Online Publication of Undergraduate Studies
Volume XIV Issue I | Spring 2023
Editors-in-Chief
Nicole Quinn Chow
Su-Yue Amy Wang
Contributing Writers
Gianna Rose Boccieri
Adam Goldstein
Lee Hatcher
Haruka Kokaze
Suebin Lee
Yuyi Lin
SoYoung (Bella) Park
Jenny Yu
Olive (Qianyu) Zhou
Creative Director
Nicole Quinn Chow
Layout & Design Coordinators
Shirley Cajamarca
Rebecca Wu
Faculty Mentor
Dr. Adina R. Schick
Special Thanks
Bethanie Railling
Dr. Linnie Green
Department of Applied Psychology
NYU Steinhardt
07 Yuyi Lin
Structural Forces at the Playground: An Interview With Dr. Hirokazu Yoshikawa
11 SoYoung Park, Suebin Lee, and Olive Zhou
Fostering Music Engagement of Young Children Displaying Autistic Symptoms
19 Jenny Yu
Benefits of Mindfulness-Based Meditation for College Students
25 Adam Goldstein
Finding Connection Through Adversity: A Discussion on Trauma and Acute Stress With Dr. Anthony Mancini
28 Haruka Kokaze
Social Support and the PTSD Symptoms of Japanese Earthquake Survivors
33 Lee Hatcher
Gender Affirmation and Depressive Symptoms
37 Gianna Boccieri
LGBTQ+ College Students and Mental Health Stigma
Welcome to the 2022-2023 issue of New York University’s Applied Psychology Online Publication of Undergraduate Studies (OPUS)! First established in 2009, OPUS provides Applied Psychology undergraduate students with a forum to share their independent work. This publication is entirely written, edited, and designed by undergraduates, and is one of the only undergraduate psychology journals in the United States.
This issue examines a range of psychological phenomena and social issues, and is divided into three parts. The first section - Human Development and Well-Being - begins with Yuyi Lin’s interview with community psychologist Dr. Hirokazu Yoshikawa, whose work focuses on the influence of early education on children’s development. Next, SoYoung Park, Suebin Lee, and Olive Zhou investigate how improvisational music therapists foster music engagement for young children displaying autistic symptoms. Finally, Jenny Yu’s literature review introduces the benefits of mindfulness-based meditation for college students.
The following section - Trauma and Recovery - features Adam Goldstein’s interview with Dr. Anthony Mancini, a clinical psychologist whose interests lie in the adaptive functions of psychological distress and how trauma and acute stress can foster social interaction. Then, Haruka Hokaze’s literature review specifically analyzes how social support can mitigate the PTSD symptoms of Japanese earthquake survivors.
The last section - LGBTQ+ Mental Health - is comprised of Lee Hatcher’s literature review exploring how gender affirmation can improve transgender youths’ depressive symptoms, and Gianna Boccieri’s study, which examines the relation between mental health stigma and the well-being and help-seeking behaviors of LGBTQ+ college students.
Thank you so much to our talented writers for their scholarly contributions, persistence, and commitment. We would also like to thank the Layout & Design Coordinators, Rebecca Wu and Shirley Cajamarca, for their hard work and enthusiasm in the creation of this issue. We are also incredibly grateful to our OPUS advisor, Bethanie Railling, for her brilliant advice and refreshing candor. Lastly, we would like to thank the Co-Directors of Undergraduate Studies in Applied Psychology, Dr. Adina Schick and Dr. Linnie Green, for their continuous support and encouragement. In particular, this issue would not have been possible without our faculty mentor Dr. Schick’s unrelenting patience, sharp wit, and dedicated guidance.
We hope the current issue can bring you new perspectives on many important topics in psychology today.
Best,
OPUS Editors
Early childhood education is key to supporting children’s development of emergent numeracy and literacy skills, socialemotional skills, and motor abilities (Rey-Guerra et al., 2022). However, vast racial, ethnic, and socioeconomic disparities affect access to and quality of early childhood education, resulting in starkly different long-term outcomes (Chaudry et al., 2021). In order to better understand what defines high-quality early childhood education and address the barriers that prevent each child from being given equal access, Dr. Hirokazu Yoshikawa, the Courtney Sale Ross Professor of Globalization and Education at the Steinhardt School of Culture, Education, and Human Development, as well as the Co-Director of the Global TIES for Children Center at New York University, was interviewed. Dr. Yoshikawa is a community and developmental psychologist who examines the effects of poverty reduction policies and early childhood programs on children’s development. He has also authored several books on early childhood education policy and immigration reform, and served on current President Joe Biden’s Unity Task Force on Education in 2020.
What inspired you to work in early childhood education?
In one of my first psychology classes, I just happened to come across an article that was a 10-year follow up of an early childhood program, and it had affected some parents’ economic well-being and their kids’ development. I thought it was interesting that a program early in life could have 10-year follow up effects so that got me into this whole field. It led me to get a research assistant position on a project with Head Start programs in Staten Island and write a Master’s thesis that was related to the topic.
What do you think is the key ingredient to educate and engage with a child?
Fostering kids’ excitement, agency, and motivation. Essentially, making learning fun is the key task for teachers of kids this age, [as well as] supporting kids’ enthusiasm and engagement in learning and play-based activities in the classroom. Through these activities, kids can learn many skills that could be social, early language, [and] early quantitative [reasoning].
Given your work on family engagement in early learning opportunities in home settings and in early childhood education centers, what are your thoughts on how family engagement and early childhood education work hand in hand to support a child’s emergent numeracy and literacy, social-emotional functioning, and motor development?
LinI think all the adults and older kids involved in young kids’ lives can really make a difference. And I wouldn’t leave out peers either, because kids are learning a great deal from their peers and friends at this age. Families, childcare centers, preschools, and larger communities need to be working together to enrich opportunities for this kind of learning. We also have to think about the larger stresses that affect families whether they be experiences of poverty or discrimination. We need the kinds of structural interventions to support families to support their kids. And that means reducing the larger structural forces that create inequality in families’ economic lives as well as their interpersonal and social lives.
How can childhood programs be adapted to fit the needs of a child based on their cultural background and social situation?
Culturally-responsive teaching is one place to start in the classroom. I think that teachers should reflect the cultural and linguistic backgrounds of the families they’re serving so we should have a diverse teaching workforce. That means also that they should be well supported both in terms of things like compensation, so that they’re not economically struggling themselves - we know that many in the early childhood workforce are actually struggling to make ends meet - but also supporting their ability to serve diverse children and foster, for example, multilingual development, recognizing that kids comes from multiple language backgrounds in classrooms. I think that also goes for kids of varying skill levels and ability levels and so we need to train teachers to be able to engage in inclusive teaching practices of kids of varying ability levels. Teachers should be really getting to know the communities and the families of the kids they serve, and that can mean doing things that might be a little unorthodox. This might be home visits to families to really get to know them from the perspective of their own neighborhoods and communities, making sure that communication is two way reciprocal forms of learning, that teachers are understanding the kinds of socialization, practices, and knowledge that the households have, that the respect for cultures of the families can be reflected in teachers’ curiosity and learning about the kinds of ways that children are learning at home. All of those approaches are examples of culturally-responsive practices.
[In response to how teachers cater to a large classroom filled with different students of different needs], some people say it’s harder to teach preschoolers than to teach older kids, because kids are just figuring out various fundamentals about how to interact with other kids and how to understand other kids’ motivations and preferences and working out things like building friendships. I think that one key is that the class size
shouldn’t be too large. That’s why we have standards in the U.S. and other countries that try to keep class sizes to a manageable level. Many other countries I work in, sometimes those class sizes are way too large so those are things we should try to pay attention to. Working with kids in small groups can often increase that ability to engage with individual kids, so one common practice is that you’re not working with the entire class at the same time all the time, but you’re often splitting kids up into pairs or allowing them to engage with other kids freely in small groups when they’re working on something like a construction or a game or an activity. Those are the activities that make it easier for teachers to pick up on individual kids’ needs, their opinions, their preferences, their ideas, allow each child the agency to have some form of control and autonomy over how they learn. And once teachers learn that that form of agency is really important, I think that can change their world view of how they teach in the classroom.
How can adults help children reconcile with and understand social inequalities?
Children are learning about the patterns of inequality in society from these micro level interactions in classrooms to later understanding that in schools, kids with certain backgrounds are overrepresented in certain contexts, and so they start learning what we would call societal inequality and how that plays out in settings like schools, but also in their neighborhoods and homes. What you raise is a huge issue that we have to tackle from a lot of different directions. We have to tackle the larger issues such as racism, white supremacy, and segregation in order to ultimately tackle how these factors affect parents, adults, kids, and youth. These factors play out in where people live, whether they can accumulate assets in their lifetime and not keep struggling economically, affect the stress levels that people experience and children’s development. We have to tackle these structural forces in order to then think about how to support family well-being and children’s development. One thing I make a pitch for is that students in applied psychology learn about issues in inequality from all the other social sciences because anthropology, economics, social psychology, political science have a great deal to say about what are these structural forces, how do they affect neighborhoods, communities, family, housing, healthcare, education, and ultimately child and youth development. I myself learned a lot from other disciplines and used those perspectives in my work when I think about inequality and child development because inequality forms from the structural level all the way down to the child level.
What do you think still needs to be improved in terms of access to early childhood education now?
One relatively ignored factor in early childhood education is the role of racism in affecting children’s opportunities in this earliest phase of education. The anthropologist Jennifer Adair has written a good book called Segregation by Experience that outlines how Black and Brown children are often denied the
autonomy of having some say in how, with whom, and with what they learn in a classroom. Their bodies are more subject to control in the name of behavioral management or discipline or classroom management. She’s observed across multiple preschool systems that Black and Brown children are more often have to deserve free play and display certain kinds of behaviors to then receive a reward of free play rather than thinking about opportunities for playful learning as being things that they can have some from freedom in, as micro as choosing who you can work on something with, or you can go on to another group to tell them how excited you are about a particular idea or about something you’re making. Those kinds of choices are restricted more for Black and Brown children. This notion of children’s agency and how they can be stifled because of these larger structural forces like racism are not understood well enough in the early childhood space. [We] may perhaps be ignoring the fact that Black and Brown kids are more likely to be expelled or suspended from a school classroom, but also that the everyday interactions between students and teachers can be greatly impacted by these forces. And so I think that poses this notion of how all children should have access to high quality learning experiences. That is one of the biggest challenges where structural forces are actually affecting kids at an everyday level within classrooms.
In this interview, Dr. Yoshikawa discusses the benefits of early childhood education for children’s development, while acknowledging the underlying structural forces that affect the quality of education and extent that children benefit from their education. That is, the degree to which children benefit from early childhood education varies according to their demographics, including race, gender, and socioeconomic status. For instance, children of color are more likely to be denied time for free play and subject to exclusionary school discipline (Skiba, 2002). Not only does this limit their time in the classroom to reap the benefits of early childhood education, but these patterns of differential treatment may lead children of color to internalize harmful societal narratives about themselves (Wolf & Kupchik, 2017). Dr. Yoshikawa is a proponent of culturally-responsive pedagogy in early childhood education programs. In other words, curricula and pedagogy should be tailored to children’s needs to foster their excitement, agency, and motivation to learn (Chaudry et al., 2021). This, in turn, can strengthen higher-order thinking skills within learning content and enhance warm, responsive teacher-child relationships - two important components of quality early education (Yoshikawa et al., 2013).
Early childhood education has the capacity to boost children’s development through nurturing and maintaining positive peer and teacher engagement in learning spaces. Although quality of and access to this education may be hindered by larger structural forces, research has shown that such barriers may be addressed through culturally-responsive teaching and
policies, along with providing more support and assistance to familiessuch barriers may be addressed through culturallyresponsive teaching and policies, along with providing more support and assistance to families (Fass, 2009; Gay, 2000). Given positive impacts of high-quality early childhood education, it is important that such policy and interventions be adopted to enable equal access and support at the playground and beyond.
Chaudry, A., Morrisey, T., Weiland, C., & Yoshikawa, H. (2021). Cradle to kindergarten: A new plan to combat inequality. Russell Sage Foundation.
Fass, S. (2009). Paid leave in the states: A critical support for low-wage workers and their families. National Center for Children in Poverty, Mailman School of Public Health, Columbia University. NCCP. https://www.nccp.org/ publication/paid-leave-in-the-states/
Gay, G. (2018). Culturally responsive teaching theory, research, and practice. Teachers College Press, Teachers College, Columbia University.
Rey-Guerra, C., Maldonado-Carreño, C., Ponguta, L. A., Nieto, A. M., & Yoshikawa, H. (2022). Family engagement in early learning opportunities at home and in early childhood education centers in Colombia. Early Childhood Research Quarterly, 58, 35–46. https://doi.org/10.1016/j. ecresq.2021.08.002
Skiba, R. J., Michael, R. S., Nardo, A. C., & Peterson, R. L. (2002). The color of discipline: sources of racial and gender disproportionality in school punishment. The Urban Review, 34(4), 317–342. https://doi.org/10.1023/a:1021320817372
Wolf, K. C., & Kupchik, A. (2017). School suspensions and adverse experiences in adulthood. Justice Quarterly, 34(3), 407-430. https://doi.org/10.1080/07418825.2016.1168475
Yoshikawa, H., Weiland, C., Brooks-Gunn, J., Burchinal, M., Espinosa, L., Gormley, W. T., Ludwig, J., Magnuson, K., Phillips, D., & Zaslow, M. (2013). Investing in our future: The evidence base on preschool. (ED579818). ERIC. https:// files.eric.ed.gov/fulltext/ED579818.pdf
Autism spectrum disorder (ASD) is a developmental disorder that can hinder one’s ability to comprehend emotions, build social skills, and respond flexibly to changes and transitions (Jadhav & Schaepper, 2021). According to the World Health Organization (2022), approximately 1% of children are diagnosed with ASD. Notably, however, many children displaying symptoms of autism do not receive a formal diagnosis during the formative early childhood years (Centers for Disease Control and Prevention, 2022). Nevertheless, the prevalence of ASD among young children has led to a focus on early identification and intervention (National Institutes of Health, 2021; U.S. Department of Health & Human Services, 2020).
One intervention that young children displaying autistic symptoms might benefit from is music therapy, particularly Improvisational Music Therapy (IMT), which has been used to address social communication, engagement, and socialemotional connections (American Music Therapy Association [AMTA], n.d.; Carpente et al., 2022; Geretsegger et al., 2012; Geretsegger et al., 2015; Kim et al., 2008; Kim et al., 2009). Specifically, the client’s music engagement, defined as therapistfacilitated involvement in the music-making process, is essential to achieving therapeutic goals in IMT, and is, to some extent, contingent on the music therapist’s skills (Aigen, 2013; Bieleninik et al., 2017; Birnbaum, 2014; Bruscia, 1988; Geretsegger, 2015; Kim et al., 2009). Yet, few studies have explored the role of IMT music therapists in fostering the music engagement of children displaying autistic symptoms.
Many early signs of autism relate to difficulties with social engagement (i.e., the ability to engage, interact, or initiate social interactions; Kiely & Flacker, 2003; Thompson et al., 2013). For example, children displaying autistic symptoms typically experience difficulties in joint attention, turn-taking, understanding of social cues, and other basic social skills (Silveira-Zaldivar et al., 2021). These challenges increase the risk of developing anxiety, depression, and social isolation, and also interfere with academic attainment and relationship and employment maintenance (Silveira-Zaldivar et al., 2021). Therefore, deficits in social interactions – especially social skills and social competence – are key targets of early interventions for children displaying autistic symptoms (Landa, 2007; SilveiraZaldivar et al., 2021; Vernon et al., 2012).
Typically, training in social skills includes initiating interactions, responding, maintaining eye contact, recognizing emotions, and understanding body language (Bellini & Peters, 2008; White et al., 2006). Nevertheless, explicit social skill
training has been found to produce limited beneficial outcomes for children with autism (Bellini & Peters, 2008; LaGasse, 2017; Weiss & Harris, 2001). By contrast, social skills training implicitly embedded in alternative forms of therapy, such as IMT, has been found to be more effective. In IMT, clients and therapists engage in musical dialogue, which closely mimics social communication, as clients actively participate in the process of music-making through attentive, interactive, and reciprocal musical interactions (LaGasse, 2017; Mayer-Benarous et al., 2021; Nordoff-Robbins Center for Music Therapy, n.d.). What makes IMT especially effective for children displaying symptoms of autism is its improvisational aspect. The flexibility inherent in musical features (e.g., rhythm, tempo, motion, and expression) can reflect the children’s here-and-now behaviors, allowing therapists to identify and focus on children’s individual needs (Aigen, 2001; AMTA, 2015; Pavlicevic, 2000; Sacks, 2008). This client-centered approach fosters children’s engagement in the sessions, which, in turn, helps them gain important social skills such as responsiveness, adaptability, organization, and attention (Kim et al., 2008; Kim et al, 2009; Nordoff-Robbins Center for Music Therapy, n.d.; Pavlicevic, 2000; Perkins et al., 2020).
The beneficial outcomes of music engagement in IMT are not only a result of the improvisation but also of the therapeutic alliance, which is defined as the collaborative relationship between therapist and client (Aigen, 2013; American Psychological Association., n.d.; Birnbaum, 2014; Kim et al., 2008; Lee & Kim, 2021; Pavlicevic, 2000). In IMT, the therapeutic alliance is achieved through clinicians and clients creating music collaboratively and spontaneously with various instruments to build interconnectedness (Bruscia, 1987; Carpente et al., 2022; Geretsegger et al., 2012; Pavlicevic 2000; Ritholz, 2014; Sacks, 2008). The greater the clients’ music engagement, the stronger the therapeutic alliance between the therapist and client, as music allows the client and the therapist to connect on an interpersonal level (Aigen, 2001; Pacliveciv, 2000; Sacks, 2008). Ultimately, the strength of the therapeutic alliance and the level of music engagement depend on the music therapist’s initiative and guidance (Aigen, 2013; Lee & Kim, 2021; Silverman, 2019). In other words, music therapists are responsible for encouraging and facilitating clients’ music engagement while also challenging them to meet their clinical goals. This is only possible once a strong therapeutic alliance is established, where clients feel safe being challenged by their therapists (Aigen, 2013).
Several studies highlight client empowerment as one of the
ways to reach this therapeutic relationship while also challenging clients to meet their goals (Daveson, 2001; Hirsch & Meckes, 2000; Magill, 2009; Rolvsjord, 2009). Empowerment in music therapy not only comes from the music-making process itself, but also when therapists help clients recognize their potential by providing positive affirmation, respect, and hope (Rolvsjord, 2009). As therapists use music to help clients engage, they also empower clients to feel less helpless or discouraged from past negative experiences and stigmatization of their symptoms (Magill, 2009). Characterized by validating interpersonal connections and mutual music engagement between therapist and client, empowerment in music therapy sessions encourages clients’ participation and helps foster positive attitude and cognitive restructuring (Daveson, 2001). In turn, clients gain a sense of control, which can facilitate an improvement in their social skills, and, ultimately, help them meet their clinical goals (Hirsch & Meckes, 2000).
Taken together, past research has shown that IMT is an effective intervention for young children displaying signs of autism (Kim et al., 2008; LaGasse, 2017; Reschke-Hernandez, 2011; Wigram & Gold, 2006). Although previous studies have focused on IMT for children of various ages (Bieleninik et al., 2017; Dekker et al., 2022; Geretsegger et al., 2012; Geretsegger et al., 2015; LaGasse, 2016; Mayer-Benarous et al., 2021; Mössler et al., 2020; Vasa et al., 2021; Whipple, 2004; White et al., 2007; Wigram & Gold, 2006), as of now, few studies have explored the use of IMT with preschoolers. There is also a lack of empirical research examining the benefits of IMT for young children displaying signs of autism (Geretsegger et al., 2014; Whipple, 2004). Most importantly, there has been limited focus on the perspectives of music therapists regarding the ways they support the music engagement of young children who are displaying signs of autism. To address these gaps, the current qualitative study explored the following question: How do IMT music therapists foster the music engagement of young children displaying autistic symptoms?
Four music therapists, recruited via the Nordoff-Robbins Center for Music Therapy, participated in the current study. All participants had clients between the ages of two and five displaying symptoms of ASD. Two of the therapists were enrolled in graduate programs in music therapy, while the other two participants had a Master’s degree in music therapy. Each of the therapists had at least two years of experience in the field of music therapy. Three therapists were East Asian and one was multiracial. All self-identified as women, and all were in their twenties.
Semi-structured interviews with nine open-ended
questions were held with each therapist. Some key questions included “How do you recognize music engagement?” and “How important is music engagement in your music therapy sessions with your client?” (See Appendix for the full list of interview questions.) Follow-up questions were asked based on therapists’ answers during the interview. All interviews were held at the Nordoff Robbins Center for Music Therapy. Interviews ranged in length from 45 to 60 minutes and were audio-recorded.
The audio recordings were initially transcribed using the website Trint, and were later reviewed by researchers, sentence by sentence, to avoid misinterpretation and mistranscription. Then, using grounded theory (i.e., thematic analysis), researchers independently read the transcripts to highlight key themes. The researchers then convened to review and discuss the themes. Ultimately, three common major themes were identified, with the inter-rater reliability at 80%.
Three main themes demonstrating how music therapists foster music engagement for young children displaying autistic symptoms emerged from the data: the flexibility of improvised music, empowerment and creation of a safe space, and the involvement of co-therapist and parents.
All four therapists described the flexibility of improvised music during IMT sessions as a critical element in supporting children’s music engagement. In contrast to pre-composed music that has strict form and structure, improvised music allowed therapists to reflect on children’s physical and emotional behaviors at the moment, by using musical elements like the chord scale and loudness. For example, when a child got distracted by the air conditioner controller in the room and rushed to observe it in detail, the therapist played the piano with an ascending scale to match the child running toward the object. Likewise, when the child stopped and looked at the air conditioner controller, the therapist paused until he rushed back, at which point the therapist resumed playing on a descending scale. In response to these improvisations, children became more musically engaged in the sessions. For example, they played with more instruments, moved or sang along with the therapist’s improvised music, and interacted with different objects in the therapy space to bidirectionally create more improvised music with the therapist. Music was also improvised to match the children’s emotional intensity. One therapist specifically mentioned using “melodic contour” (i.e., by controlling the volume or the level of pressure against the piano keys) to capture the implied emotion in children’s language and communication. For example, the therapist would play the keys softer when the child said, “This is a gift for mom” to match her tender emotions and kindness to her mother, but played the keys stronger when the child said, “I wonder where the object that I’m looking for is at” to match
her frustration and irritation. In general, therapists utilized flexible musical elements like tone, pitch, and loudness to help the children engage in the session. The therapist’s attempt to match the children’s emotions through music not only helped validate their feelings but also allowed space for the children to be more musically engaged. The children added new words to the song, stomped to the beat, and played instruments to maintain or change the mood of the music, which helped them stay invested in the creation of the music. Therapists, thus, used the flexible nature of improvised music to engage the children in the sessions.
A second theme that emerged from the data was the importance of creating a safe space and empowering the children to make them feel confident in engaging musically. For example, one music therapist stated the following:
...There’s no right or wrong music. Every music is how they respond to that thing and that moment. So, I think music engagement is really helping them to realize — to focus on what they are doing right now at the moment instead of worrying about what the outcome will be after doing this.
Using this frame of nonjudgmental music-making, therapists were able to create a “container” of validation and acceptance for the children, freeing them from criticisms of their behaviors in the session. This increased the therapeutic alliance between the therapists and the children, allowing them to feel safe to explore a variety of issues using unfamiliar instruments to create unconventional tunes, thereby better connecting with their emotions.
Furthermore, the validation and acceptance in the therapy environment helped to foster music engagement. All four therapists reported that they encouraged musical initiative by empowering the children to gain a sense of control over their music-making, such as by giving them numerous choices of instruments, musical styles, lyrics, rhythm, and beat. One of the therapists described how her method of using the child’s own words in the improvised songs allowed the child to feel empowered, stating that “...in music, using [the client’s] own language [improvisationally] is very empowering for [her] selfdevelopment [because] she’s actually taking more independence and autonomy over the musical environment that is [hers].” Through these interactions, therapists were able to give children the confidence to take initiative, leading them to be more engaged in the music-making process.
Therapists also reported that their facilitation of music engagement was often done in collaboration with co-therapists and/or the children’s parents. Three therapists highlighted the importance of collaboration between music therapists when discussing a child’s music engagement. For example, at times co-therapists contributed unique perspectives related to a child’s
music engagement, based on factors such as their closer physical proximity to the child. As one co-therapist stated: [As a co-therapist] I think I have to negotiate with the primary [therapist] because the primary therapist thinks the child is a one or two [on a music engagement scale], but I don’t think so. […] For example, he sings something but it’s so easy to miss because [the primary therapist] cannot hear sometimes while playing the piano.
Importantly, the collaboration between music therapists is characterized by their joint efforts to create the most personalized session to foster and assess children’s music engagement. Moreover, two of the music therapists mentioned parents’ role in helping to foster children’s music engagement. Some therapists noted that they invited caregivers to join, especially when children demonstrated separation anxiety, and found that parents provided support and encouragement, which the therapists could then build on to foster more music engagement. For example, when parents were encouraged to not only be physically present, but to sing along and participate in the music-making, therapists were better able to encourage the children to engage with the music. Moreover, some of the therapists elicited ideas from parents, regarding topics to discuss with the children or areas to work on, which, too, resulted in a greater ability to foster children’s music engagement.
The current study aimed to explore how IMT music therapists foster the music engagement of young children displaying autistic symptoms. Three themes emerged from interviews with music therapists: (1) the use of improvisational music as a flexible tool to encourage music engagement, (2) the importance of creating a safe therapy space to empower children during IMT sessions, and (3) working in collaboration with a cotherapist and/or a child’s parents. Each of these factors was seen as an important contributor to facilitating the music engagement of young children displaying symptoms of autism.
Findings were aligned with past research that has shown how the dynamic elements of music (e.g., volume, duration, tempo, and pitch) can be used to mirror children’s physical and emotional behaviors (Aigen, 2001; Pacliveciv, 2000). In turn, as previous work has shown (Aigen, 2001; Pacliveciv, 2000; Sacks, 2008), the fluid and communicative nature of music can foster increased music engagement and facilitate greater therapeutic relationships. Likewise, in accordance with previous literature (e.g., Kim et al, 2009; Perkins et al., 2020), results highlighted that creating a safe environment encouraged children’s music engagement during IMT sessions. Findings of the current study also demonstrated that music engagement in IMT sessions supported children’s sense of autonomy and independence. Therapists shared that children who were musically engaged were able to take control of the session by initiating the musicmaking and actively collaborating with their music therapists. Notably, one of the therapists described music engagement as
a prerequisite for interaction and improvement in developing social skills — one of the main clinical goals for these children. By using what is already known about the effectiveness of music and human emotion, young clients improved their autistic symptoms and social skills through music engagement in IMT sessions. Lastly, as indicated in previous research, cotherapists’ and parents’ involvement in IMT sessions was critical for children displaying autistic symptoms (Aigen, 2013; Lee & Kim, 2021; Silverman, 2019). Importantly, the current findings showed that a collaboration between music therapists and parents helps facilitate children’s music engagement during IMT sessions, improving the therapeutic alliances and supporting social skills (Aigen, 2013; Lee & Kim, 2021; Silverman, 2019). Extending past findings, however, the current results highlighted that the client-therapist relationship was influenced by other indirect relationships, such as those between primary therapists and co-therapists. The current study showed the significance of the diverse perspectives shared by primary and co-therapists in fostering the music engagement in children displaying autistic symptoms. These findings have important implications for music therapists seeking to promote children’s music engagement as a means of fostering their social engagement skills.
Notably, the current study was exploratory in nature. Future research should build on these findings using larger sample sizes, including a greater number of music therapists, and exploring additional factors that might play a role in how music therapists foster the music engagement of young children displaying symptoms of autism (e.g., severity of symptoms, race/ethnicity of clients and therapists). Nevertheless, findings of the current study contribute to the ongoing research in the field of music therapy, and highlight how music therapists might use IMT as a therapeutic option for young children displaying autistic symptoms.
Aigen, K. S. (2001). Popular musical styles in Nordoff-Robbins clinical improvisation. Music Therapy Perspectives, 19(1), 31-44. http://dx.doi.org/10.1093/mtp/19.1.31
Aigen, K. S. (2013). The client-therapist relationship in music therapy. In The study of music therapy: Current issues and concepts (1st ed., pp. 107-118). Routledge.
Aigen, K. S. (2013). The medium of music and clinical goals. In The study of music therapy: Current issues and concepts (1st ed., pp. 63-74). Routledge.
American Music Therapy Association. (n.d.). Music therapy with specific populations: Fact sheets, resources & bibliographies. https://www.musictherapy.org/research/factsheets/
American Music Therapy Association. (2015). Scope of music therapy practice. https://www.musictherapy.org/about/ scope_of_music_therapy_practice/
American Psychological Association. (n.d.). Therapeutic alliance. In APA Dictionary of Psychology. Retrieved April 4, 2023, from https://dictionary.apa.org/therapeutic-alliance
Bellini, S., & Peters, J. K. (2008). Social skills training for youth with autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 17(4), 857-873. https://doi.org/10.1016/j.chc.2008.06.008
Bieleninik, L., Geretsegger, M., Mössler, K., Assmus, J., Thompson, G., Gattino, G., Elefant, C., Gottfried, T., Igliozzi, R., Muratori, F., Suvini, F., Kim, J., Crawford, M. J., Odell-Miller, H., Oldfield, A., Casey, Ó., Finnemann, J., Carpente, J., Park, A. L., & Gold, C. (2017). Effects of improvisational music therapy vs enhanced standard care on symptom severity among children with autism spectrum disorder. Journal of the American Medical Association, 318(6), 525-535. https://doi.org/10.1001/jama.2017.9478
Birnbaum, J. C. (2014). Intersubjectivity and Nordoff-Robbins music therapy. Music Therapy Perspectives, 32(1), 30-37. https://doi.org/10.1093/mtp/miu004
Bruscia, K. E. (1987). Sixty-four clinical techniques. In S. Levinson., C. Maranto., P. Boone., B. Wheeler., D. R. Johnson., A. Stark., & V. A.Whiteling (Eds.), Improvisational models of music therapy (pp. 533-557). Charles C Thomas Publisher.
Bruscia, K. E. (1988). A survey of treatment procedures in improvisational music therapy. Psychology of Music, 16(1), 10-24. https://doi.org/10.1177/0305735688161002
Carpente, J., Casenhiser, D. M., Kelliher, M., Mulholland, J., Sluder, H. L., Crean, A., & Cerruto, A. (2022). The impact of imitation on engagement in minimally verbal children with autism during improvisational music therapy. Nordic Journal of Music Therapy, 31(1), 44-62. https://doi.org/10.1 080/08098131.2021.1924843
Centers for Disease Control and Prevention. (2022). Screening and diagnosis of autism spectrum disorder. Centers for Disease Control and Prevention. https://www.cdc. gov/ncbddd/autism/screening.html#:~:text=ASD%20 can%20sometimes%20be%20detected,they%20are%20 adolescents%20or%20adults
Crane, H. (2015). Music therapy and the treatment of children diagnosed with autism spectrum disorder. Lucerna, 10, 110-120. https://hdl.handle.net/10355/48998
Daveson, B. A. (2001). Empowerment: An intrinsic process and consequence of music therapy practice. Australian Journal of Music Therapy, 12, 29-38.
Dekker, L., Hooijman, L., Louwerse, A., Visser, K., Bastiaansen, D., Hoopen, L. T., Nijs, P. D., Dieleman, G., Ester, W., Rijen, S.V., Truijens, F., & Hallen, R. V. (2022). Impact of the COVID-19 pandemic on children and adolescents with autism spectrum disorder and their families: A mixed-methods study protocol. British Medical Association Open Access, 12, 1-9. https://doi.org/10.1136/ bmjopen-2021-049336
Emerson, E., Fortune, N., Llewellyn, G., & Stancliffe, R. (2021). Loneliness, social support, social isolation and wellbeing among working age adults with and without disability: Cross-sectional study. Disability and Health Journal, 14(1), 1-7.
Geretsegger, M., Holck, U., & Gold, C. (2012). Randomised controlled trial of improvisational music therapy’s effectiveness for children with autism spectrum disorders (TIME-A): Study protocol. BMC Pediatrics, 12(2), 1-9. https://doi.org/10.1186/1471-2431-12-2
Geretsegger, M., Elefant, C., Mössler, K. A., & Gold, C. (2014). Music therapy for people with autism spectrum disorder. The Cochrane Database of Systematic Reviews, 2014(6), 1-20. https://doi.org/10.1002/14651858.CD004381.pub3
Geretsegger, M., Holck, U., Carpente, J. A., Elefant, C., Kim, J., & Gold, C. (2015). Common characteristics of improvisational approaches in music therapy for children with autism spectrum disorder: Developing treatment guidelines. Journal of Music Therapy, 52(2), 258-281. https://doi.org/10.1093/jmt/thv005
Hernandez-Ruiz, E. (2021). Parent-mediated music interventions with children with ASD: A systematic review. Review Journal of Autism and Developmental Disorders, 8(4), 403-420.
Herzog, A. R., Ofstedal, M. B., & Wheeler, L. M. (2002). Social engagement and its relationship to health. Clinics in Geriatric Medicine, 18(3), 593–609. https://doi. org/10.1016/s0749-0690(02)00025-3
Hiller, J. (2009). Use of and instruction in clinical improvisation. Music Therapy Perspectives, 27(1), 25-32. https://doi. org/10.1093/mtp/27.1.25
Hirsch, S., & Meckes, D. (2000). Treatment of the whole person: incorporating emergent perspectives in collaborative medicine, empowerment, and music therapy. Journal of Psychosocial Oncology, 18(2), 65-77.
Jadhav, M., & Schaepper, M.A. (2021). What is autism spectrum disorder? American Psychiatric Association. https://www. psychiatry.org/patients-families/autism/what-is-autismspectrum-disorder
Juslin, P. N., & Sakka, L. S. (2019). Neural correlates of music
and emotion. In M. H. Thaut & D. A. Hodges (Eds.), The Oxford handbook of music and the brain (pp. 285–332). Oxford University Press.
Kiely, D. K., & Flacker, J. M. (2003). The protective effect of social engagement on 1-year mortality in a long-stay nursing home population. Journal of Clinical Epidemiology, 56(5), 472–478. https://doi.org/10.1016/s0895-4356(03)00030-1
Kim, J. (2006). The effects of improvisational music therapy on joint attention behaviors in children with autistic spectrum disorder. Unpubl. Ph.D thesis. Denmark: Aalborg University.
Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: A randomized controlled study. Journal of Autism and Developmental Disorders, 38(9), 1758-1766. https://doi.org/10.1007/s10803-008-0566-6
Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism, 13(4), 389-409. https://doi.org/10.1177/1362361309105660
LaGasse, B. (2017). Social outcomes in children with autism spectrum disorder: A review of music therapy outcomes. Patient Related Outcome Measures, 2017(8), 23-32. https:// doi.org/10.2147/prom.s106267
Landa, R. (2007). Early communication development and intervention for children with autism. Mental Retardation and Developmental Disabilities Research Reviews, 13(1), 1625. http://doi.org/10.1002/mrdd.20134
Lee, I., & Kim, Y. (2021). A structural analysis of variables related to therapeutic outcomes as perceived by music therapists and clients in guided imagery and music. The Arts in Psychotherapy, 74, 1-10. https://doi.org/10.1016/j. aip.2021.101785
Magill, L. (2009). Caregiver empowerment and music therapy: Through the eyes of bereaved caregivers of advanced cancer patients. Journal of Palliative care, 25(1), 68-75.
Mayer-Benarous, H., Benarous, X., Vonthron, F., & Cohen, D. (2021). Music therapy for children with autistic spectrum disorder and/or other neurodevelopmental disorders: A systematic review. Frontiers in Psychiatry, 12(643234), 1-21. http://doi.org/10.3389/fpsyt.2021.643234
Mayo Clinic. (2018). Autism spectrum disorder. https://www. mayoclinic.org/diseases-conditions/autism-spectrumdisorder/symptoms-cau ses/syc-20352928
Menke, B. M., Hass, J., Diener, C., & Pöschl, J. (2021). Familycentered music therapy—Empowering premature infants and their primary caregivers through music: Results of a pilot study. PloS One, 16(5), e0250071.
Mössler, K., Schmid, W., Aßmus, J., Fusar-Poli, L., & Gold, C. (2020). Attunement in music therapy for young children with autism: Revisiting qualities of relationship as mechanisms of change. Journal of Autism and Developmental Disorders, 50, 3921-3934. https://doi. org/10.1007/s10803-020-04448-w
National Institute of Health (2021, April 9). Early intervention for autism. https://www.nichd.nih.gov/health/topics/autism/ conditioninfo/treatments/early-interventi on
Nicholson, J. M., Berthelsen, D., Abad, V., Williams, K., & Bradley, J. (2008). Impact of music therapy to promote positive parenting and child development. Journal of Health Psychology, 13(2), 226-238.
Nordoff-Robbins Center for Music Therapy (n.d.). NYU | Steinhardt. https://steinhardt.nyu.edu/nordoff/research
Pasiali V. (2012). Supporting parent-child interactions: music therapy as an intervention for promoting mutually responsive orientation. Journal of music therapy, 49(3), 303–334. https://doi.org/10.1093/jmt/49.3.303
Pavlicevic, M. (2000). Improvisation in music therapy: Human communication in sound. Journal of Music Therapy, 37(4), 269-285. https://doi.org/10.1093/jmt/37.4.269
Perkins, R., Mason-Bertrand, A., Fancourt, D., Baxter, L., & Williamon, A. (2020). How participatory music engagement supports mental well-being: A metaethnography. Qualitative Health Research, 30(12), 19241940. https://doi.org/10.1177/1049732320944142
Reschke-Hernandez, A. E. (2011). History of music therapy treatment interventions for children with autism. Journal of Music Therapy, 48(2), 169-207. https://doi.org/10.1093/ jmt/48.2.169
Ritholz, M. S. (2014). The primacy of music and musical resources in Nordoff-Robbins music therapy. Music Therapy Perspectives, 32(1), 8-17. https://doi.org/10.1093/ mtp/miu017
Rolvsjord, R. (2009). Therapy as Empowerment: Clinical and political implications of empowerment philosophy in mental health practises of music therapy. Nordic Journal of Music Therapy, 13(2), 99-111. https://doi. org/10.1080/08098130409478107
Sacks, O. (2008). Keeping time: Rhythm and movement. In Musicophilia: Tales of music and the Brain (1st ed., pp. 233245). Alfred A. Knopf.
Silveira-Zaldivar, T., Özerk, G., & Özerk, K. (2021). Developing social skills and social competence in children with autism. International Electronic Journal of Elementary Education, 13(3), 341-363. https://doi.org/10.26822/iejee.2021.195
Silverman, M. J. (2019). Music therapy and therapeutic alliance in adult mental health: A qualitative investigation. Journal of Music Therapy, 56(1), 90-116.
Stamenovic, M. (2010). Engagement in music therapy: A detailed study of communication between the therapist and client presenting with severe and multiple handicaps. Victoria University of Wellington Library. http://dx.doi. org/10.26686/wgtn.16973986.v1.
Thompson, G. A., McFerran, K., S., & Gold, C. (2013). Familycentred music therapy to promote social engagement in young children with severe autism spectrum disorder: A randomized controlled study. Child: Care, Health and Development, 40(6), 840-852. https://doi.org/10.1111/
cch.12121
Trevarthen, C., & Malloch, S. N. (2000). The dance of wellbeing: Defining the musical therapeutic effect. Norsk Tidsskrift for Musikkterapi, 9(2), 3-17. https://doi. org/10.1080/08098130009477996
U.S. Department of Health & Human Services. (2020, November 4). Autism awareness and acceptance in early childhood education. https://www.acf.hhs.gov/archive/ecd/childhealth-development/asd
Vasa, R.A., Singh, V., Holingue, C., Kalb, L.G., Jang, Y. & Keefer, A. (2021). Psychiatric problems during the COVID-19 pandemic in children with autism spectrum disorder. International Society for Autism Research, 14(10), 21132119. https://doi.org/10.1002/aur.2574
Vernon, T. W., Koegel, R. L., Dauterman, H., & Stolen, K. (2012). An early social engagement intervention for young children with autism and their parents. Journal of Autism and Developmental Disorders, 42(12), 2702-2717. https:// doi.org/10.1007/s10803-012-1535-7
Weiss, M. J., & Harris, S. L. (2001). Teaching social skills to people with autism. Behavior Modification, 25(5), 785-802. https://doi.org/10.1177/0145445501255007
Whipple, J. (2004). Music in intervention for children and adolescents with autism: A meta-analysis. Journal of Music Therapy, 41(2), 90-106. https://doi.org/10.1093/jmt/41.2.90
White, S. W., Keonig, K., & Scahill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the intervention research. Journal of Autism and Developmental Disorders, 37(10), 1858-1868. https:// doi.org/10.1007/s10803-006-0320-x
Wigram, T., & Gold, C. (2006). Music therapy in the assessment and treatment of autistic spectrum disorder: Clinical application and research evidence. Child: Care, Health and Development, 32(5), 535-542. https://doi.org/10.1111/ j.1365-2214.2006.00615.x
Williams, K. E., & Berthelsen, D. (2019). Implementation of a rhythm and movement intervention to support self-regulation skills of preschool-aged children in disadvantaged communities. Psychology of Music, 47(6), 800-820. https://doi.org/10.1177/0305735619861433
Woodward, A. (2004). Music therapy for autistic children and their families: a creative spectrum. British Journal of Music Therapy, 18(1), 8-14.
World Health Organization. (2022). Autism. https://www. who.int/news-room/fact-sheets/detail/autism-spectrumdisorders#:~:text=A
Q0. Can you describe the goals of music therapy for your clients and their diagnoses?
Q1. During your sessions with your client, what do you generally notice as a common pattern that comes up during the sessions?
Q2. How do you recognize music engagement in your sessions?
Q3. How do you personally define music engagement?
Q4. How would you describe your client’s music engagement in your sessions? Q5. How important is music engagement in your music therapy sessions with your client?
Q6. How important is music engagement for your client’s personal experience with music therapy?
Q7. Do you have any previous experience with autistic clients in this age group that could be helpful for us to know about music engagement?
Q8. Is there anything else you would like to share about this topic?
College is a transformational period that brings new experiences and challenges to students (Burgstahler & Stenson, 2019; Falsafi, 2016; Shearer et al., 2016; Vidic, 2021). They are required to adjust to changes, adapt to new roles and lifestyles, manage multiple responsibilities, and maintain interpersonal relationships (Crowley et al., 2020; Falsafi, 2016; Shearer et al., 2016; Vidic, 2021), along with navigating academic tasks and achieving academic success (Tadese et al., 2022; Tentama & Abdillah, 2019). However, the demanding and stressful nature of college life, along with limited access to support from parents and old friends, often results in overall poor mental health among students (Falsafi, 2016; Shearer et al., 2016; Vidic, 2021). For example, recent research has highlighted an increase in depressive symptoms and anxiety among college students (Goodwin et al., 2022; Mayo Clinic, 2022), which, in turn, result in poor academic performance (Mihăilescu et al., 2016; Owens et al., 2012). Notably, recent work has suggested that mindfulnessbased meditation is beneficial for improving college students’ academic performance and psychological functioning (Flett et al., 2018; Lin & Mai, 2018; Parmentier et al., 2019; Quach et al., 2016; Vidic, 2021). Therefore, this literature review explored the following research question: How does practicing mindfulnessbased meditation benefit college students cognitively and psychologically?
When engaging in mindfulness-based meditation, the practitioner must focus attention on the present in a nonjudgmental way (Kabat-Zinn, 2003; Kabat-Zinn et al., 1992). Thus, it is not surprising that it is effective in improving concentration through reducing mind-wandering (Beck et al., 2017; Bennike et al., 2017; Mrazek et al., 2013; Rahl et al., 2017). Those who regularly practice mindfulness-based meditation tend to develop an enhanced awareness of their surrounding environment and better attentional monitoring abilities (Bennike et al., 2017; Mrazek et al.; 2013; Rahl et al., 2017; Wang et al., 2017). By sharpening these abilities, mindfulness-based meditation also fosters better working memory (Mrazek et al., 2013; Quach et al., 2016; Youngs et al., 2021). As a result, more cognitive resources can be freed up from processing irrelevant information to better engage in tasks at hand, which is related to higher quality of information processing (Mrazek et al., 2013; Quach et al., 2016).
In particular, mind-wandering during lectures is common among college students, especially with the distractions resulting from the presence of smartphones and other electronic devices (Stothart et al., 2015; Sumuer & Kasikci, 2022; Unsworth &
McMillan, 2017). Mind-wandering prevents college students from fully engaging with course material and interferes with their information processing, which, in turn, compromises their absorption of lecture content (Klinger, 2013; Sumuer & Kasikci, 2022; Wammes et al., 2016). With better attention control abilities, college students are more able to refocus their attention on tasks at hand effectively with improved concentration and higher engagement (Bennike et al., 2017; Kerrigan et al., 2017; Mrazek et al.; 2013). At the same time, improved working memory as a result of mindfulness-based meditation also allows college students to more effectively absorb the lecture content, and hence achieve better academic performance (Bóo et al., 2020; Mrazek et al., 2013; Quach et al., 2016).
In addition to improving task performance, mindfulnessbased meditation also helps people curb rumination, which is the process of having repeated thoughts about past negative experiences (Desrosiers et al., 2013; Edenfield & Saeed, 2012; Kropp & Sedlmeier, 2019; Shahar et al., 2010; Parmentier et al., 2019). Enhanced attention control can reduce rumination by helping people recognize their fixation on past negative events and redirect their attention toward other things (Burg & Michalak, 2010; Deng et al., 2014; Desrosiers et al., 2013; Parmentier et al., 2019; Shahar et al., 2010). Furthermore, enhanced attention control also facilitates cognitive reappraisal (i.e., reframing experiences and assigning them new meaning), which increases people’s awareness of their negative thoughts (Cerna et al., 2019; Desrosiers et al., 2013; Parmentier et al., 2019). It helps people recognize instances where they are selfblaming for failures and prompt them to intentionally seek out positive alternative ways to reinterpret negative events (Desrosiers et al., 2013; Garland et al., 2015; Parmentier et al., 2019). In addition, mindfulness-based meditation asks them to be less judgmental and more accepting of their feelings, thereby developing self-compassion, or the ability to treat themselves with understanding and care (Diedrich et al., 2016; Kropp & Sedlmeier, 2019; Shearer et al., 2016; Van Dam et al., 2013).
Cultivation of healthy emotional responses is particularly important to college students as they are transitioning from high school to adulthood (Falsafi, 2016; Schulenberg et al., 2004; Vidic, 2021). This transition involves being exposed to new experiences and challenges, along with abrupt changes in environment and social networks (Dutta et al., 2018; Falsafi, 2016; Schulenberg et al., 2004). These abrupt changes often bring great pressure and make college students more prone to experiencing negative emotions as a result of failing to make adjustments
(Dutta et al., 2018; Falsafi, 2016). Under these circumstances, mindfulness-based meditation serves as an effective practice for college students to cultivate adaptive emotional responses to negative events to better navigate through stressful life (Cerna et al., 2019; Desrosiers et al., 2013; Dvořáková et al., 2017; Falsafi, 2016; Parmentier et al., 2019). As a result of their mindfulnessbased meditation, college students can better identify when they use maladaptive coping strategies to respond to negative events, such as academic or relationship failures, and try to correct it by either switching to other more enjoyable activities or finding positive way to interpret the events (Cerna et al., 2019; Desrosiers et al., 2013; Parmentier et al., 2019; Shearer et al., 2016).
Practicing mindfulness-based meditation offers a variety of benefits to help college students adapt to stressful college life, such as improving academic performance and psychological functioning (Bóo et al., 2020; Cerna et al., 2019; Falsafi, 2016; Parmentier et al., 2019). The improved attention control abilities can be transferred to higher engagement in academic settings and to more flexibility in response to negative events (Bóo et al., 2020; Desrosiers et al., 2013; Parmentier et al., 2019; Quach et al., 2016). The techniques of mindfulness-based meditation are relatively easy to grasp, so college students can learn them on their own, using trainings that are publicly available online (Falsafi, 2016; Fish & Saul, 2019; Flett et al., 2018; Lattie et al., 2019). Another benefit of mindfulness-based meditation is that it relieves negative emotions and cultivates healthier responses without necessitating the supervision of trained professionals (Falsafi, 2016; Parmentier et al., 2019; Fish & Saul, 2019; Flett et al., 2018). Furthermore, mindfulness-based meditation is not time-consuming, as it can typically be completed in as little as 15 minutes a day, and can be done while walking or engaging in basic household tasks (Burgstahler & Stenson, 2019; Cerna et al., 2020; Falsafi, 2016; Hofmann & Gómez, 2017; Owens & Bunce, 2022; Vidic, 2021). Therefore, college students can easily integrate mindfulness-based meditation into their life by utilizing their fragmented time to practice (Burgstahler & Stenson, 2019; Falsafi, 2016; Owens & Bunce, 2022).
References
Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about Depression and its Impact on HelpSeeking Intentions. Australian and New Zealand Journal of Psychiatry, 40(1), 51–54. https://doi.org/10.1080/j.14401614.2006.01741.x
Bennike, I. H., Wieghorst, A., & Kirk, U. (2017). Online-based mindfulness training reduces behavioral markers of mind wandering. Journal of Cognitive Enhancement, 1(2), 172–181. https://doi.org/10.1007/s41465-017-0020-9
Bluth, K., & Blanton, P. W. (2013). Mindfulness and selfcompassion: Exploring pathways to adolescent emotional well-being. Journal of Child and Family Studies, 23(7), 1298–1309. https://doi.org/10.1007/s10826-013-9830-2
Bóo, S. J. M., Childs-Fegredo, J., Cooney, S., Datta, B., Dufour, G., Jones, P. B., & Galante, J. (2020). A follow‐up study to a randomised control trial to investigate the perceived impact of mindfulness on academic performance in university students. Counseling and Psychotherapy Research, 20(2), 286–301. https://doi.org/10.1002/capr.12282
Bostock, S., Crosswell, A. D., Prather, A. A., & Steptoe, A. (2019). Mindfulness on-the-go: Effects of a mindfulness meditation app on work stress and well-being. Journal of Occupational Health Psychology, 24(1), 127–138. https:// doi.org/10.1037/ocp0000118
Burg, J. M., & Michalak, J. (2010). The healthy quality of mindful breathing: Associations with rumination and depression. Cognitive Therapy and Research, 35(2), 179–185. https:// doi.org/10.1007/s10608-010-9343-x
Burgstahler, M. S., & Stenson, M. C. (2019). Effects of guided mindfulness meditation on anxiety and stress in a prehealthcare college student population: a pilot study. Journal of American College Health, 68(6), 666–672. https://doi.org /10.1080/07448481.2019.1590371
Cerna, C., García, F. E., & Téllez, A. (2019). Brief mindfulness, mental health, and cognitive processes: A randomized controlled trial. PsyCh Journal, 9(3), 359–369. https://doi. org/10.1002/pchj.325
Conway, A. R. A., Kane, M. J., & Engle, R. W. (2003). Working memory capacity and its relation to general intelligence. Trends in Cognitive Sciences, 7(12), 547–552. https://doi. org/10.1016/j.tics.2003.10.005
Crowley, C., Kapitula, L. R., & Munk, D. (2020). Mindfulness, happiness, and anxiety in a sample of college students before and after taking a meditation course. Journal of American College Health, 70(2), 493–500. https://doi.org/ 10.1080/07448481.2020.1754839
Crowley, C., & Munk, D. (2017). An examination of the impact of a college level meditation course on college student wellbeing. College Student Journal, 51(1), 91–98. https://eric. ed.gov/?id=EJ1132231
Deng, Y. Q., Li, S., & Tang, Y. Y. (2012). The relationship between wandering mind, depression and mindfulness. Mindfulness, 5(2), 124–128. https://doi.org/10.1007/s12671-012-0157-7
Desrosiers, A., Vine, V., Klemanski, D. H., & Nolen-Hoeksema, S.
(2013). Mindfulness and emotion regulation in depression and anxiety: Common and distinct mechanisms of action. Depression and Anxiety, 30(7), 654–661. https://doi. org/10.1002/da.22124
Diedrich, A., Burger, J., Kirchner, M., & Berking, M. (2016). Adaptive emotion regulation mediates the relationship between self-compassion and depression in individuals with unipolar depression. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 247–263. https://doi. org/10.1111/papt.12107
Dutta, M. J., Jin, L., & Collins, W. J. (2018). College life is stressful today – Emerging stressors and depressive symptoms in college students. Journal of American College Health, 66(7), 655–664. https://doi.org/10.1080/07448481.2018.1451869
Dvořáková, K., Kishida, M., Li, J., Elavsky, S., Broderick, P. A., Agrusti, M. R., & Greenberg, M. T. (2017b). Promoting healthy transition to college through mindfulness training with first-year college students: Pilot randomized controlled trial. Journal of American College Health, 65(4), 259–267. https://doi.org/10.1080/07448481.2017.1278605
Edenfield, T. M., & Saeed, S. A. (2012). An update on mindfulness meditation as a self-help treatment for anxiety and depression. Psychology Research and Behavior Management, 131. https://doi.org/10.2147/prbm.s34937
Eisenberg, D., Hunt, J., Speer, N. K., & Zivin, K. (2011). Mental health service utilization among college students in the United States. Journal of Nervous and Mental Disease, 199(5), 301–308. https://doi.org/10.1097/ nmd.0b013e3182175123
Falsafi, N. (2016). A randomized controlled trial of mindfulness versus yoga. Journal of the American Psychiatric Nurses Association, 22(6), 483–497. https://doi. org/10.1177/1078390316663307
Fish, M. T., & Saul, A. D. (2019). The gamification of meditation: A randomized-controlled study of a prescribed mobile mindfulness meditation application in reducing college students’ depression. Simulation & Gaming, 50(4), 419–435. https://doi.org/10.1177/1046878119851821
Flett, J. A. M., Hayne, H., Riordan, B. C., Thompson, L. M., & Conner, T. S. (2018). Mobile mindfulness meditation: A randomized controlled trial of the effect of two popular apps on mental health. Mindfulness, 10(5), 863–876. https://doi.org/10.1007/s12671-018-1050-9
Gallego, J., Aguilar-Parra, J. M., Cangas, A. J., Langer, L. I., & Mañas, I. (2014). Effect of a mindfulness program on stress, anxiety and depression in university students. The Spanish Journal of Psychology, 17. https://doi.org/10.1017/ sjp.2014.102
Garland, E. L., Hanley, A., Farb, N. A., & Froeliger, B. (2015). State mindfulness during meditation predicts enhanced cognitive reappraisal. Mindfulness, 6(2), 234–242. https:// doi.org/10.1007/s12671-013-0250-6
prevalence from 2015 to 2020: The widening treatment gap. American Journal of Preventive Medicine, 63(5), 726–733. https://doi.org/10.1016/j.amepre.2022.05.014
Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-based interventions for anxiety and depression. Psychiatric Clinics of North America, 40(4), 739–749. https://doi. org/10.1016/j.psc.2017.08.008
Holland, D. L., & Wheeler, H. (2016). College Student Stress and Mental Health: Examination of Stigmatic Views on Mental Health Counseling. Michigan Sociological Review, 30, 16.
Huberty, J., Green, J., Glissmann, C., Larkey, L., Puzia, M. E., & Lee, C. S. (2019). Efficacy of the mindfulness meditation mobile App “Calm” to reduce stress among college students: randomized controlled trial. Jmir Mhealth and Uhealth, 7(6). https://doi.org/10.2196/14273
Kabat-Zinn, J. (2003). Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical PsychologyScience and Practice, 10(2), 144–156. https://doi. org/10.1093/clipsy/bpg016
Kabat-Zinn, J., Massion, A. O., Kristeller, J. L., Peterson, L. R., Fletcher, K. E., Pbert, L., Lenderking, W. R., & Santorelli, S. F. (1992a). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149(7), 936–943. https:// doi.org/10.1176/ajp.149.7.936
Kerrigan, D., Chau, V., King, M. A., Holman, E. S., Joffe, A., & Sibinga, E. M. (2017). There is no performance, there is just this moment: The role of mindfulness instruction in promoting health and well-being among students at a highlyranked University in the United States. Journal of EvidenceBased Complementary & Alternative Medicine, 22(4), 909–918. https://doi.org/10.1177/2156587217719787
Klinger, E. (2013). Goal commitments and the content of thoughts and dreams: basic principles. Frontiers in Psychology, 4, 415.
Kropp, A., & Sedlmeier, P. (2019). What makes mindfulnessbased interventions effective? An examination of common components. Mindfulness, 10(10), 2060–2072. https://doi. org/10.1007/s12671-019-01167-x
Lattie, E. G., Lipson, S. K., & Eisenberg, D. (2019). Technology and college student mental health: Challenges and opportunities. Frontiers in Psychiatry, 10. https://doi. org/10.3389/fpsyt.2019.00246
Lin, J., & Mai, L. J. (2018). Impact of mindfulness meditation intervention on academic performance. Innovations in Education and Teaching International, 55(3), 366–375. https://doi.org/10.1080/14703297.2016.1231617
Lo, C. S. L., Ho, S. B., & Hollon, S. D. (2010). The effects of rumination and depressive symptoms on the prediction of negative attributional style among college students. Cognitive Therapy and Research, 34(2), 116–123. https:// doi.org/10.1007/s10608-009-9233-2
Mayo Clinic. (2022a, December 7). College students and depression: A guide for parents. https://www.
mayoclinichealthsystem.org/hometown-health/speakingof-health/college-students-and-depression#:~:text=A%20 recent%20study%20found%20that,identification%20 and%20treatment%20of%20depression.
Marsh, C. N., & Wilcoxon, S. A. (2015). Underutilization of mental health services among college students: An examination of system-related barriers. Journal of College Student Psychotherapy, 29(3), 227–243. https://doi.org/10. 1080/87568225.2015.1045783
Mihăilescu, A., Diaconescu, L., Ciobanu, A. A., Donisan, T., & Mihailescu, C. (2016). The impact of anxiety and depression on academic performance in undergraduate medical students. European Psychiatry. https://doi.org/10.1016/j. eurpsy.2016.01.761
Mowbray, C. T., Megivern, D., Mandiberg, J. M., Strauss, S., Stein, C. M., Collins, K. A., Kopels, S., Curlin, C., & Lett, R. W. (2006). Campus mental health services: Recommendations for change. American Journal of Orthopsychiatry, 76(2), 226–237. https://doi.org/10.1037/0002-9432.76.2.226
Mrazek, M. D., Franklin, M. S., Phillips, D. T., Baird, B., & Schooler, J. W. (2013). Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering. Psychological Science, 24(5), 776–781. https://doi.org/10.1177/0956797612459659
Owens, M., & Bunce, H. L. I. (2022). Nature-based meditation, rumination and mental wellbeing. International Journal of Environmental Research and Public Health, 19(15), 9118. https://doi.org/10.3390/ijerph19159118
Parmentier, F. B. R., García-Toro, M., García-Campayo, J., Yañez, A. M., Andrés, P., & Gili, M. (2019). Mindfulness and symptoms of depression and anxiety in the general population: The mediating roles of worry, rumination, reappraisal and suppression. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00506
Pompeo-Fargnoli, A. (2020). Mental health stigma among college students: misperceptions of perceived and personal stigmas. Journal of American College Health, 70(4), 1030–1039. https://doi.org/10.1080/07448481.2020.1784904
Quach, D., Mano, K. E. J., & Alexander, K. (2016). A randomized controlled trial examining the effect of mindfulness meditation on working memory capacity in adolescents. Journal of Adolescent Health, 58(5), 489–496. https://doi. org/10.1016/j.jadohealth.2015.09.024
Rahl, H. A., Lindsay, E. K., Pacilio, L. E., Brown, K. W., & Creswell, J. D. (2017). Brief mindfulness meditation training reduces mind wandering: The critical role of acceptance. Emotion, 17(2), 224–230. https://doi.org/10.1037/emo0000250
Salzer, M. S. (2012). A comparative study of campus experiences of college students with mental illnesses versus a general college sample. Journal of American College Health, 60(1), 1–7. https://doi.org/10.1080/07448481.2011.552537
Schulenberg, J. E., Sameroff, A. J., & Cicchetti, D. (2004). The transition to adulthood as a critical juncture in the course of psychopathology and mental health. Development
and Psychopathology, 16(04). https://doi.org/10.1017/ s0954579404040015
Shahar, B., Britton, W. B., Sbarra, D. A., Figueredo, A. J., & Bootzin, R. R. (2010). Mechanisms of change in mindfulness-based cognitive therapy for depression: Preliminary evidence from a randomized controlled trial. International Journal of Cognitive Therapy, 3(4), 402–418. https://doi.org/10.1521/ijct.2010.3.4.402
Shearer, A., Hunt, M., Chowdhury, M., & Nicol, L. (2016). Effects of a brief mindfulness meditation intervention on student stress and heart rate variability. International Journal of Stress Management, 23(2), 232–254. https://doi. org/10.1037/a0039814
Stothart, C., Mitchum, A., & Yehnert, C. (2015). The attentional cost of receiving a cell phone notification. Journal of Experimental Psychology: Human Perception and Performance, 41(4), 893–897. https://doi.org/10.1037/
xhp0000100
Sumuer, E., & Kasikci, D. (2022). The role of smartphones in college students’ mind-wandering during learning. Computers & Education, 190, 104616. https://doi. org/10.1016/j.compedu.2022.104616
Tadese, M., Yeshaneh, A., & Mulu, G. B. (2022). Determinants of good academic performance among university students in Ethiopia: a cross-sectional study. BMC Medical Education, 22(1), 395. https://doi.org/10.1186/s12909-022-03461-0
Tentama, F., & Abdillah, M. H. (2019). Student employability examined from academic achievement and self-concept. International Journal of Evaluation and Research in Education, 8(2), 243. https://doi.org/10.11591/ijere.
v8i2.18128
Tjia, J., Givens, J. L., & Shea, J. A. (2005). Factors associated with undertreatment of medical student depression. Journal of American College Health, 53(5), 219–224. https://doi. org/10.3200/jach.53.5.219-224
Unsworth, N., & McMillan, B. D. (2017). Attentional disengagements in educational contexts: A diary investigation of everyday mind-wandering and distraction. Cognitive Research: Principles and Implications, 2(1). https://doi.org/10.1186/s41235-017-0070-7
Van Dam, N. T., Hobkirk, A. L., Sheppard, S. C., Aviles-Andrews, R., & Earleywine, M. (2013). How does mindfulness reduce anxiety, depression, and stress? An exploratory examination of change processes in wait-list controlled mindfulness meditation training. Mindfulness, 5(5), 574–588. https://doi.org/10.1007/s12671-013-0229-
Vidic, Z. (2021). Multi-year investigation of a relaxation course with a mindfulness meditation component on college students’ stress, resilience, coping and mindfulness. Journal of American College Health, 1–6. https://doi.org/10.1080/0
7448481.2021.1987918
Wammes, J. D., Seli, P., Cheyne, J. A., Boucher, P., & Smilek, D. (2016). Mind wandering during lectures II: Relation to academic performance. Scholarship of Teaching
and Learning in Psychology, 2(1), 33–48. https://doi. org/10.1037/stl0000055
Wang, Y., Xu, W., Zhuang, C., & Liu, X. (2017). Does mind wandering mediate the association between mindfulness and negative mood? A preliminary study. Psychological Reports, 120(1), 118–129. https://doi. org/10.1177/0033294116686036
Youngs, M. A., Lee, S. E., Mireku, M. O., Sharma, D., & Kramer, R. S. S. (2021). Mindfulness meditation improves visual short-term memory. Psychological Reports, 124(4), 1673–1686. https://doi.org/10.1177/0033294120926670
Traditionally, trauma has been associated with a host of negative outcomes, such as persistent fatigue, sleep disorders, emotional dysregulation, and cognitive distortions (Center for Substance Abuse Treatment U.S., 2014). Yet, in recent years, researchers exploring psychological trauma have begun to highlight some of the adaptive outcomes resulting from a traumatic experience, such as the development of psychological resilience (Atkinson et al., 2009), increased empathy (Greenberg et al., 2018), and posttraumatic growth (Tedeschi & Calhoun, 2009). For the past 17 years, Clinical Psychologist Dr. Anthony Mancini, a researcher and professor at Pace University, has been investigating the adaptive functions psychological distress can have, namely how trauma and acute stress can foster social interaction. In other words, Dr. Mancini argues that under certain circumstances, the psychological stress and trauma experienced during adverse events can be a driving force in promoting social connection, leading to increased resiliency and psychosocial gains (Mancini, 2019). To better understand the nuances of trauma and stress responses, Dr. Mancini was interviewed about his recent research.
What made you start studying stress/trauma responses?
It was primarily George Bonanno, who was a professor in the Columbia PhD program. He did, at the time, very contrarian and skeptical research that challenged the assumptions about how people respond to trauma and loss. He was really a pioneer in that, and so I learned a lot from him, and thus I became interested in research. Eventually, he took me on and, actually, I was his first doctoral student – he took me on as a post-doc in his lab. I didn’t feel inherently pulled toward that [trauma and loss], but he made it really interesting. His work excited my interest and that was primarily what pushed me in that direction.
What is your favorite aspect of your research? What excites you about it?
So, I started by looking at the range of responses to trauma, that’s the work I did with George. And you end up with what he describes as prototypical patterns: most people are resilient, of course, they do fine, even through terrible events. Some struggle and get better. Some don’t get better, and they struggle with chronic distress. So I was interested in those patterns.
In the process of my research, I did a study on the Virginia Tech campus shootings, and we found a pattern of people who improved from before to after the shootings. About 10-15% of the sample showed a dramatic reduction in depression and anxiety. So that was very counterintuitive, and it turns out it was linked with the social environment. They clearly developed new social
resources as a result of the event, and this benefited, presumably, their psychological functioning. So I wanted to understand that better, and I was very much interested in the way that we react to stress, worry, tragedy, and disaster, in seeking out other people. I think that is a natural human tendency, and I think it has beneficial effects.
It tells us something important about human beings, and so that’s part of my interest. It touches on deeper questions about being human – our relationships with others, removing some of the noise and distraction and seeing to what ultimately matters. So that’s part of my curiosity in this kind of response, which I describe as “psychosocial gains from adversity.” It’s interesting that we assume stress will harm us, but it can have these paradoxical benefits.
And it works particularly at a group level, where people are now more willing to interact with each other. There’s kind of a shared sense of experience that they can use to relate to one another, perhaps to overcome barriers that may have existed before. I think it demonstrates some of the adaptive consequences of acute stressors.
How do you hope the work that you’re doing will impact the fields of psychology, mental health, counseling, etc? What do you hope, if someone were to read some of your work, to take from it and understand if they were going to put it into their own research or clinical practices?
I would say a more complex and nuanced understanding of the impact of trauma and acute stress – one that takes into account these surprising beneficial effects on social behavior and that considers the ways that stress has beneficial effects on people. There is an assumption about trauma, which is a very loaded word, that it dominates our lives, that it has all these subtle and not-so-subtle manifestations and that it’s a primary force in our psychological health, and I have very serious questions about if that’s true. So I think that viewing trauma in the round or in a more complex way, so that it’s understood to be a basic part of human experience that virtually everyone is going to go through in one way or another and that it doesn’t inherently scar us. So just to see it in a richer way, which again, is not to dispute that it can have serious negative consequences, it’s just to think of it in a slightly more complicated way.
As a final question, do you have any next steps for where you’re looking to go with your research?
I’m continuing to explore the circumstances that encourage people to interact under stress, and the nature of the stressor that can stimulate social behavior and the kinds of stressors that
don’t. It’s obvious that stress takes a variety of forms, and I think some tend to impel us towards others, others don’t. It’s certainly not my belief that stress is always good; we want some of it but we don’t want too much. So trying to better understand that link is important, and I’m actively trying to look at what the qualities and dimensions of stress are. Is it uncertainty? Is it stress in relation to other people? There’s a bunch of dimensions you can look at that might help to illuminate that link.
I’m also curious about the environment that people are in. Are there environments that tend to encourage that kind of behavior? I suspect there are. So I am interested in things that happen outside of people, that happen outside of their thoughts and preoccupations - things that aren’t strictly speaking psychological variables, but that exist in the world itself - and does that affect your propensity to interact with other people. How does that play a role in your own well-being or psychological functioning?
Conclusion
Dr. Mancini highlights the necessity of a more comprehensive understanding of trauma and acute stress’s impacts on psychological functioning. Rather than attributing a solely negative connotation to words like “trauma” and “stress,” he argues that adverse experiences should be viewed as expected parts of the human experience that can surely be detrimental, but may also be beneficial. For instance, a significant subset of trauma survivors develop an enhanced sense of resilience (Neuner, 2023), suggesting that under certain conditions, trauma and acute stress might result in adaptive outcomes for some individuals. Dr. Mancini’s research on the complexity of trauma does not delegitimize survivors’ experiences; rather, it suggests that, along with the negative outcomes, trauma and acute stress may result in psychological growth and the development of greater resilience. While the complexities of how trauma and acute stress impact psychological functioning remain, Dr. Mancini has been making great strides toward closing that gap. His innovative research challenges popular beliefs about these constructs and serves as a reminder that, especially in psychology, almost nothing is as one-sided as it might appear.
Atkinson, P. A., Martin, C. R., & Rankin, J. (2009). Resilience revisited. Journal of Psychiatric and Mental Health Nursing, 16(2), 137–145. https://doi.org/10.1111/j.13652850.2008.01341.x
Center for Substance Abuse Treatment U.S. (2014). Traumainformed care in behavioral health services. Substance Abuse and Mental Health Services Administration (US).
Greenberg, D. M., Baron-Cohen, S., Rosenberg, N., Fonagy, P., & Rentfrow, P. J. (2018). Elevated empathy in adults following childhood trauma. PloS One, 13(10), e0203886. https://doi. org/10.1371/journal.pone.0203886
Mancini, A. D. (2019). When acute adversity improves psychological health: A social-contextual framework. Psychological Review, 126(4), 486–505. https://doi. org/10.1037/rev0000144
Neuner, F. (2023). Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging. Clinical Psychology Review, 99(102219), 1–16. https://doi. org/10.1016/j.cpr.2022.102219
Tedeschi, R. G., & Calhoun, L. G. (2004). Target Article: “Posttraumatic growth: Conceptual foundations and empirical evidence.” Psychological Inquiry, 15(1), 1–18. https://doi.org/10.1207/s15327965pli1501_01
Each year, Japan experiences more than 1,500 earthquakes (World Vision, 2019). The 2011 Great East Japan Earthquake and the 1995 Great Hanshin Earthquake, with approximately 6,000 and 18,000 fatalities respectively, were amongst the most devastating, and have served as wake-up calls to the nation’s readiness and response to natural disasters (Goodwin et al., 2015; Uemoto et al., 2011). The majority of the research into the earthquakes tends to place emphasis on earthquake-resistant technological advancements in urban planning, rather than on mitigating psychological distress, such as Post Traumatic Stress Disorder (PTSD), after traumatic earthquake experiences (The Government of Japan, 2019). Yet, many survivors of the Great East Japan Earthquake and the Great Hanshin Earthquake continue to face psychological distress stemming from the traumatic experiences (Shigemura et al., 2021; The Japan Times, 2020, 2022). As a result, recent research in Japan has begun to explore how factors such as social support from different sources can help reduce the severity of PTSD symptoms of earthquake survivors (Honda et al., 2019; Kino et al., 2021). This paper, thus, explored the following research question: How does social support at the individual- and community-levels help mitigate the PTSD symptoms of Japanese earthquake survivors?
Social support at the individual level includes assistance from family and friends related to managing psychological distress during challenging times, and can help mitigate PTSD symptoms (e.g., hyperarousal) after experiencing a disaster (American Psychological Association [APA], n.d.b; Goodwin et al., 2015; Matsuyama et al., 2016). Immediate family and other relatives are the first place Japanese people go to for emotional support during times of need (Goto & Wilson, 2003). In times of distress, receiving emotional social support from immediate family and other relatives helps Japanese individuals to feel more encouraged and reassured (Ikeda, 2015). It is, thus, not surprising that research conducted in Japan has found that survivors of earthquakes and other natural disasters caused by earthquakes (e.g., tsunamis) who received social support from immediate family and other relatives soon after a traumatic experience were less likely to develop PTSD symptoms (Hikichi et al., 2016; Kino et al., 2021; Kwon et al., 2001; Teramoto et al., 2015). In turn, survivors with social support from their immediate family and other relatives were more likely to overcome their newly arisen challenges, such as adapting to temporary housing (Matsuyama et al., 2016).
Like family members, friends also play a significant role in an individual’s social support network (Hamamura,
2012). While immediate family and other relatives are often the primary source of social support for Japanese people, they also turn to close friends during difficult times (Harada et al., 2018). The evaluative support that friends provide through encouraging words can inspire those in crisis to carry on with their healing process (Ikeda, 2015). In fact, studies have shown that survivors of Japanese earthquakes who received social support from friends were more likely to cope with their PTSD symptoms (e.g., feeling isolated), than those who did not have social support from their friends (Kino et al., 2021; Kwon et al., 2001).
Social support at the community-level can also aid in the management of PTSD symptoms during difficult times (American Psychological Association [APA], n.d.b; Hikichi et al., 2016; Matsuyama et al., 2016). Similar to social support at the individual-level, community-level social support, including support from residents who live nearby, as well as from government agencies and programs, can lessen PTSD symptoms after a disaster by providing a larger scale of assistance to survivors (Matsuyama et al., 2016; Pike et al., 2021). Since Japan is a collectivist culture, Japanese people place a great emphasis on community-level social support in order to uphold their close social ties and promote group solidarity (Hikichi et al., 2016). This level of social support, often categorized as informational support, encourages the community to use its available resources and recover together as a society, building community resilience (Goodwin et al., 2015; Ikeda, 2015). Community resilience can help alleviate feelings of isolation and loneliness, which are prevalent PTSD symptoms (Hikichi et al., 2016; Matsuyama et al., 2016).
Furthermore, providing mutual assistance and instrumental support, such as exchanging information on where to gain food and water post earthquakes, ultimately enhance community resilience, helping mitigate survivors’ PTSD symptoms after experiencing a disaster (Ikeda, 2015; Kawachi & Berkman, 2014; Kino et al., 2021; Pike et al., 2021). As a result, survivors of earthquakes in Japan who relocated temporarily to prefabricated dwellings in affected areas due to losing their housing to earthquakes or tsunamis were less likely to develop PTSD, as they gained a robust social support system from living in communal housing where a tight-knit network of survivors and a sense of belonging and purpose were fostered (Kino et al., 2021; Koyama et al., 2014).
Overall, research on the 1995 Great Hanshin Earthquake and the 2011 Great East Japan Earthquake suggests that both individual-level and community-level social support are beneficial for Japanese earthquake survivors. More specifically, these forms of social support help to mitigate or address PTSD symptoms resulting from the trauma (Honda et al., 2019; Koyama et al., 2014; Teramoto et al., 2015). As the Japanese government postulated that there is 70% chance of Tokyo being struck again by an earthquake similar in magnitude to the 2011 Great East Japan Earthquake (The World, 2012), there should be a greater focus on developing prevention and intervention systems that draw on individual-level and community-level social supports to address future earthquake survivors’ development of PTSD symptoms (Kino et al., 2021).
Future studies should concentrate on how populations that depend significantly on their immediate families, such as the elderly, whose numbers are rising quickly in Japan, can benefit most from individual-level social support (Oe et al., 2017). To further understand the power of community-level social support, future disaster-related mental health crisis prevention studies should also explore how social support from international organizations (e.g., American Red Cross) might alleviate PTSD symptom development among natural disaster survivors in Japan. Finally, more research should examine how salient Japanese values (e.g., thinking of others before themselves) influence people’s provision of social support and, in turn, affect the development of PTSD symptoms (Sasaki et al., 2019).
Japan showed extraordinary resilience after the 2011 Great East Japan Earthquake and the 1995 Great Hanshin Earthquake; with an increase in social support research, the nation can further improve its capacity to heal and recover as a whole.
American Psychological Association. (n.d.a). Posttraumatic stress disorder. In APA dictionary of psychology. Retrieved from https://dictionary.apa.org/posttraumatic-stress-disorder
American Psychological Association. (n.d.b). Social support. In APA dictionary of psychology. Retrieved from https:// dictionary.apa.org/social-support
Goodwin, R., Takahashi, M., Sun, S., & Ben-Ezra, M. (2015). Psychological distress among tsunami refugees from the Great East Japan earthquake. BJPsych Open, 1(1), 92–97. https://doi.org/10.1192/bjpo.bp.115.000422
Goto, T., & Wilson, J. P. (2003). A review of the history of traumatic stress studies in Japan: From traumatic neurosis to PTSD. Trauma, Violence & Abuse, 4(3), 195–209. https:// doi.org/10.1177/1524838003004003001
Hamamura, T. (2012). Are cultures becoming individualistic? A cross-temporal comparison of individualism–collectivism in the United States and Japan. Personality and Social Psychology Review, 16(1), 3–24. https://doi. org/10.1177/1088868311411587
Harada, K., Sugisawa, H., Sugihara, Y., Yanagisawa, S., & Shimmei, M. (2018). Social support, negative interactions, and mental health: Evidence of cross-domain buffering effects among older adults in Japan. Research on Aging, 40(4), 388–405. https://doi.org/10.1177/0164027517701446
Hikichi, H., Aida, J., Tsuboya, T., Kondo, K., & Kawachi, I. (2016). Can community social cohesion prevent posttraumatic stress disorder in the aftermath of a disaster? A natural experiment from the 2011 Tohoku earthquake and tsunami. American Journal of Epidemiology, 183(10), 902–910. https://doi.org/10.1093/aje/kwv335
Honda, Y., Fujiwara, T., Yagi, J., Homma, H., Mashiko, H., Nagao, K., Okuyama, M., Ono-Kihara, M., & Kihara, M. (2019). Long-term impact of parental post-traumatic stress disorder symptoms on mental health of their offspring after the Great East Japan earthquake. Frontiers in Psychiatry, 10, 1–14. https://doi.org/10.3389/fpsyt.2019.00496
Ikeda, T. (2015) Can perceived social support buffer trauma impacts?: On the outcome of posttraumatic stress responses and dissociative tendencies. Graduate School of Humanities and Social Sciences, Hiroshima University, 3(64), 105–112.
Kanehara, A., Umeda, M., & Kawakami, N. (2015). Barriers to mental health care in Japan: Results from the World Mental Health Japan Survey. Psychiatry and Clinical Neurosciences, 69(9), 523–533. https://doi.org/10.1111/pcn.12267
Kawachi, I., & Berkman, L. F. (2014). Social cohesion, social capital, and health. In L.F. Berkman & I. Kawachi (Eds.), Social epidemiology (2nd ed., pp. 290–319). Oxford University Press.
Kawakami, N., Tsuchiya, M., Umeda, M., Koenen, K. C., Kessler, R. C., & World Mental Health Survey Japan (2014). Trauma and posttraumatic stress disorder in Japan: Results from the World Mental Health Japan Survey. Journal of Psychiatric Research, 53, 157–165. https://doi.org/10.1016/j. jpsychires.2014.01.015
Kikuzawa, S., Pescosolido, B., Kasahara-Kiritani, M., Matoba, T., Yamaki, C., & Sugiyama, K. (2019). Mental health care and the cultural toolboxes of the present-day Japanese population: Examining suggested patterns of care and their correlates. Social Science & Medicine, 228, 252–261. https://doi.org/10.1016/j.socscimed.2019.03.004
Kino, S., Aida, J., Kondo, K., & Kawachi, I. (2021). Persistent mental health impacts of disaster. Five-year follow-up after the 2011 Great East Japan earthquake and tsunami: Iwanuma study. Journal of Psychiatric Research, 136, 452–459. https://doi.org/10.1016/j.jpsychires.2020.08.016
Koyama, S., Aida, J., Kawachi, I., Kondo, N., Subramanian, S. V., Ito, K., Kobashi, G., Masuno, K., Kondo, K., & Osaka, K. (2014). Social support improves mental health among the victims relocated to temporary housing following the Great East Japan earthquake and tsunami. The Tohoku Journal of Experimental Medicine, 234(3), 241–247. https:// doi.org/10.1620/tjem.234.241
Kwon, Y. S., Maruyama, S., & Morimoto, K. (2001). Life events and posttraumatic stress in Hanshin-Awaji earthquake victims. Environmental Health and Preventive Medicine, 6(2), 97–103. https://doi.org/10.1007/BF02897953
Matsuyama, Y., Aida, J., Hase, A., Sato, Y., Koyama, S., Tsuboya, T., & Osaka, K. (2016). Do community- and individuallevel social relationships contribute to the mental health of disaster survivors? A multilevel prospective study after the Great East Japan earthquake. Social Science & Medicine, 151, 187–195. https://doi.org/10.1016/j. socscimed.2016.01.008
Mojaverian, T., Hashimoto, T., & Kim, H. S. (2013). Cultural differences in professional help seeking: A comparison of Japan and the U.S. Frontiers in Psychology, 3(615), 1–8. https://doi.org/10.3389/fpsyg.2012.00615
Motoo, Y., Seki, T., & Tsutani, K. (2011). Traditional Japanese medicine, Kampo: Its history and current status. Chinese Journal of Integrative Medicine, 17(2), 85–87. https://doi. org/10.1007/s11655-011-0653-y
Nagamine, M., Giltay, E. J., Shigemura, J., van der Wee, N. J., Yamamoto, T., Takahashi, Y., Saito, T., Tanichi, M., Koga, M., Toda, H., Shimizu, K., Yoshino, A., & Vermetten, E. (2020). Assessment of factors associated with longterm posttraumatic stress symptoms among 56388 first responders after the 2011 Great East Japan earthquake. The Journal of the American Medical Association Network Open, 3(9), 1–13. https://doi.org/10.1001/ jamanetworkopen.2020.18339
Nakane, Y., Jorm, A. F., Yoshioka, K., Christensen, H., Nakane, H., & Griffiths, K. M. (2005). Public beliefs about causes and risk factors for mental disorders: A comparison of Japan and Australia. BMC Psychiatry, 5(33), 1–9. https:// doi.org/10.1186/1471-244X-5-33
Oe, M., Takahashi, H., Maeda, M., Harigane, M., Fujii, S., Miura, I., Nagai, M., Yabe, H., Ohira, T., Suzuki, Y., Yasumura, S., & Abe, M. (2017). Changes of posttraumatic stress
responses in evacuated residents and their related factors. Asia-Pacific Journal of Public Health, 29, 182–192. https:// doi.org/10.1177/1010539516680733
Pike, K. M., Rebello, T. J., Hanasaki, S., Narita-Ohtaki, R., Kaufman, P., Akiyama, T., Doerries, B., Yang, L. H., Suzuki, N., Magill, E. B., & Yasumura, S. (2021). The Tōhoku Theater Project in postdisaster Japan: An exemplar for addressing community mental health in the context of disaster. Psychiatric Services, 00, 1–4. https://doi.org/10.1176/appi.
ps.202000520
Sasaki, Y., Aida, J., Tsuji, T., Koyama, S., Tsuboya, T., Saito, T., Kondo, K., & Kawachi, I. (2019). Pre-disaster social support is protective for onset of post-disaster depression: Prospective study from the Great East Japan earthquake & tsunami. Scientific Reports, 9(1), 1–10. https://doi. org/10.1038/s41598-019-55953-7
Shigemura, J., Terayama, T., Kurosawa, M., Kobayashi, Y., Toda, H., Nagamine, M., & Yoshino, A. (2021). Mental health consequences for survivors of the 2011 Fukushima nuclear disaster: A systematic review. Part 1: Psychological consequences. CNS Spectrums, 26(1), 14–29. https:// doi:10.1017/S1092852920000164
Teramoto, C., Matsunaga, A., & Nagata, S. (2015). Crosssectional study of social support and psychological distress among displaced earthquake survivors in Japan. Japan Journal of Nursing Science, 12(4), 320–329. https://doi. org/10.1111/jjns.12071
The Government of Japan. (2019, March 19). Technologies supporting the future: The never-ending effort for earthquake safety. https://www.japan.go.jp/regions/resilientjapan/ earthquake.html
The Japan Times. (2022, January 17). Kobe marks 27th anniversary of deadly Hanshin quake. https://www.japantimes.co.jp/ news/2022/01/17/national/kobe-quake-anniversary/
The Japan Times. (2020, March 9). Missing persons toll from 3/11 stands at 2,529, nine years on. https://www.japantimes. co.jp/news/2020/03/07/national/missing-japan-3-11disasters/
The World. (2012, January 26). Japan earthquake: Tokyo residents fear the big one. https://theworld.org/stories/2012-01-26/ japan-earthquake-tokyo-residents-fear-big-one
Uemoto, M., Asakawa, A., Takamiya, S., Asakawa, K., & Inui, A. (2011). Kobe earthquake and post-traumatic stress in school-aged children. International Journal of Behavioral Medicine, 19(3), 243–251. https://doi.org/10.1007/s12529011-9184-3
United States Geological Survey. (n.d.). Which country has the most earthquakes? https://www.usgs.gov/faqs/whichcountry-has-most-earthquakes
Wang, S., Shi, X., Chen, X., Zhu, Y., Chen, H., & Fan, F. (2021). Earthquake exposure and PTSD symptoms among disasterexposed adolescents: A moderated mediation model of sleep problems and resilience. Frontiers in Psychiatry, 12, 1–10. https://doi.org/10.3389/fpsyt.2021.577328
World Vision. (2020, February 29). 2011 Japan earthquake and tsunami: Facts, FAQs, and how to help. https://www. worldvision.org/disaster-relief-news-stories
The suicide rate for transgender youth between the ages of 10 and 21 is approximately 45%, roughly nine times the suicide rate of the general U.S. population (James et al., 2016; Johns et al., 2019). Further, research has found that a majority of transgender youth have reported suicidal ideations (Austin et al., 2016; Price- Feeny et al., 2019), most often as a result of exposure to victimization, discrimination, and harassment (Austin et al., 2018; Bockting et al., 2013; Johns et al., 2019). The high suicide rates point to increased rates of depression in the transgender youth population (Clark et al., 2014; Olsen et al., 2016). In fact, transgender youth report higher rates of depressive moods than their cisgender counterparts (i.e., 86% vs. 56%; Price-Feeny et al., 2019). Given these statistics, it is crucial to identify protective factors that reduce depressive symptoms for transgender youth (Hass et al., 2014; Johns et al., 2018).
Research has shown that gender affirmations (i.e., the interpersonal confirmation of one’s gender from outside sources; Sevelius, 2017) are pivotal for a transgender person’s development through transition (Doyle, 2022), because they are related to lower depressive systems as well as lower anxiety and overall psychological distress (King & Gamarel, 2021). Gender affirmation includes peer and adult acceptance of a youth’s gender identity, using the correct names and pronouns of a transgender youth, and actively acknowledging a youth’s gender identity (Larry et al., 2002; McGuire et al., 2016; Pollitt et al., 2019). Recent research suggests that gender affirmation supports self-esteem and self-perception, which in turn lowers depressive symptoms (Arcelus et al., 2016; McGuire et al., 2016; Torres, 2020). As such, this review examined how gender affirmations mitigate depressive symptoms among transgender youth through self-esteem and self-perception.
Depressive symptoms such as loss of interest in activities, feelings of sadness and hopelessness, and tiredness can result from low self-esteem (Arcelus et al., 2016; Romijnders et al., 2017). Low self-esteem, or confidence in one’s own worth and abilities, affects many aspects of life and can lead to thoughts of death or suicide (Arcelus et al., 2016; Romijnders et al., 2017). Transgender youth report lower self-esteem overall than their non-transgender peers. Further, transgender youth believe that increasing their levels of confidence, self-determination, and feelings of empowerment led to an increase in their self-esteem, which, in turn, served as a mechanism for greater self-accept of their gender identity and expression (Romijnders et al., 2017). This suggests that positive self-esteem might mitigate depressive symptoms through self-acceptance (Romijnders et al., 2017).
Depressive symptoms, as triggered by low self-esteem, can be alleviated by gender affirmations from different social groups, such as friends, family, and figures of authority (Kia et al., 2021; Marraccini et al., 2022; Price & Green, 2021). Affirmations such as preferred pronoun usage and active acknowledgment of their gender identity from adult figures bolster the self-esteem of transgender youth (Kia et al., 2021; Mariccini et al., 2021; Price & Green, 2021). Those whose chosen name is used by authority figures like parents and teachers have more positive mental health outcomes; they experience higher self-esteem, decreased depressive symptoms, and fewer suicidal ideations (Pollitt et al., 2019; Russel et al., 2017). In fact, research has shown that when a youth who is transgender has at least one adult in their life who affirms their gender identity, their risk of suicide is reduced by 33% (Price & Green, 2021).
Similarly, factors that positively impact self-esteem can be significantly increased via gender affirmations (Price & Green, 2021). For example, transgender youth feel safer when a trusted adult affirms their gender identity (Kia et al., 2021; Mariccini et al., 2021; Price & Green, 2021). A greater sense of safety raises self-esteem and, in turn, lowers depressive symptoms (Kia et al., 2021; Marraccini et al., 2022; Price & Green, 2021). Moreover, an affirming body image - having a perception of one’s body that matches the gender that they identify with - can positively impact the self-esteem of transgender youth (McGuire et al., 2016). Body image (i.e., how one perceives their physical appearance) has been shown to be a significant factor in depressive symptoms for all youth but is particularly more prominent for transgender youth (Smolak et al., 2001).
Moreover, a negative body image (i.e., how one perceives their physical appearance) has been shown to be a particularly strong predictor of depressive symptoms for transgender youth (Smolak et al., 2001). Therefore, puberty suppressors that extend the period of prepubescence for transgender youth by blocking the onset of puberty can be particularly important in allowing transgender youth more time to decide the next steps of their gender transition. Puberty suppressors have been shown to raise self-esteem and lower negative thoughts about body image via gender affirmations from peers and adults, thereby improving mental health outcomes (Turban et al., 2020; van der Miesen et al., 2018). At the same time, additional medical interventions that support an affirming body image - having a perception of one’s body that matches the gender that they identify withcan positively impact the self-esteem of transgender youth via promoting gender affirmations, as well (McGuire et al., 2016).
Another element that can impact depressive symptoms is self-perception, a person’s view of their mental or physical attributes. Self-perception answers the question, “Who am I?” (Torres, 2020). Because of the lack of congruence between their gender identity and how they are perceived socially, answering this question is much more difficult for transgender youth as compared to cisgender youth (Rijn et al., 2012). As a result, they are more unsure of their personhood (Rijn et al., 2012), and their negative self-perception leads to increased depressive symptoms such as suicidal thoughts (Rijn et al., 2012; Durwood et al., 2017; Kuper et al., 2018). Yet, negative self-perception, like selfesteem, can be mitigated by gender affirmations from different social groups (Kia et al., 2021; Price & Green, 2021).
One way to bolster self-perception is by having at least one accepting and gender-affirming peer (Kia et al., 2021; Price & Green, 2021). Through actions such as using the correct name or pronouns, the protective support provided by peers helps to raise transgender youth’s self-perception (Kia et al., 2021; Price & Green, 2021). Furthermore, peers’ affirmation of gendered clothing choices positively impacts transgender youth’s body image (McGuire et al., 2016). This improved positive body image can help boost self-perception, thus improving transgender youth’s mental health by lowering depressive symptoms and suicidal ideations (Kia et al., 2021; McGuire et al., 2016; Price & Green, 2021).
In addition to peers, supportive parents can bolster the selfperception of transgender youth (Grossman et al., 2021; Johns et al., 2018). Parental support through gender affirmations raises the self-perception of transgender youth by easing the perceived burden of being transgender (e.g., feeling embarrassed about having to deal with being transgender in public; Simons et al., 2013) and, thus, lowers depressive symptoms (Grossman et al., 2021; Johns et al., 2018). In fact, transgender youth who have parents who are gender affirming reduce depressive symptoms so much that transgender youth report the same level of selfperception as their cisgender counterparts, and demonstrate a marked improvement in their overall mental health (Alanko & Lund, 2020).
The literature on gender affirmations for transgender youth indicates that gender affirmations promote better selfesteem and self-perception (Boza & Perry, 2014; Durwood et al.; Kaplan et al., 2016; Kia et al., 2021; Kota et al., 2020; Kuper et al., 2018; Marraccini et al., 2022; Moody & Smith, 2013; Price & Green, 2021; Turban et al., 2020; Veale et al., 2017; Zeluf et al., 2018). In turn, improving self-esteem and self-perception helps to alleviate depressive symptoms for transgender youth (Rijn et al., 2012; Grannis et al., 2021; Hayden, 2020; Kuper et al., 2018; McGuire et al., 2016). The importance of gender affirmations for supporting the mental health of transgender youth cannot be understated. Thus, prevention and intervention efforts should be aimed at ways of educating the general public about
the simple everyday actions they can take, such as using correct names and pronouns. Future research should also examine more closely the effects of political and social actions that promote gender affirmations on the well-being of transgender youth. This could glean more knowledge regarding how to best support transgender youth.
Alanko, K., & Lund, H. (2020). Transgender youth and social support: A survey study on the effects of good relationships on well-being and mental health. Young, 28(2), 199-216. https://doi.org/10.1177/1103308819850039
Arcelus, J., Claes, L., Witcomb, G. L., Marshall, E., & Bouman, W. P. (2016). Risk factors for non-suicidal self-injury among trans youth. The Journal of Sexual Medicine, 13(3), 402–412. https://doi.org/10.1016/j.jsxm.2016.01.003
Austin, A., Craig, S. L., D’Souza, S., & McInroy, L. B. (2020). Suicidality among transgender youth: Elucidating the role of interpersonal risk factors. Journal of Interpersonal Violence, 36(5-6), NP2696–NP2718. https://doi. org/10.1177/0886260520915554
Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103(5), 943–951. https://doi.org/10.2105/ajph.2013.301241
Boza, C., & Nicholson Perry, K. (2014). Gender-related victimization, perceived social support, and predictors of depression among transgender Australians. International Journal of Transgenderism, 15(1), 35–52. https://doi.org/1 0.1080/15532739.2014.890558
Clark, T. C., Lucassen, M. F. G., Bullen, P., Denny, S. J., Fleming, T. M., Robinson, E. M., & Rossen, F. V. (2014). The health and well-being of transgender high school students: Results from the New Zealand Adolescent Health Survey (Youth’12). Journal of Adolescent Health, 55(1), 93–99. https://doi.org/10.1016/j.jadohealth.2013.11.008
Doyle, D. M. (2022). Transgender identity: Development, management and affirmation. Current Opinion in Psychology, 48, 101467. https://doi.org/10.1016/j. copsyc.2022.101467
Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2). https://doi.org/10.1016/j. jaac.2016.10.016
Fontanari, A. M., Vilanova, F., Schneider, M. A., Chinazzo, I., Soll, B. M., Schwarz, K., Lobato, M. I., & Brandelli Costa, A. (2020). Gender affirmation is associated with transgender and gender nonbinary youth mental health improvement. LGBT Health, 7(5), 237–247. https://doi.org/10.1089/ lgbt.2019.0046
Grannis, C., Leibowitz, S. F., Gahn, S., Nahata, L., Morningstar, M., Mattson, W. I., Chen, D., Strang, J. F., & Nelson, E. E. (2021). Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys. Psychoneuroendocrinology, 132, 1–8. https://doi. org/10.1016/j.psyneuen.2021.105358
Grossman, A. H., D’augelli, A. R., & Frank, J. A. (2011). Aspects of psychological resilience among transgender youth. Journal of LGBT Youth, 8(2), 103–115. https://doi.org/10.1 080/19361653.2011.541347
Hayden, L. (2020). Nurturing healthy transitions: Nutrition, exercise, and body image for transgender and gender diverse youth. In Y. N. Evans & A. D. Docter (Eds.), Adolescent nutrition (pp. 95–820). Springer, Cham. https:// doi.org/10.1007/978-3-030-45103-5_26
James, S. E., Herman, J. L., Anafi, M., Mottet, L., Keisling, M., & Rankin, S. (2015). The Report of the 2015 U.S. Transgender Survey. Washington DC: National Center for Transgender Equality.
Johns, M. M., Beltran, O., Armstrong, H. L., Jayne, P. E., & Barrios, L. C. (2018). Protective factors among transgender and gender-variant youth: A systematic review by socioecological level. The Journal of Primary Prevention, 39(3), 263–301. https://doi.org/10.1007/s10935-018-05089
Kia, H., MacKinnon, K. R., Abramovich, A., & Bonato, S. (2021). Peer support as a protective factor against suicide in trans populations: A scoping review. Social Science & Medicine, 279, 114026. https://doi.org/10.1016/j. socscimed.2021.114026
King, W. M., & Gamarel, K. E. (2021). A scoping review examining social and legal gender affirmation and health among transgender populations. Transgender Health, 6(1), 5–22. https://doi.org/10.1089/trgh.2020.0025
Kota, K. K., Salazar, L. F., Culbreth, R. E., Crosby, R. A., & Jones, J. (2020). Psychosocial mediators of perceived stigma and suicidal ideation among transgender women. BioMedCentral Public Health, 20(1), 1-20. https://doi. org/10.1186/s12889-020-8177-z
Kuper, L. E., Adams, N., & Mustanski, B. S. (2018). Exploring cross-sectional predictors of suicide ideation, attempt, and risk in a large online sample of transgender and gendernonconforming youth and young adults. LGBT Health, 5(7), 391–400. https://doi.org/10.1089/lgbt.2017.0259
Marraccini, M. E., Ingram, K. M., Naser, S. C., Grapin, S. L., Toole, E. N., O’Neill, J. C., Chin, A. J., Martinez, R. R., & Griffin, D. (2022). The roles of school in supporting LGBTQ+ Youth: A systematic review and ecological framework for understanding risk for suicide-related thoughts and behaviors. Journal of School Psychology, 91, 27–49. https://doi.org/10.1016/j.jsp.2021.11.006
McGuire, J. K., Doty, J. L., Catalpa, J. M., & Ola, C. (2016). Body image in transgender young people: Findings from a qualitative, community-based study. Body Image, 18, 96–107. https://doi.org/10.1016/j.bodyim.2016.06.004
Moody, C., & Smith, N. G. (2013). Suicide protective factors among trans adults. Archives of Sexual Behavior, 42(5), 739–752. https://doi.org/10.1007/s10508-013-0099-8
Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3) 1-3. https:// doi.org/10.1542/peds.2015-3223
Pollitt, A. M., Ioverno, S., Russell, S. T., Li, G., & Grossman, A. H. (2019). Predictors and mental health benefits of chosen
name use among transgender youth. Youth & Society, 53(2), 320–341. https://doi.org/10.1177/0044118x19855898
Price, M. N., & Green, A. E. (2021). Association of gender identity acceptance with fewer suicide attempts among transgender and nonbinary youth. Transgender Health https://doi.org/10.1089/trgh.2021.0079
Price-Feeney, M., Green, A. E., & Dorison, S. (2020). Understanding the mental health of transgender and nonbinary youth. Journal of Adolescent Health, 66(6). https://doi.org/10.1016/j.jadohealth.2019.11.314
Reisner, S. L., Biello, K. B., White Hughto, J. M., Kuhns, L., Mayer, K. H., Garofalo, R., & Mimiaga, M. J. (2016). Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women. JAMA Pediatrics, 170(5), 481-486. https://doi.org/10.1001/jamapediatrics.2016.0067
Rijn, A. B.-van, Steensma, T. D., Kreukels, B. P. C., & CohenKettenis, P. T. (2012). Self-perception in a clinical sample of gender variant children. Clinical Child Psychology and Psychiatry, 18(3), 464–474. https://doi. org/10.1177/1359104512460621
Romijnders, K. A., Wilkerson, J. M., Crutzen, R., Kok, G., Bauldry, J., & Lawler, S. M. (2017). Strengthening social ties to increase confidence and self-esteem among sexual and gender minority youth. Health Promotion Practice, 18(3), 341–347. https://doi.org/10.1177/1524839917690335
Romito, M., Salk, R. H., Roberts, S. R., Thoma, B. C., Levine, M. D., & Choukas-Bradley, S. (2021). Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth. Body Image, 37, 50–62. https://doi.org/10.1016/j. bodyim.2021.01.008
Sevelius, J., Dickey, L. m., & Singh, A. A. (2017). Engaging in TGNC-affirmative research. In A. Singh & L. M. Dickey (Eds.), Affirmative counseling and psychological practice with transgender and gender nonconforming clients (pp. 231–246). American Psychological Association. https:// doi.org/10.1037/14957-012
Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793. https://doi.org/10.1016/j.jadohealth.2013.07.019
Smolak, L., & Levine, M. P. (2001). Body image in children. In J. K. Thompson & L. Smolak (Eds.), Body image, eating disorders, and obesity in youth: Assessment, prevention, and treatment (pp. 41–66). American Psychological Association. https://doi.org/10.1037/10404-002
Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2) 1-8. https://doi. org/10.1542/peds.2019-1725
Van der Miesen, A. I. R., Steensma, T. D., de Vries, A. L. C., Bos, H., & Popma, A. (2020). Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers.
Journal of Adolescent Health, 66(6), 699–704. https://doi. org/10.1016/j.jadohealth.2019.12.018
Vanhalst, J., Luyckx, K., Scholte, R.H., Engels, R. C., & Goossens, L. (2013). Low self-esteem as a risk factor for loneliness in adolescence: Perceived - but not actual - social acceptance as an underlying mechanism. Journal of Abnormal Child Psychology, 41, 1067–1081. https://doi.org/10.1007/ s10802-013-9751-y
Veale, J. F., Watson, R. J., Peter, T., & Saewyc, E. M. (2017). Mental health disparities among Canadian transgender youth. Journal of Adolescent Health, 60(1), 44–49. https:// doi.org/10.1016/j.jadohealth.2016.09.014
Zeluf, G., Dhejne, C., Orre, C., Mannheimer, L. N., Deogan, C., Höijer, J., Winzer, R., & Thorson, A. E. (2018). Targeted victimization and suicidality among trans people: A webbased survey. LGBT Health, 5(3), 180–190. https://doi. org/10.1089/lgbt.2017.0011
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are at an increased risk for mental health problems as compared to heterosexual and cisgender people (Gmelin et al., 2022; Price-Feeney et al., 2020; Semlyen et al., 2016; Wanta et al., 2019). For instance, lesbian, gay, and bisexual individuals are twice as likely to have depression, anxiety, and substance use issues than their heterosexual counterparts (Gmelin et al., 2022; Semlyen et al., 2016; Substance Abuse and Mental Health Services Association, 2016), and transgender individuals are four times as likely to be diagnosed with anxiety, personality disorders, schizophrenia, and post-traumatic stress disorder (PTSD) than their cisgender counterparts (Price-Feeney et al., 2020; Wanta et al., 2019). The minority stress theory posits that the disproportionate mental health issues LGBTQ+ people face are due to stressors from hostile social environments, such as homophobia, prejudice, discrimination, and stigma (Meyer, 2003). In particular, LGBTQ+ young adults in college are an at-risk population and are more likely to be depressed or to have attempted suicide than their heterosexual counterparts (Alessi et al., 2017; Greathouse et al., 2018; Lipson et al., 2022). Despite the mental health challenges they face, LGBTQ+ college students avoid seeking treatment, which can be explained by the mental health stigma, but little research has been done on how the stigma impacts them (Martin, 2010; O’Connor et al., 2018).
College students face many stressors that can negatively impact their mental health, including academic stress, transition to college related stress, financial stress, and relationship stressors that make them at-risk for mental health issues (Hurst et al., 2012). Considering that 75% of lifetime mental disorders will onset between ages 18-25, which increases lifetime prevalence and comorbidity with additional mental disorders, these stressors compound college students’ risk of mental health issues (Kessler et al., 2005; Kessler et al., 2007; Suvisaari et al., 2008; Wittchen et al., 1998). Recently, in the United States, college students’ mental health issues have been increasing (LeViness et al., 2020; Lipson et al., 2022), and this has been further exacerbated by the COVID-19 pandemic, with college students reporting increased symptoms of anxiety, difficulty concentrating, increased concerns about academic performance, and increased depressive thoughts (Son et al., 2020; Wang et al., 2020).
LGBTQ+ college students are disproportionately impacted by the stressors that college students face, and, therefore, report using their college counseling services for more frequent and prolonged periods than heterosexual college students (Reeves
et al., 2018). For example, LGBTQ+ college students are nearly four times more likely to be depressed, experience feelings of hopelessness, or have attempted suicide than their heterosexual college counterparts (Centers for Disease Control and Prevention [CDC], 2021; Greathouse et al., 2018; Hurst et al., 2012; Price-Feeney et al., 2020; The Trevor Project, 2022). One reason for the disproportionate issues that LGBTQ+ college students face is that they experience dual stressors, as they have to deal with stressors exclusive to their queer identity (e.g., microaggressions, discrimination, and sexual stigma) and also the stressors of being a college student (e.g., academic, financial, and relationship stress; Alessi et al., 2017; Hurst et al., 2012). Furthermore, negative campus climates that are not accepting of queer students and perpetuate homophobia and transphobia increase the negative well-being of LGBTQ+ college students (Thacker Darrow et al., 2022).
Despite the disproportionate mental health struggles that they face, factors such as positive social support (e.g., family and friends that support their queer identity, being friends with LGBTQ+ individuals; Doty et al., 2010; McDonald, 2018) and identity self-awareness (i.e. a belief that one’s sexual identity increases one’s awareness of one’s own feelings and strengths; Amador et al., 1991; Knight et al., 2018; Meyer, 2015, p. 210; Pistella et al., 2023) have been shown to protect against this increased risk (Poteat et al., 2015; Wilkerson et al., 2016; Williams et al., 2005). Additionally, recent literature highlights how LGBTQ+ college students are resilient and able to thrive in the face of homophobia and transphobia (Hill et al., 2020; Nicolazzo, 2016; Riggle & Rotosky, 2011; Singh et al., 2014). Although these protective factors exist, LGBTQ+ college students note a number of barriers to treatment, such as long waitlists, not feeling comfortable going, and their university not having LGBTQ+ counseling centers (The Trevor Project, 2022).
One of the most notable barriers to treatment is the mental health stigma (i.e., the negative views toward a person or group of people who have been diagnosed with or perceived to have mental health issues, mental disorders, and/or mental illnesses; American Psychiatric Association, 2020; Dudley, 2000; Goffman, 1964). Research has shown that the stigma surrounding mental health leads to decreased likelihood to seek treatment or stay with treatment (Yanos et al., 2020), and is a potential reason for the under-reporting of mental disorders (Bharadwaj et al., 2017). For example, mental disorders are reported less than physical health conditions, such as diabetes or cardiovascular disease (Bharadwaj et al., 2017). College students report that they avoid
seeking treatment due to a fear of being judged, discriminated against, or being treated differently by classmates and university faculty/staff (Eisenberg et al., 2009; Martin, 2010).
It is important to distinguish the two types of mental health stigma – public stigma and self-stigma – since they have different impacts on individuals (Corrigan, 2004; Corrigan & Penn, 1999). Public stigma refers to the negative stereotypes about mental illness held by people in society (e.g., people with mental illnesses are crazy and dangerous), which creates feelings of shame and a lack of seeking treatment for people with mental health issues (Corrigan, 2004; Corrigan & Penn, 1999; Corrigan & Shapiro, 2010; New Freedom Commission on Mental Health, 2003; Parcesepe & Cabassa, 2012; Walker et al., 2008). On the other hand, self-stigma refers to when an individual who identifies with the stigmatized group internalizes and believes the negative stereotypes (Corrigan, 2004; Corrigan & Penn, 1999). Research has shown that self-stigma is more strongly associated with lower help-seeking behaviors than public stigma and significantly prolongs recovery for individuals with mental illnesses (Oexle et al., 2018; Ritsher et al., 2003; Yu et al., 2022). Although there is limited research focusing on LGBTQ+ college students, existing literature does show that internalized self-stigma in LGBTQ+ individuals is associated with negative attitudes towards the self and lower feelings of safety and contentment (O’Connor et al., 2018; Pistella et al., 2023). Additionally, it has been demonstrated that low self-awareness about their sexual/gender identity is associated with less coping and resiliency to minority stressors due to a decrease in social adjustment and well-being (Meyer, 2015; Pistella et al., 2023). Despite LGBTQ+ college students’ greater risks for mental health issues (Alessi et al., 2017; Greathouse et al., 2018), few studies have looked at how the mental health stigma influences their psychological well-being and help-seeking behaviors (O’Connor et al., 2018).
Few studies have focused on the personal experiences of LGBTQ+ college students and how mental health stigma influences their psychological well-being and help-seeking behaviors. The research that has been done has focused on the dual stigma experienced by LGBTQ+ adults with severe mental health issues, highlighting how they feel out of place in both queer communities and mental health settings based on the intersection of their identities (O’Connor et al., 2018). Although these findings are substantial and begin to explore the influences of the mental health stigma, they do not take into account the experiences of LGBTQ+ college students, who are unique atrisk population due to the intersection of being a queer college student (Alessi et al., 2017; Greathouse et al., 2018; Reeves et al., 2018). Therefore, this qualitative study explored the following research question: How does the stigma surrounding mental health issues relate to the well-being and help-seeking behaviors of LGBTQ+ college students?
Participants included seven college students (N = 7) from New York University (NYU) that self-identify as LGBTQ+ individuals and were recruited through social media and by word of mouth. Requirements for participation included: being currently enrolled in a college/university and identifying as a member of the LGBTQ+ community. Six participants disclosed their race/ethnicity (see Fig. 1 for full breakdown) and the majority identified as White. All participants identified as one or more of the LGBTQ+ identities: queer (4), lesbian (4), gay (2), bisexual (1), and asexual (1). The following gender identities were represented: cisgender woman (4), genderqueer (2), and transgender (1) with pronouns of she/her (4), she/they (2), and he/him (1). All participants reported their degree tracks with a majority completing their Bachelor’s degree (see Fig. 2 for full breakdown). The mean age of the participants was 21 years old.
This study was conducted using an open-ended survey through Google Forms (see Appendix A) where participants were first asked demographic questions such as age, race/ethnicity, gender identity, and sexual identity. For questions asking about gender, sexual, and race/ethnicity identity, participants were asked to write all identities they associated with in their own words. Participants were then asked about their experience as an LGBTQ+ college student and if the mental health stigma has had an influence on their psychological well-being and help-seeking behaviors (e.g., “How do you believe the stigma surrounding mental health influences your well-being as an LGBTQ+ college student?”). An open-ended survey was used since discussions of stigma and one’s gender and sexual identity can be very sensitive topics and this method allowed for more participant comfort. Participants were also made aware that participation in the survey is voluntary and that responses to every question were not required.
Results were coded using a thematic grounded theory approach by analyzing one participant’s response (14.3%) at the sentence level and creating themes that emerged within the data related to the research question. These themes were then examined on the next participant’s response to check for alignment and were re-evaluated if new themes emerged. All data was then coded by one researcher.
This study aimed to address the gaps in the literature surrounding how the mental health stigma impacts LGBTQ+ college students’ well-being and help-seeking behaviors. Thematic analysis led to the emergence of four major themes: campus environment, social support, self-awareness, and exposure to prejudice. While results did indicate that the mental health stigma has impacts on the well-being and help-seeking
behaviors of LGBTQ+ college students, it also indicated that each theme was able to have a dual impact on stigma: the themes that emerged either had a positive or negative influence on the mental health stigma depending on the participant’s experience. The findings of this study build upon previous research on college students and LGBTQ+ people individually by providing a unique understanding of how the mental health stigma impacts individuals when these identities intersect.
Analysis of the data indicated that the campus views and attitudes toward queer students and mental health issues have an impact on the well-being, help-seeking behaviors, and mental health stigma of LGBTQ+ college students. Four participants noted that they do not believe that mental health stigma has much of an impact on them as LGBTQ+ students due to their supportive campus environment. Participants stated that the campus’s openness to LGBTQ+ students and discussions about mental health helps to encourage a sense of community and promotes seeking treatment. For example, one participant stated that the faculty’s attitudes toward seeking treatment largely influenced them to utilize their campus counseling resources.
On the other hand, five participants indicated that they perceive a lack of support or inadequate resources from their college campus. Four of these participants noted feeling that the campus does not view mental health issues as one of their top concerns and instead advances a “just grit your teeth and get through it” mentality, with one participant directly stating this as a barrier to treatment. Two participants noted that some faculty members are unsupportive and do “not accept mental health concerns as a legitimate reason to ask for an extension or take time off.” In relation to LGBTQ+ college students, one participant said:
I think that in order to fight the very common feeling of not being able to seek help that is shared among LGBTQ student[s] is for the university to show more of an effort to give services for students. I really haven’t seen much.
Although the participants had differing experiences with campus environment, these findings are in line with previous research that highlights how campuses can provide either a positive or negative environment for their LGBTQ+ students (Ellis, 2009; Evans et al., 2017; Horn & Szalacha, 2009; Longerbeam et al., 2007; Thacker Darrow et al., 2022). Previous research has shown that classroom climate, residence hall environment, and faculty attitudes can promote either positive or negative experiences depending on the campus’ support of LGBTQ+ college students (Evans et al., 2017; Stevens, 2004; Tetreault et al., 2013). The findings of this study expand upon previous research (e.g., Evans et al., 2017), but also indicate that campus environment can act as a protective or risk factor for mental health stigma and overall well-being and help-seeking behaviors of LGBTQ+ college students.
In participants’ responses, six mentioned the theme of social support in some capacity. For this study, social support was defined as one’s social network, such as family, friends, and support groups, that helps them to cope with stressors (APA, n.d. -b). Of these participants, three noted that having family members who are supportive of both their queer identity and mental health issues increased their help-seeking behaviors and reduced the impacts of stigma, with two participants noting the same influences from their friends with similar identities. Two participants indicated that they had unsupportive family members who did not take mental health seriously, which was noted as a big barrier to accessing and seeking treatment. Interestingly, one participant highlighted that when they are with less accepting social groups (i.e., family), they feel the influence of the mental health stigma more than when they are with more accepting social support (i.e., queer community).
These findings further expand upon previous research that highlights how social support can reduce mental health issues and suicidality while increasing self-esteem and wellbeing (Doty et al., 2010; McDonald, 2018; Poteat et al., 2015; Wilkerson et al., 2016; Williams et al., 2005). The results of this study are able to demonstrate the dual impact social support can have on LGBTQ+ students’ well-being and help-seeking, but also how it can help to mitigate the influences from the mental health stigma.
For the purposes of this paper, self-awareness was defined as one’s awareness of their mental health issues (e.g., need for treatment) and queer identity (e.g., comfortability with sexuality; Amador et al., 1991; Meyer, 2015). Four participants highlighted that their psychology classes have frequent discussions about mental health and this has made them “hyper-aware” of their struggles, the mental health stigma, and when it is necessary to seek treatment. For example, one participant stated that they do not feel like the mental health stigma has much of an influence on their well-being due to their psychology major. Additionally, one participant stated that they do not feel their mental health and LGBTQ+ identity “intertwined” in any way due to their comfortability with their sexuality and, therefore, they felt not impacted by the mental health stigma. This was a unique finding that highlights how one’s self-awareness about their own sexual and/or gender identity can reduce the impacts of the mental health stigma. Additionally, another participant communicated that they “sometimes feel invalidated” about their identity but their comfortability with their sexual orientation has been a protective factor for their well-being.
In line with previous research, these findings support that self-awareness about one’s mental health issues and/ or mental disorders is a protective factor against the mental health stigma (Amador et al., 1991; Knight et al., 2018; Meyer, 2015). Furthermore, these findings also indicate how selfawareness about one’s sexual and/or gender identity and their
comfortability with that identity can decrease internalized selfstigma and increase positive attitudes toward themselves and their safety, which also protects against the mental health stigma (Pistella et al., 2023). The finding of education being a protective factor does support previous findings of knowledge mitigating the mental health stigma (Martin, 2010), but these results highlight the protective role higher education and/or studying psychology has for LGBTQ+ students.
Four participants stated incidences of exposure to prejudice, which includes stereotypes, discrimination, and judgment about being queer and/or having mental health issues that perpetuate feelings of shame and guilt (APA, n.d. -a). These participants expressed that these exposures made them feel invalidated and socially isolated, which had negative impacts on their wellbeing. Three participants highlighted moments of being forced to be resilient due to their family, community, and/or university not supporting their mental health struggles, which created barriers to help-seeking. One participant, in particular, noted they gained resiliency in the face of these situations but was also forced to self-advocate for treatment at a young age, which they noted had negative influences on their well-being.
These findings expand upon the minority stress theory on how exposure to prejudice negatively impacts LGBTQ+ people and individuals with mental disorders (Eisenberg et al., 2009; Feinstein et al., 2012; Herek, 2004; Meyer, 2003; Walch et al., 2016; Yang & Mak, 2017) and highlights the unique ways it influences LGBTQ+ college students in terms of their well-being and help-seeking behaviors. An interesting concept of “forced resiliency” emerged surrounding mental health prejudices, which is different than the previous research that demonstrated how LGBTQ+ individuals are resilient in the face of sexual/ gender identity prejudices, such as homophobia and transphobia (Hill et al., 2020; Nicolazzo, 2016; Riggle & Rotosky, 2011; Singh et al., 2014). This topic of “forced resiliency” may be important for future research to consider when working with LGBTQ+ people and people with mental health struggles considering the differing stigmas they face surrounding their identities (Feinstein et al., 2012; Herek, 2004; Meyer, 2003; Yang & Mak, 2017).
The current study sheds light on the impacts of the mental health stigma on an at-risk, marginalized community which has previously been under-researched. The results of this study indicate that the mental health stigma does have an impact on LGBTQ+ college students’ well-being and help-seeking behaviors, but protective factors, such as self-awareness and social support, help to negate the impact and vice versa. These findings highlight the experiences of queer students, a population of increasing research concern, and can help college campuses better understand the needs of their queer students. Most notably, the importance of a supportive campus environment and adequate resources provided to queer college students,
such as LGBTQ+ centers, clubs, and counseling centers, were demonstrated as protective factors against the mental health stigma. Furthermore, the protective and risk factors against mental health stigma presented in this study can help to inform mental health professionals more about LGBTQ+ college students and create targeted treatments to address the unique stressors they face as a marginalized community and college students. Moreover, findings regarding the implications of the mental health stigma on individuals allow researchers, mental health professionals, and policymakers to better develop ways to mitigate these influences. Lastly, these findings can help to oppose the anti-LGBTQ+ laws and policies currently circulating since they focus on the experiences of LGBTQ+ individuals and the impacts of their mental health.
Due to the limited research on this specific population, the researcher chose to focus on the experiences of LGBTQ+ college students at New York University to gain an initial understanding of the impacts of the mental health stigma. To further advance the findings on this topic, future research may explore how the experiences of queer students at other colleges are similar or different from these preliminary results. Additionally, the majority of participants in this sample were in a psychology-related field and further research should be conducted with a wider range of areas of study to examine how different educational pathways play a role on the impact of the mental health stigma. Although the sample size of the current study did not permit this, future research could examine how different mental disorder diagnoses potentially relate to the mental health stigma. Additionally, considering how gender minorities are at a greater risk for mental health issues than sexual minorities (Wanta et al., 2019), future research should examine how the mental health stigma impacts the separate LGBTQ+ identities individually to discern differences in experiences, if any. Moreover, various cultures hold more traditional views on mental health and LGBTQ+ people, which can have an impact on well-being and helpseeking behaviors (Department of Health and Human Services, 2001), and, therefore, future research should examine how race/ ethnicity and culture have an influence on the mental health stigma. Lastly, to explore this finding of “forced resiliency” more, future research should examine if LGBTQ+ individuals also feel like their resiliency in the face of sexual/gender prejudices is “forced” since previous research does not mention it. This will be most successfully conducted using qualitative measures since it is based on the participants’ experiences that will be difficult to capture using quantitative measures.
I am a self-identifying bisexual, cisgender woman that has struggled with mental health issues in my life and am in a unique position to understand this community’s struggle with stigma regarding our sexual identity and mental health. Additionally, my identity as a White, cisgender woman may put me in a position where I could misinterpret the responses of my BIPOC and transgender participants since I cannot fully understand
their experiences of oppression and discrimination. To help with this issue, open-ended surveys were used to allow participants to explain their own experiences. While analyzing the data, I focused only on the participant’s responses and experiences while putting my own aside. I did this by acknowledging that my own experiences will not be the same for everyone and that the participant’s experiences are the most important. This helped to code the data objectively and not misconstrue any of the participant’s experiences.
Alessi, E. J., Sapiro, B., Khan, S., & Craig, S. L. (2017). The firstyear university experience for sexual minority students: A grounded theory exploration. Journal of LGBT Youth, 14(1), 71-92. https://doi.org/10.1080/19361653.2016.1256
013
Amador, X. F., Strauss, D. H., Yale, S. A., & Gorman, J. M. (1991). Awareness of illness in schizophrenia. Schizophrenia Bulletin, 17(1), 113-132. https://doi.org/10.1093/schbul/17.1.113
American Psychiatric Association. (n.d. -a). Prejudice. In APA Dictionary of Psychology. https://dictionary.apa.org/ prejudice
American Psychiatric Association. (n.d. -b). Social support. In APA Dictionary of Psychology. https://dictionary.apa.org/ social-support
American Psychiatric Association. (2020). Stigma, prejudice and discrimination against people with mental illness. https://www.psychiatry.org/patients-families/stigma-anddiscrimination
Bharadwaj, P., Pai, M. M., & Suziedelyte, A. (2017). Mental health stigma. Economics Letters, 159, 57-60. https://doi. org/10.1016/j.econlet.2017.06.028
Centers for Disease Control and Prevention. (2020). Health disparities among LGBTQ youth. https://www.cdc.gov/ healthyyouth/disparities/health-disparities-among-lgbtqyouth.htm
Corrigan, P. W. (2004). How stigma interferes with mental health care. American Psychologist, 57(7), 614-625. https:// doi.org/10.1037/0003-066x.59.7.614
Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric symptoms. American Psychologist, 54(9), 765-776. https://doi. org/10.1037/0003-066X.54.9.765
Corrigan, P. W., & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30(8), 907-922. https:// doi.org/10.1016/j.cpr.2010.06.004
Department of Health and Human Services (2001). Mental health: Culture, race, and ethnicity - A supplement to mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of Surgeon General.
Doty, N. D., Willoughby, B. L. B., Lindahl, K. M., Malik, N. M. (2010). Sexuality related social support among lesbian, gay, and bisexual youth. Journal of Youth and Adolescence, 39(10), 1134-1147. https://doi.org/10.1007/s10964-0109566-x
Dudley, J. R. (2000). Confronting stigma within the services system. Social Work, 45(5), 449-455. https://doi. org/10.1093/sw/45.5.449
Dunbar, M. S., Sontag-Padilla, L., Ramchand, R., Seelam, R., & Stein, B. D. (2017). Mental health service utilization among lesbian, gay, bisexual, and questioning or queer college students. Journal of Adolescent Health, 61(3), 294-301. https://doi.org/10.1016/j.jadohealth.2017.03.008
Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66(5), 522–541. https://doi.org/10.1177/1077558709335173
Ellis, S. J. (2009). Diversity and inclusivity at university: A survey of the experiences of lesbian, gay, bisexual and trans (LGBT) students in the UK. Higher Education, 57, 723-739. https://doi.org/10.1007/s10734-008-9172-y Evans, R., Nagoshi, J. L., Nagoshi, C., Wheeler, J., & Henderson, J. (2017). Voices from the story untold: Lesbian, gay, bisexual, trans, and queer college students’ experiences with campus climate. Journal of Gay & Lesbian Social Services, 29(4), 426-444. https://doi.org/10.1080/1053872 0.2018.1378144
Feinstein, B. A., Goldfried, M. R., & Davila, J. (2012). The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of internalized homonegativity and rejection sensitivity as potential mechanisms. Journal of Consulting and Clinical Psychology, 80(5), 917-927. https://doi. org/10.1037/a0029425
Fish, J. N. (2020). Future directions in understanding and addressing mental health among LGBTQ+ youth. Journal of Clinical Child & Adolescent Psychology, 49(6), 943-956. https://doi.org/10.1080/15374416.2020.1815207
Gmelin, JO. H., De Vries, Y. A., Baams, L., Augilar-Gaxiola, S., Alonso, J., Borges, G., Bunting, B., Cardoso, G., Florescu, S., Gureje, O., Karam, E. G., Kawakami, N., Lee, S., Mneimneh, Z., Navarro-Mateu, F., Posada-Villa, J., Rapsey, C., Slade, T., Stagnaro, J. C., … de Jonge, P. (2022). Increased risk for mental disorders among LGB individuals: Cross-national evidence from the World Mental Health Surveys. Social Psychiatry and Psychiatric Epidemiology. https://doi-org. proxy.library.nyu.edu/10.1007/s00127-022-02320-z
Goffman, E. (1964). Stigma: Notes on the management of spoiled identity. Social Forces, 43(1), 127-128. https://doi. org/10.1093/sf/43.1.127
Greathouse, M., BrckaLorenz, A., Hoban, M., Huesman, R., Rankin, S., & Stolzenberg, E. B. (2018). Queer-spectrum and trans-spectrum student experiences in American higher education. Rutgers.
Herek, G. M. (2004). Beyond “homophobia”: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research & Social Policy, 1, 6-24. https://doi. org/10.1525/srsp.2004.1.2.6
Hill, R. L., Nguyen, D. J., Kilgo, C. A., Lange, A. C., Shea, H. D., Renn, K. A., & Woodford, M. R. (2020). How LGBTQ+ students thrive in college. Journal of Student Affairs Research and Practice, 58(3), 267-281. https://doi.org/10.1 080/19496591.2020.1738241
Horn, S. S., & Szalacha, L. A. (2009). School differences in heterosexual students’ attitudes about homosexuality and prejudice based on sexual orientation. International Journal of Developmental Science, 3(1), 64-79. https://doi.
org/10.3233/DEV-2009-3108
Hurst, C. S., Baranik, L. E., & Daniel, F. (2012). College student stressors: A review of the qualitative research. Stress and Health, 29(4), 275-285. https://doi.org/10.1002/smi.2465
Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Psychiatry Opinion, 20(4), 359-364. https://doi.org/10.1097/YCO.0b013e32816ebc8c
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-ofonset distributions of DSM-IV Disorders in the national comorbidity survey replication. Archives of General Psychology, 62(6), 593-602. https://doi.org/10.1001/ archpsyc.62.6.593
Knight, F., Kokanović, R., Ridge, D., Brophy, L., Hill, N., JohnstonAtaata, K., & Herrman, H. (2018). Supported decisionmaking: The expectations held by people with experience of mental illness. Qualitative Health Research, 28(6), 10021015. https://doi.org/10.1177/1049732318762371
Kosciw, J. G., Palmer, N. A., Kull, R. M., & Greytak, E. A. (2012). The effect of negative school climate on academic outcomes for LGBT youth and the role of in-school supports. Journal of School Violence, 12(1), 45-63. https://doi.org/10.1080/15 388220.2012.732546
LeViness, P., Gorman, K., Braun, L., Koenig, L., & Bershad, C. (2020). The Association for University and Counseling Center Directors annual survey: 2019. The Association for University and Counseling Center Directors. https:// www.aucccd.org/assets/documents/Survey/2019%20 AUCCCD%20Survey-2020-05-31-PUBLIC.pdf
Lipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., Patterson, A., Singh, M., & Eisenberg, D. (2022). Trends in college student mental health and help-seeking by race/ ethnicity: Findings from the national healthy minds study, 2013-2021. Journal of Affective Disorders, 306(1), 138-147. https://doi.org/10.1016/j.jad.2022.03.038
Longerbeam, S., Inkelas, K. K., Johnson, D. R., & Lee, Z. S. (2007). Lesbian, gay, and bisexual college student experiences: An exploratory study. Journal of College Student Development, 48(2), 215-230. https://doi.org/10.1353/csd.2007.0017
Martin, J. M. (2010). Stigma and student mental health in higher education. Higher Education Research & Development, 29(3), 259–274. https://doi.org/10.1080/07294360903470969
McDonald, K. (2018). Social support and mental health in LGBTQ adolescents: A review of the literature. Issues in Mental Health Nursing, 39(1), 16-29. https://doi.org/10.108 0/01612840.2017.1398283
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674697. https://doi.org/10.1037/0033-2909.129.5.674
Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2(3), 209-213.
https://doi.org/10.1037/sgd0000132
Mojtabai, R. (2007). Americans’ attitudes toward mental health treatment seeking: 1990-2003. Psychiatric Services, 58(5), 642-651. https://doi.org/10.1176/ps.2007.58.5.642
New Freedom Commission on Mental Health. (2003). Achieving the Promise: Transforming Mental Health Care in America. Final Report. Rockville, MD: US Department of Health and Human Service. DHHS publication SMA-03-3832. https:// oembed-dmh.mo.gov/media/pdf/achieving-promisetransforming-mental-health-care-america-report Nicolazzo, Z. (2016). Trans* in college: Transgender students’ strategies for navigating campus life and the institutional politics of inclusion. Stylus Publishing.
O’Connor, L. K., Pleskach, P., & Yanos, P. (2018). The experience of dual stigma among LGBTQ individuals with severe mental illness. American Journal of Psychiatric Rehabilitation, 21(1), 167-187. https://muse.jhu.edu/article/759951
Oexle, N., Müller, M., Kawohl, W., Xu, Z., Viering, S., Wyss, C., Vetter, S., & Rüsch, N. (2018). Self-stigma as a barrier to recovery: A longitudinal study. European Archives of Psychiatry and Clinical Neuroscience, 268, 209-212. https:// doi.org/10.1007/s00406-017-0773-2
Ojeda, V. D., & Bergstresser, S. M. (2008). Gender, raceethnicity, and psychosocial barriers to mental health care: An examination of perceptions and attitudes among adults reporting unmet need. Journal of Health and Social Behavior, 49(3), 317-334. https://doi. org/10.1177/002214650804900306
Parcesepe, A. M., & Cabassa, L. J. (2012). Public stigma of mental illness in the United States: A systematic literature review. Administration and Policy in Mental Health and Mental Health Services Research, 40, 384-399. https://doi. org/10.1007/s10488-012-0430-z
Pistella, J., Rosati, F., & Baiocco, R. (2023). Feeling safe and content: Relationship to internalized sexual stigma, selfawareness, and identity uncertainty in Italian lesbian and bisexual women. Journal of Lesbian Studies, 27(1), 41-59. https://doi.org/10.1080/10894160.2022.2087344
Poteat, V. P., Yoshikawa, H., Calzo, J. P., Gray, M. L., DiGiovanni, C. D., Lipkin, A., & Shaw, M. P. (2015). Contextualizing Gay‐Straight alliances: Student, advisor, and structural factors related to positive youth development among members. Child Development, 86(1), 176–193. https://doi. org/10.1111/cdev.12289
Price-Feeney, M., Green, A. E., & Dorison, S. (2020). Understanding the mental health of transgender and nonbinary youth. Journal of Adolescent Health, 66(6), 684690. https://doi.org/10.1016/j.jadohealth.2019.11.314
Reeves, B., Rojas-Guyler, L., Brown, J., Bennett, K., & Bennett, S. (2021). Attitudes toward health care needs and utilization of a university health center among LGBT and non-LGBT college students. Journal of American College Health, 1-9. https://doi.org/10.1080/07448481.2021.1898400
Riggle, E. D., & Rostosky, S. S. (2011). A positive view of LGBTQ:
Embracing identity and cultivating well-being. Rowman & Littlefield Publishers.
Ritsher, J.B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Research, 121(1), 31-49. https://doi. org/10.1016/j.psychres.2003.08.008
Schreiner, L. A. (2010a). The “thriving quotient”: A new vision for student success. About Campus, 15(2), 2–10. https:// doi.org/10.1002/abc.20016
Semlyen, J., King, M., Varney, J., & Haggar-Johnson, G. (2016). Sexual orientation and symptoms of common mental disorder or low wellbeing: Combined meta-analysis of 12 UK population health surveys. BMC Psychiatry, 16, Article 67. https://doi.org/10.1186/s12888-016-0767-z
Singh, A. A., Meng, S. E., & Hansen, A. W. (2014). “I am my own gender”: Resilience strategies of trans youth. Journal of Counseling & Development, 92(2), 208–218. https://doi. org/10.1002/j.1556-6676.2014.00150.x
Son, C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. (2020). Effects of COVID-19 on college students’ mental health in the United States: Interview survey study. Journal of Medical Internet Research, 22(9), Article e21279. https:// doi.org/10.2196/21279
Stevens, R. A., Jr. (2004). Understanding gay identity development within the college environment. Journal of College Student Development, 45(2), 185-206. https://doi. org/10.1353/csd.2004.0028
Substance Abuse and Mental Health Services Association. (2016). Sexual orientation and estimates of adult substance use and mental health: Results from the 2015 national survey on drug use and health. https://www.samhsa.gov/ data/sites/default/files/NSDUH-SexualOrientation-2015/ NSDUH-SexualOrientation-2015/NSDUHSexualOrientation-2015.htm
Suvisaari, J., Aalto-Setälä, T., Tuulio-Henriksson, A., Härkänen, T., Saarni, S. I., Perälä, J., Schreck, M., Castaneda, A., Hintikka, J., Kestilä, L., Lähteenmäki, S., Latvala, A., Koskinen, S., Marttunen, M., Aro, H., & Lönnqvist, J. (2008). Mental disorders in young adulthood. Psychological Medicine, 39(2), 287-299. https://doi.org/10.1017/ s0033291708003632
Tetreault, P. A., Fette, R., Meidlinger, P. C., & Hope, D. (2013). Perceptions of campus climate by sexual minorities. Journal of Homosexuality, 60(7), 947-964. https://doi.org/ 10.1080/00918369.2013.774874
Thacker Darrow, N. E., Duran, A., Weise, J. A., & Guffin, J. P. (2022). LGBTQ+ college students’ mental health: A content analysis of research published 2009–2019. Journal of Gay & Lesbian Social Services, 1–30. https://doi.org/10.1080/1053 8720.2022.2093302
The Trevor Project. (2022). 2022 national survey on LGBTQ youth mental health. https://www.thetrevorproject.org/ survey-2022/assets/static/trevor01_2022survey_final.pdf
Walch, S. E., Ngamake, S. T., Bovornusvakool, W., & Walker,
S. V. (2016). Discrimination, internalized homophobia, and concealment in sexual minority physical and mental health. Psychology of Sexual Orientation and Gender Diversity, 3(1), 37–48. https://doi.org/10.1037/sgd0000146
Walker, J. S., Coleman, D., Lee, J., Squire, P. N., & Friesen, B. J. (2008). Children’s stigmatization of childhood depression and ADHD: Magnitude and demographic variation in a national sample. Child and Adolescent Psychiatry, 47(8), 912-920. https://doi.org/10.1097/CHI.0b013e318179961a
Wang, X., Hegde, S., Son, C., Keller, B., Smith, A., & Sasangohar, F. (2020). Investigating mental health of US college students during the COVID-19 pandemic: Cross-sectional survey study. Journal of Medical Internet Research, 22(9), Article e22817. https://doi.org/10.2196/22817
Wanta, J. W., Niforatos, J. D., Durbak, E., Viguera, A., & Altinay, M. (2019). Mental health diagnoses among transgender patients in the clinical setting: An all-payer electronic health record study. Transgender Health, 4(1), 313-315. https://doi.org/10.1089/trgh.2019.0029
Wilkerson, J. M., Schick, V. R., Romijnders, K. A., Bauldry, J., Butame, S. A., & Montrose, C. (2016). Social support, depression, self-esteem, and coping among LGBTQ adolescents participating in Hatch Youth. Health Promotion Practice. https://doi.org/10.1177/152483991665446
Williams, T., Connolly, J., & Pepler, D. (2005). Peer victimization, social support, and psychosocial adjustment of sexual minority adolescents. Journal of Youth and Adolescence, 34(5), 471–482. https://doi.org/10.1007/s10964-0057264-x
Wittchen, H.-U., Nelson, C. B., & Lachner, G. (1998). Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychological Medicine, 28(1), 109–126. https://doi.org/10.1017/s0033291797005928
Woodford, M. R., Kulick, A., & Atteberry, B. (2015). Protective factors, campus climate, and health outcomes among sexual minority college students. Journal of Diversity in Higher Education, 8(2), 73–87. https://doi.org/10.1037/ a0038552
Yang, X., & Mak, W. W. S. (2016). The differential moderating roles of self-compassion and mindfulness in self-stigma and well-being among people living with mental illness or HIV. Mindfulness, 8, 595-602. https://doi.org/10.1007/ s12671-016-0635-4
Yanos, P. T., DeLuca, J. S., Roe, D., & Lysaker, P. H. (2020). The impact of illness identity on recovery from severe mental illness: A review of the evidence. Psychiatry Research, 288, Article 112950. https://doi.org/10.1016/j. psychres.2020.112950
Yu, B. C. L., Chio, F. H. N., Chan, K. K. Y., Mak, W. W. S., Zhang, G., Vogel, D., & Lai, M. H. C. (2022). Associations between public and self-stigma of help-seeking with helpseeking attitudes and intention: A meta-analytic structural equation modeling approach. Journal of Counseling Psychology. Advance online publication. http://dx.doi.
Figure 1
Participant Demographics: Race/Ethnicity
Participant Demographics: Degree Tracks
1. What is your age?
2. What college/university do you attend?
3. What is your college major/program?
4. What is your current year in college?
5. What pronouns do you use/prefer?
6. What term(s) best describe your gender identity? List all that apply.
7. What term(s) best describe your LGBTQ+ identity? List all that apply.
8. What term(s) best describe your racial/ethnic identity? List all that apply.
1. What is your experience like as an LGBTQ+ college student in terms of your mental well-being?
2. How has your queer identity impacted the way you think about mental health, if at all?
3. Have you ever been diagnosed with a mental health disorder? List all that apply, if applicable.
4. What messages about mental health have you received from your community/family/school/university?
5. How do you think these messages have impacted your opinions on seeking professional help, if at all?
6. Please describe a time in college when you have been exposed to the stigma surrounding your sexual/gender identity, if applicable.
7. Please describe a time in college when you have been exposed to the mental health stigma, if applicable.
8. How do you believe the stigma surrounding mental health influences your well-being as an LGBTQ+ college student, if at all?
9. Is there anything else you would like to add about mental health stigma, your experience as an LGBTQ+ college student, or how the mental health stigma influences your well-being as an LGBTQ+ college student?
10. If you feel comfortable being contacted for potential follow-up, please leave your email.
Nicole Quinn Chow Editor-in-Chief | Creative Director nqc204@nyu.edu
Nicole Quinn Chow is a senior double-majoring in Applied Psychology and Art History (‘23). She works as a research assistant at the Families and Children Experiencing Success Lab, which focuses on supporting youths with behavioral difficulties and their families. Her research interests lie in child development and clinical interventions. She is currently working on her honors thesis under the mentorship of Dr. Anil Chacko, which explores access to treatment for children with ADHD. In the future, she aspires to become a clinical psychologist to improve children’s mental health.
Su-Yue Amy Wang Editor-in-Chief
syw320@nyu.edu
Su-Yue Amy Wang is a senior in Applied Psychology (‘23) with minors in Teacher Education and Mathematics. She works as a research assistant with the Researching Inequity in Society Ecologically (RISE) Lab and is currently completing her honors thesis on exclusionary school discipline under Dr. Shabnam Javdani’s mentorship. Her research interests include addressing inequalities within education and disrupting the school-toprison pipeline, and she will be pursuing a PhD in social psychology after graduation.
sjc725@nyu.edu
Shirley Cajamarca is a junior majoring in Applied Psychology (‘24) with a strong desire to explore different career paths. She joined OPUS because she believes in the importance of encouraging and supporting undergraduate students to showcase their excellent work. She values the amazing community that OPUS has created and wishes to continue working with the team. Shirley remains optimistic and excited about her future.
Rebecca Wu Layout & Design Coordinator
rw2602@nyu.edu
Rebecca Wu is a senior in Applied Psychology (‘23) minoring in Economics. She is a research assistant at the SMART Beginnings Lab, which focuses on the school readiness of children from low income families. She plans to pursue a Master’s degree in user experience design, which connects her interests in psychology and design.
Contributing
Writergrb341@nyu.edu
Gianna Rose Boccieri is a senior in an accelerated Master’s program earning a BS in Applied Psychology (‘23) and an MA in Counseling for Mental Health and Wellness (‘24). She also minors in American Sign Language and concentrates in Child and Adolescent Mental Health Studies. She works as a research assistant on the ARCADIA for Suicide Prevention team and has been a Steinhardt Peer Mentor since 2021. In the future, she hopes to work with LGBTQ+ youth and individuals who have lost loved ones to suicide through her counseling practice and research.
Adam Goldstein
Contributing
Writerafg4614@nyu.edu
Adam Goldstein is a sophomore studying Global Public Health and Applied Psychology (‘25). Originally a native New Yorker, Adam left NYC to attend American University in Washington D.C., but transferred to NYU for the Spring ‘23 semester. Since starting at NYU, Adam has joined OPUS as a contributing writer, is a member of NYU’s Active Minds chapter, and is a student worker at the School of Global Public Health’s undergraduate office. With a passion for mental health awareness and treatment, Adam is eager to explore the intersection of public health and psychology to address the mental health epidemic on a population level.
Lee Hatcher
Contributing
Writerglh279@nyu.edu
Lee Hatcher is a senior earning a combined degree in Applied Psychology (‘23) with a Master’s in Mental Health and Wellness Counseling (‘24). His minor is in American Sign Language but has two other focuses: French Studies and Child and Adolescent Mental Health. He is currently researching diversity within PhD scholarship opportunities and hopes to publish more of his work.
Contributing Writer
hk2851@nyu.edu
Haruka Kokaze is a senior enrolled in an accelerated program with a BS in Applied Psychology (‘23) and an MA in Counseling for Mental Health and Wellness (‘24). Her dream is to become a transnational psychologist for Japanese and Japanese Americans across the U.S. and Japan. Her curiosity in multicultural psychology comes from living in diverse cities and witnessing how mainstream mental health practices and resources are often not functional for non-Western populations. She is also a research assistant at various labs affiliated with Columbia University and NYU.
Suebin Lee
Contributing Writer
sl7622@nyu.edu
Suebin Lee is a senior in the accelerated Master’s program with a BS in Applied Psychology (‘23) and an MA in Counseling for Mental Health and Wellness (‘24). She is a 1.5-generation Korean-American who grew up in NYC after immigrating from South Korea. In the past, she volunteered in the Korean-American community to help foster cultural identities and at the Nordoff-Robbins Center for Music Therapy to explore the field of creative arts therapy. Currently, she is working towards obtaining an LMHC licensure in NY to provide bilingual services for underserved immigrant populations.
Yuyi LinContributing Writer
yl9060@nyu.edu
Yuyi Lin is a sophomore on the Pre-Health track in Applied Psychology (‘25) with a minor in Chemistry. In the past, she has coded for a WEIRD meta-analysis examining demographic representation within school psychology publications and advocated for girls and gender expansive youth who are at-risk for involvement or are involved in the juvenile justice system. Currently, she is a clinical research assistant at NYU Langone working in preventative diabetes and runs a Theravada Buddhism camp for Burmese American youth. In the future, she hopes to combine her interests in nutrition and education into a career pursuing medicine.
Contributing Writer
sp5562@nyu.edu
SoYoung (Bella) Park is a senior in B.S./M.A. for Applied Psychology (‘23) and Counseling for Mental Health and Wellness (‘24) with a minor in Sociology. During her undergraduate years, she explored her interests in psychology through research, clinical, and leadership roles at Rory Meyers College of Nursing, The Psychology Times, ABRA & CARA Retreat, Kurtz Psychology Consulting PC, and APUG Club. SoYoung hopes to provide bilingual services to international students and Asian American young adults to help them navigate their multicultural identity through research and counseling.
Jenny Yu
Contributing Writer
jy2865@nyu.edu
Jenny Yu is a senior in Applied Psychology and Global Public Health (Fall ‘23) with a minor in Data Science. Currently, she works as a research assistant at Culture, Emotion, and Health Lab at NYU Steinhardt, working for projects related to emotion regulation. She also works as a research assistant at IDEAS lab at NYU Langone, participating in both a qualitative research project targeting Chinese Americans smokers with Type II diabetes and a quantitative project for Covid-19 data analysis. In the future, she plans to study biostatistics and work in the field of healthcare.
Contributing Writer
qz990@nyu.edu
Olive (Qianyu) Zhou is a senior earning a BS in Applied Psychology (’23) at New York University. She minors in Nutrition and Urban Design & Architecture Studies. Currently, she works as a research assistant at the NYU Advocacy and Community-Based Trauma Studies (ACTS) Lab, participating in projects related to domestic violence. She also volunteers as a filmer at NYU Nordoff-Robbins Center for Music Therapy. She will continue to study counseling at UPenn. In the future, she hopes to become a novelist, photographer, and a therapist.
