Cross-Cultural Adjustment & Emotional Well Being

1. Cross-Cultural Adjustment &Emotional Well Being Aneesa Shariff, Ph.D., & Arlette Ngoubene-Atioky, M.Ed. UBC Counselling Services

2. Workshop Objectives • Understand the natural process and issues in cross-cultural adjustment • Recognize common symptoms of depression, anxiety, and schizophrenia • When to seek help from us

3. UBC Counselling Services • Who we are • Where we are located- 1040 Brock Hall • What issues we deal with: top 3 concerns & range of services • Individual & group counselling, referrals to other campus and outside services, information on various mental health issues

4. Mental Health Concerns • UBC students said they experienced the following mental health issues at least once in the last year (UBC NCHA, 2009): • 36% - felt so depressed it was difficult to function • 54% - felt overwhelming anxiety • 57% - felt things were hopeless • 70% - felt very sad • 88% - felt exhausted but not from physical activity • Mental health concerns cause academic problems for a large percentage of UBC students, at a higher rate (5-10% higher)than other Canadian schools (NCHA 2008).

5. Acculturation (Berry, 2003) • Acculturation= involves 2 choices that ask: • 1) How much of our home cultural behaviours, beliefs, practices to keep? • 2) How much of the host country’s cultural behaviours, beliefs, and practices to adopt?

6. Acculturation • Four acculturation strategies result: • 1) Integration • 2) Assimilation • 3) Separation • 4) Marginalization • Integration or separation tends to predict better mental health, but context dependent

7. Identity Confusion & 3rd Culture • Identity confusion • Cultural shock / Acculturative stress • Malleability of cultural identity • Integration of self-identity • “Home” • Third Culture Kid (TCK): • house/family culture, country of residence culture, school culture, mobile/international culture • International student identity: cultural shock, SES, highly educated and high perseverance, family/cultural pressure and negative consequence of failure, TCK identity, lower citizenry/minority status, discrimination, home sickness, & culture loss

8. Perceived Racism & Mental Health • Research in USA and Europe has looked at racism-mental health link. • My doctoral dissertation explored the relationship between acculturation, racism, and mental health in Canada • PR predicts depression, anxiety, and stress over and above other factors, including acculturation

9. Perceived Racism & Paranoia • Common to think Canada is multicultural and racism not a problem here • Reporting racism can often be interpreted as “paranoia” or over sensitivity • For some stigmatized groups, there is a “healthy cultural paranoia” that represents their reality

10. Sexual identity • Canadian and UBC standards • UBC support and advocacy (Pride UBC, Equity office, Access & Diversity)

11. Depression • Sadness, suicidal thoughts, loss of pleasure in activities just one aspect of how depression can express itself • In many cultures depression is expressed through physical symptoms • Sleep, appetite, fatigue, energy, & others specific to culture

12. Why Depressed? • First time in response to stressful experience: acculturation, identity, moving to a new country, loneliness/loss of support system, academic disappointments, relationship break ups, family illness, etc. • Combo of stress/environment & genetic predisposition

13. Anxiety • Anxiety • Stress response: Fly, fight, freeze • Thoughts automatic, intrusive catastrophizing • Heart racing, breathing difficulty, racing thoughts, concentration problems, no physical-related symptoms detected by doctor • What causes anxiety? • Significantly stressful or traumatic life events, substance use (coffee, alcohol, medications or illicit substances), biological factors (family history, change in brain activity) • International student stress: acculturation, academic and family pressure, home sickness • Action • Do you make time each day for relaxation and fun? • Are you getting the emotional support you need? • Are you taking care of your body? • Are you overloaded with responsibilities?

14. Schizophrenia • Includes delusions (odd thoughts), hallucinations (e.g. Hearing voices/seeing things that are not there), disorganized thoughts (incoherent language), or disorganized behaviour (e.g., freezing in certain positions, deterioration of personal hygiene, inappropriate sexual/aggressive behaviours)

15. Schizophrenia • Requires medication at minimum • Therapy to improve social skills • Paranoid thoughts alone are not necessarily schizophrenia (e.g., convinced of being discriminated against, racism, social exclusion, etc) • Healthy cultural paranoia vs. Functional paranoia

16. Case Example 1 • Vinay is a 18 year old international student who arrived at UBC from India three months ago. He says “I wake up at 3 in the morning and I can’t get back to sleep. It’s my nerves. I keep on thinking and thinking.” He also reports that he feels tired all the time and that he tries to study but can’t stop thinking of what he has to do for his classes. Vinay has lost 10 pounds and says that he does not feel hungry anymore. He states that “There is nothing in my life that I enjoy.” During your conversation, Vinay says that his stomach and his head begin to hurt him again. Vinay mentions that he is probably failing this semester.

17. Case Example 2 Helen is a 20 year old international student from South Africa. Helen tells you that when she goes to class, she often has sudden attacks of nausea, perspiring, a feeling of unreality, and trembling. These symptoms become quite intense within a few minutes and last less than half an hour. Helen says that the episodes are so uncomfortable that she occasionally does not go to class or avoid leaving her off-campus apartment. She says that these symptoms become more specifically associated with certain responsibilities, such as group meetings with fellow classmates and/or class presentations. She worries that her face and expressions may be displeasing to others and/or that her body odor is offensive.

18. Case Example 3 Zhuo Ju, a 24 year old international student from Taiwan in his fourth year of study. Zhuo Ju, informs you that he is quitting school because Oprah is carrying his baby. He tells you that Oprah began talking to him on TV and then one day came out from the TV. He states that Oprah has visited his apartment several times. He also mentions that he had called Oprah multiple times, sent letters about her pregnancy and was waiting for her response. He wishes to go and see her so that they resolve “visitation rights” to “their” child. He said he understood that she would not be able to marry him, or even to acknowledge her love for him, because of her public position. In his apartment, you find evidence that his fantasized relationship (the TV with pre-recorded Oprah shows, Oprah magazines, and love letters) had existed for years.

19. What You Can Do Talk to the student in private A time when you both are not rushed. Give the student your undivided attention. Describe concerning behavior, express your concern, and ask if everything is OK I’ve noticed ….. (use concrete, behavioral language) I’m concerned ….. Is everything OK? Listen without trying to solve the problem or provide an opinion Can help the student feel cared about as an individual. Avoid judging, evaluation, or criticizing. Respect the student’s value system even if you don’t agree Avoid offering an opinion even if the student asks. Instead, restate your concerns.

20. What You Can Do Convey hope Assure the student that things can get better and that there are options. Tell them it can be helpful to talk to someone they’re close to: “Have you been able to talk to anyone about this? a family member? Friend?” Refer Be direct. Let the student know that you believe it is important to access professional counselling assistance in this situation. Inform the student that counselling is confidential and free of charge. If the student is receptive, suggest that he/she go to Counselling Services and tell the student how to access service there

21. What not to do? Not respond Ignore anything significant stated Ask unrelated questions after someone has shared feelings or information Clichéd responses Make inferences without securing sufficient information Advice giving (outside of your role): ‘shoulds’ Pity

22. Summary & Conclusions • Many of the stressors (loneliness/identity/fitting in, etc) are normal for all young adults • Your role is to support students in need to access our services, don’t burden yourselves with trying to provide counselling • Drop in initial consult at Counselling Services

23. Questions ?