beliefs, represented by cognitive manifestations affect illness behavior. For example, studies on reaction to pain demonstrate that Jews and Italians tend to verbalize more when in pain than white Anglo-Saxon Protestants. Jewish and Italian children are taught to avoid physical injury; they become anxious when they are in pain, and complain. Other cultures, such as white Anglo-Saxon Protestants, are taught to be tough and take pain; these children tend to endure pain without complaining or crying (Banja, 1996, pp. 279-280).
Cultural cognitions also affect treatment processes. Culture includes socioeconomic status, education, occupation, religion, and experience that influence a patient's cognitive mind-set when entering a therapeutic relationship. Entrenched cultural beliefs are difficult to change. Cognitive therapies attempt to alter a patient's thinking or cognitions and beliefs or schemata; both are important in maintaining mental health. It is suggested that cognitive therapy can be useful with different cultural groups if the intervention includes cultural adaptations (Banja, pp. 280; Holdsworth, 1995, p. 484, & Iwamasa, 1993, p. 234).
African Americans, Latinos, & Asians
Studies with African Americans demonstrate cultural beliefs that differ from the White population. For example, Black families are more tolerant of family member disturbance; older relatives are valued and cognitive declines are less important. Black caregivers expect the caregiving experience. Blacks may experience hardships due to poverty, racism, segregation, and life stressors that cannot be easily changed and this may contribute to the development of existing cultural cognitive coping mechanisms. Blacks demonstrate their ability to use cognitive-restructuring; they view caregiving from a positive perspective and demonstrate less resulting depression than White caregivers (Haley, Roth, Coleton, Ford, West, Collins, & Isobe, 1996, pp. ...