Research Proposal
I.
Title: A Structured Writing Intervention for Mexican American College Students
with Maladaptive Thoughts Related to Educational Success at UT
II.
Investigators: Gladys S. Valdez, M.A.
III.
Hypothesis, Research Questions, or Goals of the Project: The aim of this study is
to examine whether a writing intervention (Traditional Writing Paradigm) which has
been shown to be effective in alleviating psychological symptoms will prove to be
efficacious in modifying the maladaptive thoughts and in reducing worry of Mexican
American college students of differing cultural identity levels. Furthermore, this
study aims to examine whether modifying the writing intervention in order to make it
more structured and directive will impact the degree of modification of participants’
dysfunctional thoughts and reduction in overall worry. Past research with diverse
Latino populations has shown that participants prefer more structured and directive
therapies when compared to non-directive therapeutic styles. Similarly, research has
also shown that the more structured and directive therapies appear to be more
efficacious when working with Latino populations.
Thus, it is hypothesized that:
1. Both writing interventions – Traditional Writing Paradigm (TWP) and the
Structured Writing Intervention (SWI) – will have a larger modifying effect in
participants’ maladaptive thoughts compared to the control condition.
2. Both writing interventions – Traditional Writing Paradigm (TWP) and the
Structured Writing Intervention (SWI) – will show greater reductions in
participants’ overall worry compared to the control condition.
3. The Structured Writing Intervention (SWI) will have a larger modifying effect in
participants’ maladaptive thoughts compared to Traditional Writing Paradigm
(TWP).
4. The Structured Writing Intervention (SWI) will show greater reductions in
participants’ overall worry compared to Traditional Writing Paradigm (TWP).
5. The effects of the Structured Writing Intervention (SWI) will be moderated by
participants’ cultural identity identification.
a) It is hypothesized that the more participants identify with traditional
Mexican cultural values, beliefs, and practices, the more efficacious the
SWI will be compared to the TWP.
b) Conversely, those participants who are more identified with mainstream
American cultural values, beliefs, and practices will experience a greater
reduction in symptoms in the TWP group than in the SWI group.
IV.
Background and Significance:
Even though more than one in eight individuals living in the United States is
currently considered to be Hispanic/Latino (U.S. Census Bureau, 2003), very little is
known about how to best provide mental health services to this rapidly-growing
population. Currently, there is a paucity of empirical data supporting the efficacy of
treatments for any disorders when working with Latinos. However, a review of
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theoretical, survey and a handful of empirical studies suggests that when working with
Latino clients, the treatment modalities which appear to be most efficacious are those
that are active, directive, problem-focused, concrete, and structured (Block, 1978;
Botvin, Dusenbury, Baker, James-Ortiz, & Kerner, 1989; Carrillo,1978; Comas-Diaz,
1981; Comas-Diaz & Duncan, 1985; Constantino, Malgady, & Rogler, 1985;
Constantino, Malgady, Rogler, & Castillo, 1989; Figueroa-Torres & Pearson, 1979;
Kanel, 2002; Morgan, 1975; Naun, 1971; Prieto-Bayard & Baker, 1986; RamirezBoulette, 1976; Szapocznik, Kurtines, Foote, Perez-Vidal, & Hervis, 1983;
Szapocznik, Rio, et al., 1986; Szapocznik, Santisteban, et al., 1989; Szapocznik, Rio,
et al., 1989; Telles & collegues,1995). It is important to note, however, that the term
Latino used in these studies describes people of many racial and national backgrounds.
Furthermore, none of the studies reviewed examined the influence of cultural identity
or level acculturation on the efficacy of the treatments reviewed.
A therapeutic intervention which may prove to be effective in treating
psychological disorders when working with Latino populations is the basic writing
paradigm, developed by Pennebaker (1997). The writing paradigm is a writing
intervention in which participants are instructed to write continuously about an
emotional topic (e.g. coming to college, leaving home for the first time) for 3-5
consecutive days, with each writing session lasting 15-30 minutes. Participants write
in an anonymous, unique, and isolated environment, without regard to sentence
structure, grammar, or punctuation.
Over the last twenty years, researchers have found that when compared to control
writing conditions, writing paradigm participants report significantly less negative
affect (Greenberg & Stone, 1992; Greenberg, Wortman, & Stone, 1996; Murray&
Segal, 1994), report enhanced positive mood (Burton & King, 2004), report less
physical symptoms (Smyth, Stone, Hurewitz, & Kaell, 1999), and reduce the number
of physician visits in the subsequent 2 months to four years (Cameron & Nicholls,
1996; Greenberg & Stone, 1992; Richards, Pennebaker, & Beal, 1995; Francis &
Pennebaker, 1992; Pennebaker, Barger, & Tiebout, 1989). Participants in the writing
paradigm conditions have also reported a reduction of sleep onset for patients with
insomnia (Harvey & Farrell, 2003), have enhanced immune functioning (Esterling,
Antoni, Fletcher, & Margulies, 1994), and improved behavioral changes, such as jobseeking behaviors following unemployment (Spera, Buhrfeind, & Pennebaker, 1994).
While a few studies have not been able to replicate these positive effects mentioned
above (Pennebaker & Beall, 1986; Pennebaker, Kiecolt-Glaser, & Glaser, 1988;
Pennebaker & Francis, 1996; and Petrie, Booth, Pennebaker, Davidson, & Thomas,
1995), overall findings supporting the effectiveness of the writing paradigm are
considered significant. These findings also hold true across different national samples
(Rime, 1995 and Dominguez, Valderrama, Meza, Perez, Silva, Martinez, Mendez, &
Olvera, 1995), and across samples of differing educational attainment (Richards,
Pennebaker, & Beal, 1995; Spera, Buhrfeind, & Pennebaker, 1994).
There are several conceptual frameworks which have been posited in order to
attempt to explain why the writing paradigm serves as an effective therapeutic tool.
The original framework, known as the inhibition model (Pennebaker, 1989) proposed
that the writing paradigm served as an effective therapeutic tool because writing about
emotional experiences can be cathartic and helps individuals release inhibited
emotions. A more recent model put forth by Pennebaker, Mayne, & Francis (1997),
suggests that those individuals that benefit most from the writing paradigm are those
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that are able to process information and construct a meaningful story, or gain insight
into their own life events. A final framework proposed by King (2001) is that writing
may serve to promote self-awareness and self-regulation. Her research has shown that
writing about goals or positive experiences may be a way to prepare for the future in a
realistic manner; much in the same way that it is encouraged through certain types of
cognitive-behavioral interventions, such as cognitive restructuring. Thus, research has
shown that when the content of the stories produced is structured and goal-oriented,
individuals are reporting the most benefits from the writing paradigm intervention.
The sparse theoretical and empirical treatment literature on Latinos suggests that
the treatment modalities which appear to be most efficacious when working with this
population are those that are problem-focused and structured. Similarly, the literature
reviewed examining the efficacy of the writing paradigm as a therapeutic intervention
suggests that regardless of outcome measure studied, those individuals that reported
the most benefits were those that may have used the writing intervention as a way to
process information, problem-solve, and better understand their current stressors.
Therefore, the aim of this study is to examine whether the modification of the
writing paradigm into a more structured, problem-focused writing intervention will
facilitate in the reduction of Latino participants’ dysfunctional thoughts and in the
reduction in their overall worry. In order to explore this objective, participants will be
assigned to one of three conditions – the traditional writing paradigm (TWP)
condition, the structured writing intervention (SWI) condition, or to a control group
condition. It is expected that both the SWI and TWP conditions will have larger
modifying effects in participants’ maladaptive thoughts and show greater reductions in
worry compared to participants in the control condition. However, because the SWI
condition will be more problem-focused and structured, it is expected that participants
in this condition will have larger modifying effects in their maladaptive thoughts and
show greater reductions in worry compared to participants in the TWP condition.
The innovation of this study is to assess the relative impact of cultural identity
identification on the efficacy of the treatment interventions. Past studies have
classified all people of Latin origin in the same category and ignored unique
distinctions based on national origin and cultural identity identification. Thus this
study will only recruit participants of Mexican origin and will examine whether the
effects of the writing interventions are moderated by participants’ cultural identity
identification. It is hypothesized that the more participants identify with traditional
Mexican cultural values, beliefs, and practices, the more efficacious the SWI will be
compared to the TWP. Conversely, the more participants identify with mainstream
American cultural values, beliefs, and practices, the more efficacious the TWP will be
compared to the SWI.
V.
Research Method, Design, and Proposed Statistical Analysis:
Participants will be randomly assigned to one of three conditions (30 participants
per condition): Traditional Writing Paradigm (TWP), Structured Writing Intervention
(SWI), or a control condition.
Measures
The participants will be asked to state how strongly they believe the experimental
thought (“I worry a lot about my academic career at UT and at times this makes me
feel sad and/or anxious”) by rating it on a scale from 1-100 (from a low of “not at all”
to a ceiling of “extremely believe”). Self-report instruments will be completed before
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they are randomly assigned to their respective conditions. These measures all have
positive data on their reliability and validity. The Acculturation Rating Scale for
Mexican Americans – II (ARSMA-II; Cuéllar, Arnold, & Maldonado, 1995) and the
Family Attitudes Scale (FAS; Ramirez, 1999) will be administered to assess for
acculturation/cultural identity identification and identification with traditional
Mexican and American mainstream values. To assess depressive symptoms and
general anxiety, the Beck Depression Inventory (BDI; Beck & Steer, 1987) and the
Beck Anxiety Inventory (BAI; Beck & Steer, 1990) will be administered. In order to
assess overall psychological distress, the Brief Symptoms Inventory (BSI; Derogatis,
1993) will be utilized. To assess for degree of proficiency in English and Spanish, the
Bilingual Self-Rating Questionnaire will be utilized (Amuchastegui, Rodriguez, &
Sanchez, 1984). In addition, the participants will be asked to complete a
demographic questionnaire to assess general background variables.
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Procedure
Participants will be recruited through posted advertisements that state the
experimental thought (described above) or recruited from the introductory
psychology subject pool. If participants endorse the experimental thought, selfidentify to be of Mexican descent, and are 18 years of age or older, they will be asked
to join the study and scheduled to come to the laboratory to participate in three study
sessions. Once participants join the study, they will be randomly assigned to one of
the three study conditions. Once they arrive to the first study session, all participants
will complete a consent form (see attached), sign two copies and return one to the
research assistant. Once consent is given, participants will keep a copy of the consent
form and the research assistant will be place the copy in a binder in a locked cabinet
away from any participant data.
If consent is given, then participants will complete the aforementioned measures,
and return them to the research assistant. Upon completion of measures, research
assistants will screen the BDI and BSI scales to assess for suicidal/homicidal thoughts
on item 9 on the BDI and items 9, 39, and 40 on the BSI. If participants endorse
affirmative answers on these questions, research assistants will contact the primary
investigator and her supervisor, who is a licensed psychologist, immediately.
Furthermore, participants will also be referred to the Counseling and Mental Health
Center at the University of Texas at Austin.
After measures are completed, participants in the control condition will then be
instructed to copy pages from a statistics textbook by handwriting onto blank sheets
of paper for 15 consecutive minutes. Both the TWP condition and the SWI condition
will also write for 15 consecutive minutes on the topic of their experimental thought
(“I worry a lot about my academic career at UT and at times this makes me feel sad
and/or anxious”. However, the TWP condition will be instructed to write without
regard to grammar, spelling, or sentence structure, and to simply let their emotions
flow. The SWI will also be instructed to write without regard to grammar, spelling,
or sentence structure, but they will answer a set of questions instructed to challenge
the validity of the individuals’ thoughts and provide confirming and disconfirming
evidence regarding the target thought (see appendix). Following all conditions,
participants will be asked to re-evaluate the accuracy of their target thought. Second
and third session dates will be scheduled for the following consecutive days, in which
the same procedures will take place. Self-report measure will be repeated only on the
third evaluation date.
A follow-up evaluation will be conducted two weeks later via electronic mail, at
which time participants will retake the measures that assess level of anxiety,
depression, and rate the degree to which they believe the target thought to be accurate
at this time.
Data Analysis
The data will be analyzed by using an analysis of covariance design. The
independent variable will be treatment condition, with scores on the ARSMA and the
BIS used as covariates. The dependent variables will be the differences in the
outcome measures described above from pre-treatment to post-treatment and 2-week
follow-up. Background variables (i.e. socioeconomic status, gender, generational
level, and level of language proficiency) will be controlled for.
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Regression analyses will also be conducted to examine the moderating effects of
cultural identity and acculturation on the efficacy of the different treatment
interventions.
VI.
Human Subject Interactions:
A. Sources of potential participants: The sample will consist of 90 college
students who meet the following criteria: (a) consider themselves to be of Mexican
origin/descent; (b) are 18 years of age or older; and (d) endorse the thought, “I worry
a lot about my academic career at UT and at times this makes me feel sad and/or
anxious.” Participants will be recruited from various student-based organizations
from The University of Texas at Austin. Data will be collected starting October 2005
and human subject involvement in this project is expected to end in August 2006.
B. Procedures for the recruitment of the participants: In order to recruit the
sample, fliers will be posted at various student-based organizations such as the
Hispanic Business Student Association, Movimiento Estudiantil Chicano de Aztlan
(MEChA), Sigma Lambda Gamma, Kappa Delta Chi, and the Mexican Student
Association. Copies of the fliers are appended.
C. Procedure for obtaining informed consent: Participants will be asked to sign a
written consent letter at the beginning of the study. I have enclosed the consent letter
for your review.
D. Research Protocol: Participants who endorse the experimental thought will
complete the aforementioned measures before being assigned to their respective
conditions. Completion of the study measures will take approximately twenty
minutes. Following randomization, the control condition complete a copying writing
task, while the experimental conditions will be asked to write for 15 consecutive
minutes given their instructions. Following the respective conditions, participants will
be asked to re-evaluate the accuracy of their target thought. All conditions will last
approximately forty-five minutes to complete during the first session, twenty minutes
the second session, and forty-five minutes the third session.
A follow-up evaluation will be conducted two weeks later via electronic mail, in
which the participants will be asked to retake the measures that assess level of
anxiety, depression, and rate the degree to which they believe the target thought to be
accurate at this time. This follow-up assessment will take approximately ten minutes.
Upon completion of the study, participants will receive class credit for their
participation in the experiment.
E. Privacy and confidentiality of participants: Participants will maintain control
throughout the study over the content and amount of information they choose to share
with the experimenter and research assistants. They have the right to withdraw from
the study at any time without penalty. Confidentiality of participants will always be
maintained.
F. Confidentiality of the research data: Research data will remain confidential at
all times. It will be kept in a locked file cabinet in a locked office, and access to the
data will be limited to the researcher and her associates. Data will be assigned a
participant number that will not be linked back to the participants’ names or any other
identifying data once the data has been entered a computerized data base.
G. Research resources: This researcher and researcher assistants will recruit and
conduct the experiment. There is laboratory space available in the Seay Building
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(Psychology Department) to run participants. An academic year is sufficient time to
recruit and run the anticipated 90 participants. If participants require psychological
emergency services, the primary researcher’s supervisor is a licensed psychologist in
Texas and can be contacted should the need arise. Also, the University of Texas
Mental Health and Counseling Center is conveniently located adjacent to the
Psychology department and participants can be referred to their facility if necessary.
VII.
Potential risks: It is possible that the completion of some of the questionnaires and/or
treatment conditions may trigger or exacerbate existing individual problems. Hence,
participants will be given the name and number of Professor Manuel Ramirez III, Ph.D.
(the principal investigator’s supervisor) and will be informed that they can contact him
at any time. The supervisor of the principal investigator is a licensed psychologist in
Texas and has a part-time practice in Clinical Psychology. Participants will also be
given the telephone number of the UT Mental Health and Counseling Center.
Participants will be informed of the potential risks of the study. In addition, great
measures will be taken to maintain the confidentiality of participants’ data. Due to the
procedure of the study, the participants’ questionnaires will be labeled by numbers
which can be linked back to their names. However, after the participants have
responded to the follow-up assessment via electronic mail, the participants’ data will be
reassigned a number that cannot be traced back to their names. Furthermore, all data
will be kept in a secure, locked filing cabinet located inside a locked office.
VIII. Potential benefits: The treatment conditions can potentially reduce participants’
maladaptive thoughts regarding academic concerns. Furthermore treatment conditions
may also reduce participants’ reported symptoms of anxiety/depression. Participation
may also help participants resolve personal conflicts or feel less stigma about seeking
psychological or medical services, should these be necessary. Additionally, the
modified writing intervention may prove to be an effective culturally sensitive
intervention for Mexican American students as proposed.
IX.
Sites or agencies involved in the research project besides The University of Texas
at Austin: N/A
X.
Review by another IRB: N/A
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