with the need for more PTSD treatment studies to examine QOL outcomes at posttreatment and follow‐up.

Difficulty tolerating distress (e.g., distress tolerance [DT]) and regulating emotions (e.g., emotion regulation [ER]) are implicated as transdiagnostic risk factors for various internalizing disorders. The present study investigated the relationships among six internalizing disorder symptoms, baseline ER, and DT in college students ( N = 137) to identify which internalizing disorders were most closely associated with DT. We expected ER and internalizing symptoms to be associated with DT and that ER would moderate relationships among internalizing symptoms and both trait DT and state distress. Results indicated that ER, Post-traumatic Stress Disorder (PTSD), and social anxiety symptoms influenced trait DT. ER moderated the associations between depression, anxiety, and panic disorder (PD) symptoms, and trait DT at the .05 level. Similarly, ER moderated the association between PD symptoms and anticipatory distress at the .05 level. However, these analyses did not withstand the Bonferroni adjustment ( p = .008) for multiple comparisons. Findings suggest that, when considering transdiagnostic symptoms, certain internalizing symptoms (i.e., social anxiety, PTSD) may have a stronger influence on trait DT. Further, strong ER abilities may buffer the adverse effects of internalizing symptoms on one’s perceived ability to handle distress. These patterns may not translate to individuals’ behavioral capacity to handle distress.

Health inequities have persisted in scientific examination and subsequent efforts related to prevention, detection, and, particularly, treatment of mental health disorders and symptoms over most of the history of our field. In the past decade, the tide has been slowly turning to make the promotion of mental health care equity across all segments of the population more mainstream, and the momentum to do so has further accelerated in the past 5 years. This review provides a brief summary of what we currently know about mental health care inequities (across a range of identity markers), and a brief discussion about what the role of social justice and advocacy has been and can continue to be in the field of clinical science. Following this, several specific areas of scholarship are reviewed in terms of their contributions to promoting mental health care equity, namely: community-based research and community-driven mental health treatment adaptations, task-shifting efforts in domestic and global settings, utilization of technology innovations to promote such work and increase access, and policy efforts stemming from such work. The review ends off with a commentary on lessons learned and potential future directions for the field. Taken together, it is hoped that it will be clearer for clinical science scholars and trainees to grasp what role we can and should have as clinical psychologists in promoting mental health care equity in the communities we serve and in society at large.

A Cultural Humility and Social Justice Approach to Psychotherapy: Seven Applied Guidelines for Evidence-Based Practice provides an applied guide for working with clients from a diverse set of intersectional identities within the context of evidence-based practice. The presented guidelines are derived from the consensus across published literature and established practice guidelines. The author also draws on her extensive clinical experience with a range of clients and therapy protocols/approaches, her active and ongoing research program in addressing health disparities, and considerable work in training clinicians across practice settings in incorporating diversity perspectives into evidence-based treatments to present practical ways to engage in culturally humble, socially just clinical practice. The presented guidelines cover the full trajectory of psychotherapy, spanning assessment, treatment, and relapse prevention, and further includes some considerations of these principles within the context of clinical supervision. The book provides worksheets, reflection exercises, and shorthand figures to assist clinicians of all training levels in making these concepts as applied and easy to use in clinical practice as possible.