A Culturally-Responsive View of Anxiety in the Asian Community
Anxiety is on the rise. 43% of adults say they feel more anxious in 2024 than they did last year, up from 37% in 2023. That’s nearly half of all adults!
In some ways, this statistic isn’t very surprising. Now, more than ever, there are numerous things competing for our attention. News and instant communication tools are readily accessible, making it hard to get out of our brains and into our bodies. The cost of living is rising, inflation is high, yet wages and salaries haven’t grown at similar speeds. Macro events such as elections and climate change contribute to a sense of impending doom. All of this leads to heightened levels of social, financial, physical, and mental anxiety.
Fortunately, efforts to normalize anxiety are also on the rise. Recent movies like Turning Red, Didi, and Inside Out 2 reflect society’s readiness to embrace conversations about anxiety.
How does this apply to Asian American, Native Hawaiian and Pacific Islander (AANHPI) individuals? What can we do about it? First, let’s start by defining and examining anxiety.
What is anxiety?
Anxiety is a feeling of fear, dread, and uneasiness. At some point in one’s life, you will feel a bit of anxiety in some form. Everyone does! It’s a natural emotion that can actually be useful in helping us function. People often feel anxious in stressful situations, and in a sense, anxiety can be a “boost of energy or help you focus.” Anxiety can help you meet tight deadlines, determine what is socially appropriate behavior in particular settings, and help you plan to mitigate against potentially harmful future situations.
However, when one’s anxiety is no longer temporary and becomes overwhelming, they may have an anxiety disorder in which their symptoms interfere with daily activities like school, work, and relationships. Some forms of anxiety disorders include:
Generalized Anxiety Disorder (GAD), characterized by excessive worrying
Panic Disorder, which involves repetitive panic attacks characterized by intense fear
Phobias, where people have an intense fear of something that poses little or no actual danger
Having an anxiety disorder impacts one’s mental health and can worsen depression, substance misuse, insomnia, social isolation, an overall poor quality of life and, in drastic cases, suicide. How can you tell if you have anxiety? Your body may be giving you signs.
What are Common Signs and Physical Symptoms of Anxiety?
Anxiety is not only limited to mental symptoms but physical ones as well. Common physical symptoms when feeling anxious include difficulty breathing, tense muscles, trembling, a rapid heartbeat, and pain and bloating in your abdomen. These are all the results of the stress response when the body releases cortisol as it prepares for “fight or flight.” Evolutionarily, this adaptation was helpful when we were much more active and outside for longer periods of time. However, today’s modern age of consumption and sedation means we face different issues, even though our body still operates on similar neurological alert systems.
What happens if these symptoms persist without actively being addressed? Untreated anxiety can have long-term effects for all areas of health. For example, the hormones adrenalin and cortisol are responsible for increased heartbeat and breathing, which can help when facing a threat. But these hormones also affect digestion and blood sugar. Over time, these problems can compound to lead to:
Heart disease, strokes ,and heart failure
Migraines
Back problems
Vision problems
Diabetes
Thyroid problems such as hyperthyroidism
Chronic pain or irritable bowel syndrome
And more…
Therefore, we need to pay attention to these signs before our body’s warning system goes into crisis mode!
How Does Anxiety Show Up in Asian Culture?
Cultural factors play a significant role in shaping the mental health of Asians. Traditional Asian values emphasize the importance of family, where each member holds a “distinct role and position within a hierarchical structure.” Each person is expected to function within that role, submitting to the larger needs of the family. Rituals and customs such as “ancestor worship, family celebrations, and funeral rites” reinforce this concept. Mutual obligations and shame are the mechanisms that help to reinforce societal expectations and proper behavior.
What happens when these norms come into conflict with “American” expectations, especially in high school and college? For example, Asian young adults at school may face pressure from their classmates to smoke, drink, and have sex in ways that directly contradict their family’s more traditional expectations. Consequently, this leads to bicultural tension and acculturative stress, which is the tension of choosing between “American” and “Non-American” ways. In particular, international students and new immigrants face these tensions as they navigate severe and sudden challenges in coping with the demands of a new country.
The term collectivism refers to the relationship and interdependence between members of social organizations. Collectivistic cultures value harmony within the group. An example of this would be stricter rules for social behaviors, which are often highly valued in Southeast Asian countries. This implies that individuals in these cultures are more easily embarrassed in the case of shortcomings regarding these expectations. Presenting embarrassment is more common in collectivistic cultures, and guilt and self-blame, a person's individual feelings and thoughts are more common in individualistic cultures. When one deviates from expected social rules, they face guilt. All of this suggests that the “cultural orientation of a person and the cultural norms” have a wide contribution to mental health.
Self-construal refers to "an overarching schema that defines how people relate to others." Individuals in Asian cultures possess interdependent self-construals because "they view themselves as being intricately connected and integrated with others in the social group." These people see themselves as an extension of their social group and strive to maintain harmony in relationships.
An example of a specific cultural anxiety is Taijin kyofusho (TKS), more commonly present in Japanese and Korean cultures, but has also been reported in other cultures. This disorder involves people being concerned about doing something that will offend or embarrass the other person, not themselves. This can be the fear to offend others by "emitting offensive odors, blushing, staring inappropriately, and presenting an improper facial expression or physical deformity.” Another example of collectivism is the concept of Kapwa in Filipino culture; Anise Health therapist Claudine Lucena views Kapwa positively as a form of communal healing and support.
However, social stigma, shame, and the cultural imperative to "save face" frequently contributed to higher senses of social anxiety for Asians. These factors contribute to a reluctance to acknowledge or seek help for psychological distress. Thus, understanding and addressing these cultural dynamics is crucial in ensuring the provision of effective mental health support for Asian communities.
How Does Anxiety Impact Asian Americans and Pacific Islanders, Particularly Youth and Young Adults?
Asian American children and youth are highly affected by anxiety. Evidence suggests Asian American children might be at greater risk for anxiety disorders relative to non-Asian US children. Some estimates suggest that a third of all Asian American children were at elevated risk for anxiety, somatization and depressive problems. Another study found that Asian American kindergarten children have higher levels of internalizing problems, blaming themselves; consequently, this leads to higher levels of depression and lower interpersonal relationship skills. Some researchers have made the connection to parenting and teaching practices in Asian culture - ones that involve assumptions around obedience, control, indirect communication - that lead to higher parent-child conflict and higher rates of anxiety.
Social anxiety involves fear of scrutiny or negative evaluation by others. Evidence suggests that Asian American college students report higher social anxiety symptoms this is likely because of a variety of reasons but a dominant one being the role of peer comparison and acceptance in Eastern cultures causing sensitivity to social cues and emotional responses (Markus & Kitayama, 1991).
How do you explain elevated social anxiety in Asian American youth and young adults? Asian American students exhibited greater concerns about losing face and reported more experiences of shame socialization from parents compared to European Americans. Additionally, these students displayed lower emotion recognition abilities, particularly in identifying negative emotions. This leads to a very interesting dichotomy. These findings suggest that, on one hand, Asian Americans value awareness of others' emotions but, on the other hand, may lack skills that help students fit in to non-Asian norms due to cultural and social factors, specifically one being taught as children to be "polite, quiet, and humble.”
What Are Practical Solutions to Address Anxiety in Asian Americans?
First, remember it is normal to feel anxious. Hearing other people share their experiences can help you feel less alone. Therefore, you can look into joining a culturally-informed peer support group that doesn’t criticize or blame who you are. Instead, the group - facilitated by a mental health professional - can help you learn stress management techniques and mindfulness tools.
Second, get better at identifying how anxiety shows up for you. Do you feel jittery and overstimulated? Look for calm places to slow down your mind and breathing. Do you feel disassociated? Go for a walk to connect with your body and pay attention to what you can directly experience.
For parents, early childhood anxiety prevention programs like ParentCorps, a culturally-informed child mental health program, prioritize enhancing teachers’ cultural competence and fostering positive parent–child relationships. Strengthening Early Emotional Development (SEED), a program that integrates emotional socialization practices pertaining to anxiety, parent–child relationships, children's emotional awareness and comprehension, and coping strategies.
Finally, surround yourself with well-trained experts. Find a therapist and coach that works for you and determine what modality of care fits your needs, such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT) or Dialectical Behavior Therapy (DBT).
