(PS1-11) Cultural Adaptation of Acceptance and Commitment Therapy for Latinx Individuals with Co-occurring Anxiety and Alcohol Use Disorder

Abstract Text:

Background: Alcohol misuse, a leading global cause of mortality, often co-occurs with anxiety, a prevalent psychiatric disorder. Latinx individuals, comprising 19% of the U.S. population, experience more severe and prolonged symptoms of both conditions compared to non-Latinx White persons. Targeting shared underlying processes is crucial, as it allows for a more effective treatment approach. Acceptance and Commitment Therapy (ACT) targets experiential avoidance (EA), a key shared vulnerability process, by addressing a person’s rigid unwillingness to remain in contact with uncomfortable internal experiences. However, ACT has not been adapted for dual diagnoses of alcohol misuse and anxiety within the Latinx community, which faces unique cultural and structural barriers to care.

Objective: To explore perspectives on: (1) the clarity and relatability of ACT strategies to the treatment needs of the target population and (2) the cultural relevance of ACT concepts.

Method: Qualitative focus groups were conducted among Latino men and women in residential treatment centers across the Greater Boston Area. Inclusion criteria being dually diagnoses with co-occurring anxiety and alcohol misuse. Focus groups were held on-site and conducted in Spanish or English. Focus groups were transcribed, and a thematic analysis approach was used to analyze the data.

Results: Three 90-minute focus groups were conducted with a total of 20 participants (n=13 males). Two major themes emerged across these groups: (1) participants preferred simple, concrete metaphors with actionable strategies to manage stressors over abstract examples in ACT therapy, and (2) perceived cultural stigma and fear of judgment were identified as significant barriers to seeking help. Differences in worldview emerged between male and female groups. Male participants expressed a fatalistic worldview, accepting life's challenges as inevitable and uncontrollable, and emphasizing the need for endurance. In contrast, female participants adopted a worldview focused on resistance, highlighting the importance of taking action to change or mitigate difficult circumstances.

Conclusions: Engagement with Acceptance and Commitment Therapy (ACT) can be enhanced by emphasizing concrete, actionable strategies and practical examples that demonstrate the real-world utility of ACT metaphors, especially during periods of heightened anxiety. However, initial resistance to ACT concepts like emotional openness and acceptance may arise from cultural stigma and fear of judgment, underscoring the need to address these barriers directly within sessions. The observed connections between fatalism and endurance among men, as well as resistance and resilience among women, present an opportunity to teach emotional acceptance in a culturally congruent manner. Approaching therapy in this way can help individuals navigate difficult emotions and life challenges by leveraging themes of resistance, grit, and cultural pride to improve treatment outcomes. Further research is necessary to identify additional themes that can inform the adaptation of ACT for this population.