Healing Intergenerational Trauma in the Southeast Asian American Community

A Dissertation

Presented to the Faculty of the School of Psychology & Counseling

Regent University

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In Partial Fulfillment

Of the Requirements for the Degree of

Doctor of Philosophy
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Counseling and Psychological Studies

By

Savannah Pham

December 2023
 School of Psychology and Counseling

Regent University

This is to certify that the dissertation prepared by:

Savannah Pham

Titled

HEALING INTERGENERATIONAL TRAUMA IN THE SOUTHEAST ASIAN

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AMERICAN COMMUNITY
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Has been approved by their committee as satisfactory completion of

the dissertation requirement for the degree of Doctor of Philosophy.

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Approved By:

Paula Coutinho, Ph.D., Committee Chairperson

School of Psychology and Counseling

Amy Simmons, Ph.D., Committee Member

School of Psychology and Counseling

Jessica Guilfoyle, Ph.D., Program Director

School of Psychology and Counseling

December 2023
 Abstract

Southeast Asian (i.e., Cambodian, Hmong, Laotian, and Vietnamese) refugees who migrated to

the United States during the latter half of the 20th century experienced numerous traumatic events

prior to and during migration (e.g., war, genocide, starvation). Intergenerational trauma is

defined as the trauma that gets passed down from those who directly experienced a traumatic

event to subsequent generations. Given the high levels of trauma and related symptoms among

Southeast Asian refugees, research indicates that refugee offspring experience high levels of

intergenerational trauma. Moreover, intergenerational trauma is associated with poorer

psychological adjustment, including high levels of depression and anxiety. There are high rates

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of mental health disorders and low rates of mental health service utilization within the Southeast
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Asian community. Little research has examined ways to treat intergenerational trauma in the

Southeast Asian community. Therefore, this culturally sensitive program aims to address these
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needs. Clinicians can implement this 6-module group to help second-generation Southeast Asian

Americans heal from intergenerational trauma. Topics include psychoeducation about

intergenerational trauma and the psychobiology of trauma, incorporation of cultural values and
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holistic practices, as well as meaning making and a survival genogram. Pre- and post-assessment

measures will be used to gather empirical data to assess the program’s effectiveness.

Keywords: intergenerational trauma, Southeast Asian Americans, psychological

adjustment

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 Acknowledgments

This dissertation is dedicated to my parents, Tang Pham and Kina Mam Pham, as their

refugee journeys from Vietnam and Cambodia inspired me to complete this project. I am

eternally grateful for your sacrifices and in constant awe of your resilience. Words are not

enough to describe my appreciation.

Virginia, Alex, and Cody, thank you for always looking out for me and for your

unwavering support. Vanuyen, thank you for being my best friend; I love how we have

supported and affirmed every version of each other. Alexander, thank you for believing in me,

even when I doubted myself.

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I would also like to express a tremendous amount of gratitude to my dissertation
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committee, Dr. Paula Coutinho and Dr. Amy Simmons. This dissertation would not be possible

without the ongoing support and guidance that I have received from you both. Thank you for
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helping me bring this project that I have been dreaming about for a long time to life.

.
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 Table of Contents

Abstract .......................................................................................................................................... iii

Acknowledgments.......................................................................................................................... iv

List of Tables ............................................................................................................................... viii

Chapter I: Introduction and Literature Review ............................................................................... 1

Historical Background................................................................................................................. 1

Cambodian Refugees ............................................................................................................... 3

Vietnamese Refugees .............................................................................................................. 3

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Laotian and Hmong Refugees ................................................................................................. 4

Post-Migration Experiences .................................................................................................... 4

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Trauma in Southeast Asian Refugees ...................................................................................... 5

Intergenerational Trauma ............................................................................................................ 6

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Research among Offspring of Holocaust Survivors ................................................................ 7

Impact of Intergenerational Trauma on Second-Generation Southeast Asian Americans ...... 8

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Mental Health Disparities ........................................................................................................ 9

Southeast Asian Culture and Norms ......................................................................................... 10

Impact of Culture on the Presentation of Mental Health Concerns ....................................... 11

Holistic and Indigenous Healing Practices ........................................................................ 12

Treatment of Intergenerational Trauma .................................................................................... 13

Treatment Programs in Indigenous and Aboriginal Communities in Canada ....................... 13

Body Psychotherapy .............................................................................................................. 15

Meaning Making and Survival Messages .............................................................................. 16

Statement of the Problem ......................................................................................................... 18

Purpose of the Study ................................................................................................................. 19

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 Definition of Terms ............................................................................................................... 20

Chapter II: Methods and Procedures............................................................................................. 22

Target Audience ........................................................................................................................ 22

Inclusion/Exclusion Criteria .................................................................................................. 22

Participant Recruitment ......................................................................................................... 23

Program Overview .................................................................................................................... 23

Assessments .............................................................................................................................. 25

Internalizing Symptoms ......................................................................................................... 26

Program Impact ..................................................................................................................... 26

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Chapter III: Results ....................................................................................................................... 27

Week One .................................................................................................................................. 27

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Week Two ................................................................................................................................. 28
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Week Three ............................................................................................................................... 28

Week Four ................................................................................................................................. 29

Week Five ................................................................................................................................. 30

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Week Six ................................................................................................................................... 31

Chapter IV: Discussion ................................................................................................................. 33

Clinical Implications ................................................................................................................. 35

Limitations ................................................................................................................................ 36

Future Directions ....................................................................................................................... 38

Spiritual Integration................................................................................................................... 39

Conclusion................................................................................................................................. 42

References ..................................................................................................................................... 43

Appendix A ................................................................................................................................... 53

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Appendix B ................................................................................................................................... 55

Appendix C ................................................................................................................................... 58

Appendix D ................................................................................................................................... 59

Appendix E ................................................................................................................................... 60

Appendix F.................................................................................................................................... 66

Appendix G ................................................................................................................................... 70

Appendix H ................................................................................................................................... 75

Appendix I .................................................................................................................................... 80

Appendix J .................................................................................................................................... 87

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 List of Tables

Table 1 Curriculum Modules ....................................................................................................... 24

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 Chapter I: Introduction and Literature Review

Southeast Asian (i.e., Cambodian, Hmong, Laotian, and Vietnamese) refugees who

migrated to the United States during the latter half of the 20th century experienced numerous

traumatic events prior to and during migration (e.g., war, genocide, starvation; Southeast Asian

Resource Action Center [SEARAC], 2020). Due to the highly traumatic conditions experienced

prior to and during migration, Southeast Asian refugees exhibit high levels of post-traumatic

stress disorder (Carlson & Rosser-Hogan, 1992; Field et al., 2013; Hsu et al., 2004).

Intergenerational trauma is defined as the trauma that gets passed down from those who directly

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experienced a traumatic event to later generations (Isobel et al., 2019). Given the high levels of

trauma and related symptoms among Southeast Asian refugees, research indicates that refugee
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offspring (i.e., second-generation Southeast Asian Americans) experience high levels of

intergenerational trauma (Han, 2006; Sangalang et al., 2017). Moreover, intergenerational

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trauma in second-generation Southeast Asian Americans is associated with poorer psychological

adjustment, including high levels of depression, anxiety, behavioral symptoms, physical

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violence, and general psychological distress (Field et al., 2013; Maffini & Pham, 2016;

Sangalang & Vang, 2017; Sangalang et al., 2017; Sangalang et al., 2018). Despite the amount of

empirical evidence highlighting the negative impact of intergenerational trauma on second-

generation Southeast Asian Americans, there is minimal research on how to help this population

heal from intergenerational trauma. Hence, this dissertation aims to develop culturally sensitive

resources and training materials that clinicians can use when working with the offspring of

Southeast Asian refugees.

Historical Background

Southeast Asians comprise a unique subset of the Asian population in the United States

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for two main reasons. First, the arrival of Southeast Asians in the United States is relatively

recent compared to other Asian subgroups (Dinh, 2009). Second, Southeast Asians came to the

United States as refugees in 1975, following the end of the Vietnam War. The United Nations

defines a refugee as “someone who is unable or unwilling to return to their country of origin

owing to a well-founded fear of being persecuted for reasons of race, religion, nationality,

membership of a particular social group, or political opinion” (United Nations General

Assembly, 1951). In 1975, the United States Congress passed the Indochina Migration and

Refugee Assistance Act (H.R.6755, 1975). This act allowed for the immediate resettlement of

130,000 Southeast Asian refugees in the United States. Between the years of 1975 and 1979, an

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additional 300,000 Southeast Asian refugees were resettled. Due to a growing refugee crisis, the
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Refugee Act of 1980 increased the yearly maximum for refugees from 17,400 to 50,000 (S.643,

1980). This act also generated a process whereby the maximum numbers could be increased in
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case of emergencies. Approximately 1.3 million Southeast Asian refugees were resettled in the

United States between 1975 and 2010. To date, this has been the largest refugee resettlement in

American history.
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It is important to understand the historical context that forced Southeast Asian refugees

out of their home countries and to resettle in the United States. Prior to migration, many

Southeast Asians experienced threats to their lives after communist organizations seized control

of their home countries (Abueg & Chun, 1996). Most Southeast Asians also experienced forced

separation from or witnessed the deaths of family members and loved ones as they fled from

their homeland (Dinh, 2009). After fleeing their home countries, Southeast Asians continued to

experience stressors. While residing in refugee camps, they were frequently detained in

environments that were unsafe, overcrowded, and unsanitary (Abueg & Chun, 1996). Many

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refugees and their families resided in these camps for years at a time. Moreover, while waiting in

these camps, Southeast Asians continued to experience uncertainty about their future and the fate

of their loved ones. Although Southeast Asians experienced many shared premigration stressors,

each refugee subgroup also had a unique set of circumstances leading up to their forced

migration (Dinh, 2009).

Cambodian Refugees

Cambodian individuals experienced the “Killing Fields” genocide between 1975 to 1979

(Hsu et al., 2004; SEARAC, 2020). Pol Pot and the Khmer Rouge, a communist regime, aimed

to restructure Cambodian society and culture (Kinzie et al., 1989). Due to the communist

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regime’s societal ideals and goals, over 25% of the country’s population (i.e., more than one
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million Cambodian individuals) died due to execution, starvation, and disease (Kinzie et al.,

1990). Cambodians also experienced forced separation from family members (Abueg & Chun,
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1996). For example, children were often subjected to agricultural labor camps and were

forcefully removed from their parents (Kinzie et al., 1989). In these camps, children were forced

to endure hard labor, torture, beatings, starvation, disease, and killings. In 1979, after
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experiencing the Pol Pot regime for four years, Vietnam occupied Cambodia. Consequently,

many Cambodians were forced to become refugees and escaped to Thailand before being sent to

other countries, including the United States (Kinzie et al., 1998).

Vietnamese Refugees

Vietnamese refugees resettled in the United States in primarily two waves. The first wave

of refugees migrated to the United States in 1975 after the fall of Saigon, which signified the end

of the Vietnam War. Moreover, the non-communist South Vietnamese regime also collapsed.

This wave of refugees consisted of educated and professional classes in Vietnam and was mostly

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made up of family units (Hsu et al., 2004). The second wave of Vietnamese refugees fled their

homeland between 1977 and 1980. The majority of these second-wave refugees were from rural

and less educated backgrounds; they are often referred to as the “boat people” (Dinh, 2009). The

boat people endured severe migration traumas as they fled Vietnam on overcrowded fishing

boats; over 200,000 people died at sea (Dinh, 2009). Additionally, pirates took over more than

80% of the fishing boats. These pirates killed, robbed, and assaulted many of the boat

passengers. Those who successfully fled Vietnam landed in Thailand refugee camps, which had

some of the worst living conditions (Dinh, 2009). For example, while residing in these camps,

Vietnamese refugees experienced overcrowding, starvation and poor nutrition, and unsanitary

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conditions.

Laotian and Hmong Refugees

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Laotian and Hmong people had harrowing experiences similar to Cambodian and
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Vietnamese people. In 1979, the Pathet Lao (i.e., communist political movement) gained control

of Laos (Abueg & Chun, 1996). Thousands of Laotians escaped to Thailand, where they were

detained in refugee camps (Abueg & Chun, 1996). Additionally, Hmong people were affected by
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the Pathet Lao because their communities were located in Laos’ mountainous areas. Many

Laotian and Hmong refugees were ultimately resettled in the United States.

Post-Migration Experiences

Even upon resettlement in the United States, Southeast Asian refugees continued to

experience stressors and challenges. The United States government opted to spread Southeast

Asian refugees throughout the country in order to inhibit the establishment of ethnic enclaves

and to reduce the possible effects of refugee resettlement to one specific area (Dinh, 2009). This

resulted in many Southeast Asian refugees settling in cities and rural communities with minimal

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access to other Southeast Asian individuals. Many Southeast Asians were subjected to violence

within their communities (Lee et al., 2015). Southeast Asian refugees also experienced

significant discrimination and were victims of hate crimes (Chung & Bemak, 2006). Another

common challenge of resettlement was with regard to unemployment and underemployment,

which contributed to economic difficulties (Dinh, 2009). Many Southeast Asian refugees also

experienced survivor’s guilt because they were able to leave their home countries while many

others were not able to (Chung & Bemak, 2006). All of these experiences intensified the stress

that Southeast Asian refugees experienced even after resettling in the United States.

Trauma in Southeast Asian Refugees

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Given the significant amount of exposure to life-threatening situations and death prior to
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migration, there is a high prevalence of trauma in Southeast Asian refugees. The American

Psychological Association defines trauma as, “an emotional response to a terrible event like an
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accident, rape, or natural disaster. Immediately after the event, shock and denial are typical.

Longer term reactions include unpredictable emotions, flashbacks, strained relationships, and

even physical symptoms like headaches or nausea” (2022). Studies have demonstrated that
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Southeast Asian refugees exhibited elevated levels of post-traumatic stress disorder (e.g.,

heightened startle responses, nightmares, irritability, dissociative symptoms, etc.) upon arrival in

the United States and even a decade after arrival (Carlson & Rosser-Hogan, 1992; Kinzie et al.,

1990). Yet, because of cultural beliefs that may stigmatize or ignore mental health, coupled with

a lack of culturally sensitive resources, these trauma symptoms have gone largely untreated

among Southeast Asian refugees (Chung & Bemak, 2006; Kim & Kim, 2014). These untreated

trauma symptoms may impair survivors’ capacity for parenting. Consequently, even though

refugee offspring have not experienced the original traumatic incidents, these unresolved trauma

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symptoms are transmitted from their parents (Isobel et al., 2019; Isobel et al., 2021).

Intergenerational Trauma

Intergenerational trauma is broadly defined as how the trauma experienced by one

generation impacts the well-being of subsequent generations (Isobel et al., 2019). Traumatic

experiences can be systemic, as evidenced in Southeast Asian refugee communities, in terms of

exposure to war, genocide, poverty, and colonization (Kira, 2022). Traumatic experiences can

also occur on a micro-level, including experiences with discrimination and relational trauma or

abuse. Southeast Asian refugees collectively experienced systemic trauma as they fled their

home countries and also experienced their own micro-level traumas. Exposure to traumatic

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events causes a rupture in a person’s life and routine; such exposure demands coping and
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adapting (Danieli, 1998). Whether or not trauma survivors openly talk about their experiences,

trauma gets passed down to offspring due to behavior patterns, systems, unprocessed emotions,
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and values (Cherepanov, 2015). Moreover, the offspring of refugees and survivors learn to

operate in ways that can mirror their parents’ traumatic behaviors; this transmission of trauma

often occurs unintentionally (Isobel et al., 2021). Consequently, trauma that is passed down and
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impacts subsequent generations can manifest in many different ways, including an inability to

regulate emotions, hypervigilance and mistrust of others, unhealthy parent-child dynamics,

restricted emotional expression, reliance on substances, low self-esteem, shame, depression, and

anxiety (Jeyasundaram et al., 2020; Menzies, 2010).

Although there are no precise theories about intergenerational trauma, the transmission of

trauma is theorized to be both an environmental and biological process. People’s lived

experiences and their genetic predispositions impact their worldview and behaviors they engage

in (Rosenthal, 2021). In the developmental period, children learn ways of adjusting to and coping

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with stressors based on their interactions and observations with parents. Through their actions,

emotions, and physiological sensations, children begin to learn how the world works (Rosenthal,

2021). A caregiver with a trauma history and symptoms may unconsciously transmit messages

that the world is dangerous, and that people are not to be trusted. In turn, children may begin to

mirror and repeat patterns and behaviors that they have learned from their parents.

In addition, research on epigenetics explores the ways in which exposure to traumatic

events and chronic stress can impact gene expression (Williams, 2013). For example, research

with mice has demonstrated that fear experiences can be transferred through genetics, even

without any direct social or environmental transmission. In their experiments, mice who were

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exposed to odor fear conditioning prior to conception demonstrated an increased fear response in
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subsequent generations (Dias & Ressler, 2013). This finding further highlights the ways in which

trauma can be passed down through genetic and biological factors.

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Research among the Offspring of Holocaust Survivors

Intergenerational trauma was first conceptualized and studied in 1966, when Canadian

clinicians observed that the children of Holocaust survivors exhibited significant psychological
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problems, despite not having experienced any traumatic events firsthand (Rakoff et al., 1966).

The Holocaust involved the intentional killings of six million Jewish people during the Second

World War (Lev-Wiesel, 2007). During the Holocaust, people were forced to endure significant

physical and psychological suffering, such as witnessing death and cruelty, experiencing

humiliation and violence, being physically separated from loved ones, experiencing starvation,

and more. Holocaust survivors have reported symptoms of post-traumatic stress, including

intrusive thoughts, anxious behaviors, and avoidant behaviors (Lev-Wiesel, 2007). Although the

children of Holocaust survivors were not directly exposed to the traumatic events, they have also

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exhibited high levels of trauma symptoms (Felsen, 1998). For example, one such study indicated

that 31% of adult offspring of Holocaust survivors met criteria for post-traumatic stress disorder

compared to adults who were not the children of Holocaust survivors (Yehuda et al., 1998).

Additionally, the children of Holocaust survivors have been identified as having a higher

vulnerability to stress compared to individuals who were not the offspring of Holocaust survivors

(Yehuda et al., 1998).

Impact of Intergenerational Trauma on Second-Generation Southeast Asian Americans

More recent research within the past two decades examined levels of intergenerational

trauma among the offspring of Southeast Asian refugees living in the United States. Studies have

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found that among second-generation Southeast Asian Americans, there are high levels of
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intergenerational trauma and perceived parental trauma (Han, 2006; Sangalang & Vang, 2017;

Spencer & Le, 2006). Research has indicated that the intergenerational transmission of trauma
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might occur via a lack of communication (Jeyasundaram et al., 2020; Kelstrup & Carlsson,

2022). For example, Southeast Asian refugee parents may not openly communicate about their

trauma which can contribute to heightened family dysfunction and impact offspring
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psychological adjustment. Moreover, parents with higher levels of trauma may have difficulty

being responsive caregivers, which can contribute to insecure parent-child attachment and impact

children’s mental health (Han, 2006). One qualitative study also highlighted how the adult

offspring of refugees may experience heightened distress and poorer psychological outcomes

because they feel indebted to their parents coupled with a fear of failing and not living up to their

parents’ sacrifices (Jeyasundaram et al., 2020). Offspring of refugees may also inherit an

obligation to succeed for the sake of family members who are no longer living and/or to honor

the sacrifices of their parents (Kwan, 2019).

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 High levels of intergenerational trauma correlate with poorer psychological outcomes

among second-generation Southeast Asian Americans. Research indicates that intergenerational

trauma correlates with higher rates of depression, anxiety, behavioral symptoms, physical

violence, and general psychological distress among Southeast Asian refugee offspring (Field et

al., 2013; Maffini & Pham, 2016; Sangalang & Vang, 2017; Sangalang et al., 2017; Sangalang et

al., 2018).

Mental Health Disparities

Currently, there are over 2.5 million Southeast Asian Americans living in the United

States (SEARAC, 2020). Many Southeast Asian Americans have limited English proficiency and

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are low-income, which makes addressing physical and mental health conditions difficult.
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Epidemiological data has indicated that Southeast Asian Americans have a higher prevalence of

any mental health disorder (e.g., mood disorders, anxiety disorders, substance use disorders)
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compared to other East Asian or South Asian Americans (Lee et al., 2015). Refugees’ migration-

related and untreated trauma may be linked to these higher rates of mental health disorders. In

addition to higher rates of mental health disorders, Southeast Asian Americans also have the
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lowest levels of mental health service utilization among Asian subgroups (Lee et al., 2015).

Numerous factors influence the under-utilization of mental health resources by Southeast

Asian Americans. One important factor is the stigma associated with mental health concerns

(Dinh, 2009). In Southeast Asia, mental health disorders are not as well understood and might be

considered spiritual suffering. Additionally, because “face” is so important (i.e., not bringing

shame to the family name and unit), parents may also discourage help-seeking behaviors (Leong

& Lau, 2001). Moreover, Asian Americans generally respond more positively to sources of

support that are more informal (e.g., herbalist, family, friends) compared to more formal sources

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of support (e.g., psychologist, physician; Kim & Lee, 2022). In turn, many Asian Americans

prefer a holistic approach to treatment. Rather than focusing solely on the diagnosis and

treatment of a specific psychological concern, Asian Americans prefer an approach that

incorporates an emphasis on both the mind and the body. Overall, there is a lack of culturally

sensitive intervention models among the Asian American community more broadly, and among

the Southeast Asian American community (Augsberger et al. 2015; Kim & Lee, 2022).

Southeast Asian Culture and Norms

Given a lack of culturally sensitive treatment models for Southeast Asian Americans, it is

important to highlight the unique cultural factors and norms that exist within this community.

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The American Psychological Association defines culture as, “the distinctive customs, values,
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beliefs, knowledge, art, and language of a society or community. These values and concepts are

passed on from generation to generation, and they are the basis for everyday behaviors and
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practices” (2023). Through generations, Southeast Asian people have passed down traditional

cultural practices and values.

Southeast Asian cultures tend to be collectivistic, which means that the needs of the
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group are more important than the needs of the individual (Paik et al., 2017). Consequently,

relationships with other family members and other community members play a central role in

people’s identity. There is also an emphasis on avoiding disagreement and maintaining harmony

(Mathews, 2000). Therefore, the cultural norm is for people to control their emotions and

expressions in interpersonal interactions. The family structure values hierarchical norms and

interdependence, with the father as the head of the household and decision maker (Mathews,

2000; Paik et al., 2017). There is also a significant importance placed on familial obligation,

obedience, and respect for elders (Mathews, 2000; Trieu, 2016). Given the significance of family

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obligation and relationships, resolving personal matters and conflicts remains within the family

unit rather than seeking outside or formal help.

There are also some cultural nuances within each Southeast Asian American subgroup.

Cambodian culture emphasizes respect for not only elders, but also ancestors (Paik et al., 2017).

Laotian culture also underscores a hierarchical and patriarchal family structure, where parents

tend to become stricter as their children grow older (Moore et al., 1997). Cambodian and Laotian

cultures were both strongly influenced by Hinduism, Brahmanism, and Theravada Buddhism.

These religions underscore the importance of harmony. Vietnamese traditions are strongly

influenced by Confucianism and Mahayana Buddhism, both of which underscore the importance

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of community and family (Leung et al., 1997). Vietnamese children are typically raised with the
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notion that their successes bring honor to their family unit. Hmong people hail from a tribal

culture, so large family networks are typical (Paik et al., 1997). Hmong culture also has strong
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ties to animistic and shamanistic religion. However, many Vietnamese and Hmong people living

in the United States embraced Christianity (Moua & Lamborn, 2010). Overall, understanding the

cultural nuances of Southeast Asian communities can help inform treatment with this population.
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Centering treatment around these collectivistic values (e.g., strong family bonds, respect for

elders, religion, and spirituality) is beneficial to treatment and can further improve Southeast

Asian American health and well-being (Millner et al., 2021).

Impact of Culture on the Presentation of Mental Health Concerns

Southeast Asian culture also tends to have a more holistic perspective on both mental and

physical health, in that the mind and body are well integrated (Yeh, 2000). This may be the

reason why mental illness and emotional problems in Southeast Asians tend to manifest as

somatic complaints and physical symptoms (Haque, 2010). For example, a Southeast person

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 experiencing depression might be more likely to report feeling muscle tension, low energy,

decreased appetite, and insomnia. A Southeast Asian person is less likely to endorse feelings of

sadness or depressed mood. Southeast Asian refugees and second-generation Southeast Asian

Americans have reported a high number of somatic complaints in medical settings (Yeh, 2000).

Additionally, given the stigma around mental illness, physical complaints tend to be more

socially acceptable than emotional or psychological problems. Consequently, the higher rates of

somatic complaints coupled with the emphasis on keeping matters within the family unit results

in a lower tendency to seek out professional help. Instead, many Southeast Asians rely on

holistic and traditional practices (e.g., the use of herbs, acupuncture, yoga, etc.) to manage

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mental health concerns (Haque, 2010).

Holistic and Indigenous Healing Practices

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Traditional, indigenous cultural beliefs and practices impact the presentation of mental
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health concerns and related practices (Chung & Lin, 1994). Southeast Asian Americans continue

to draw from traditional healing practices from their home countries to treat both physical and

mental health concerns. The use of Chinese herbs and medicine continues to be a common
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practice given that they can be used independently (Chung & Lin, 1994). Moreover, these herbs

and medicines are thought to be health-promoting and have preventative qualities. Another

common indigenous practice is called “cia cio” or coin rubbing, where a coin or spoon is used to

rub warm oil onto the skin (Hsu et al., 2004). This practice is used to help alleviate minor

illnesses. Traditional healing practices also include the use of mindfulness, yoga exercises, and

breathing techniques (Millner et al., 2021).

Given that psychology and mental health practices are deeply rooted in Western contexts

and cultures, Asian cultural values and traditional practices are sometimes perceived as

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