A Review of Culture Shock: Attitudes, Effects and the Experience of International Students

: In light of increasing globalization and the rising trend of international study, this paper reviews prominent literature as well as benchmark studies on culture shock, focusing on the experience of international students. First, it takes a look at concepts of the phenomenon, both negative and positive. This is followed by a discussion of the physical and psychosocial effects of culture shock, prior to detailed discussion of international students and their cultural adjustment problems. A number of suggestions are provided for educational institutions as well as international students regarding how best to manage and overcome culture shock.


Introduction
Increasing globalization and decreasing distances have opened up new horizons for students. Some of the most prominent countries in the world, such as the UK, Australia, New Zealand and the USA, are keen to recruit foreign students for many reasons (Andrade 2006, Lombard 2014. Altbach (1991) writes: "foreign students are among the most important and visible elements of (this) internationalization" (cited by Kelly, Moores & Moogan 2012: 25). In 2008, as many as 417,000 international students were studying in the United Kingdom (Kelly, Moores & Moogan 2012). China witnessed a 100% increase in international-student enrolment from 1998 to 2003, while the US witnessed a 72% increase from 2000 to 2014 (Mesidor & Sly 2016). By 2014, foreign students were the fifth-largest American "export" in the service division (Bevis & Lucas 2007, as cited by Yan & Berliner 2011). Globally, the number of foreign students was roughly 1.5 million in 2003 (Bochner 2003), increasing to two million by 2008, and is expected to rise to eight million by 2025 (Altbach 2004, cited by Pandian 2008). Increase in commercial value/revenue is one benefit of internationalization in education; however, there is the added benefit of a healthier learning environment with focus towards learning beyond the curriculum. Internationalization offers students the chance to acquaint themselves with a job market that is radically moving towards an international culture.
While exposure to a new culture helps prepare students for the job market, it also offers its share of challenges. Foreign students tend to get upset when they move away from their home culture, because culture is "the collective programming of the mind that distinguishes the members of one group of people from others" (Hofstede 2011: 2)including everything from values and power distance to uncertainty avoidance and economic systems. Students need time and guidance to adapt to the host culture. A cultural move is usually not smooth because "...the sojourner's body must not only adjust to new altitudes, foods, temperatures and pathogens, but also may experience symptoms associated with psychological distresssuch as fatigue, asthma, hives, headaches, or ulcers" (Befus 1988: 386). Oberg (1960: 142), credited with coining the term "culture shock", defines it as "the anxiety that results from losing all our familiar signs and symbols of social intercourse." This review analyzes prominent literature on culture shock to answer: 1.
How has the concept of culture shock developed over time; is it regarded as unfavorably now as it was in the beginning? 2.
What are the consequences of culture shock on the individuals experiencing it? 3.
How does culture shock affect international students? 4.
What can be done to help international students undergo culture shock smoothly?

Culture shock: Is it necessarily negative?
While the concept of culture shock is neither new nor scarcely understood, researchers are divided whether it is undesirable. Some view it as a disease or as one of the disagreeable consequences of exposure to a new culture. Others see it as a natural process, the eventual benefits of which outweigh any initial distress. Oberg (1954Oberg ( , 1960 views culture shock as a disease and not a social-psychological phenomenon. He writes (1954: 1) that culture shock is "an occupational disease of people who have been suddenly transplanted abroad. Like most ailments it has its own etiology, symptoms, and cure." Oberg is among the pioneers of research on culture shock. Many early scholars share his cynical view. Garza-Guerrero (1974: 410) describes culture shock as a "stressful, anxietyprovoking situation, a violent encounter", devoting the paper to demonstrating how culture shock causes "mourning" of one's own culture and people while severely jeopardizing one's identity. Befus (1988: 387) defines culture shock as "an adjustment reaction syndrome caused by cumulative, multiple, and interactive stress in the intellectual, behavioral, emotional, and physiological levels of a person recently relocated to an unfamiliar culture." Using loaded terms such as "disruption" (1988: 381) to describe culture shock, Befus discusses "treatments" and "remedies" (p. 382) for its "symptoms" in light of it causing "human suffering" (1988: 382). Stewart and Leggat (1998: 84) similarly write that culture shock has "symptoms"; is "unpleasant"; causes "anxiety", suffering, and "distress"; and has negative consequences. Zapf (1991) takes a more neutral stance. He believes that culture shock is undesirable but does not present it as fiercely negative. He does describe it as "a state of stress" (1991: 109), but that it is just a single phase in a process of individual growth. Nevertheless, one can detect an underlying assumption that culture shock is a psychological disease needing treatment. This is evident in the remedies he suggests, which are discussed at length later in this paper. Zhou and colleagues (2008: 63) define culture shock as "the collective impact of (such) unfamiliar experiences on cultural travelers in general". In their review, they note the beginning of a movement away from highly negative perspectives on culture shock from the 1980s, spurred by a move away from a perspective based on clinical medicine to one based on social psychology and education instead.
One of the first scholars to take culture shock positively was David (1971: 44), who suggested that "...an intercultural experience may be a valuable way of increasing one's perceptiveness and effectiveness": that is, liberating oneself from one's familiar surroundings and interacting with people who are different can lead to greater self-awareness. On the same page, he dismisses the downside of culture shock by describing it as "...a decrease in socialpersonal adjustment, with the usual behavioral or neurotic symptoms which occur when a person is undergoing a stressful situation". He is so convinced of the value of experience abroad that he recommends exposing oneself to a new culture for over a year as the ideal way to learn about one's own opinions, pre-conceived notions, and ideology. Adler (1975) argued that, even though the concept is inherently negative, culture shock may lead to personal growth and maturity. Defining culture shock as "a form of anxiety which results from the misunderstanding of commonly perceived and understood signs and symbols of social interaction," he describes it as a temporary state in which one moves from dependence on a familiar environment to dependence on oneself in potentially unfamiliar terrain. Church (1982) contended that culture shock has welcome long-term effects. In addition to enhanced self-awareness, culture shock inhibits ethnocentrism while increasing the ability to perceive things more open-mindedly and view things from many perspectives. Martin (1986) argued that international students were likely to experience personal growth as a result of their experience abroad, including increased understanding of various cultures, personal independence and tolerance for ambiguity. Bochner (2003) takes the view that culture shock is a widely misused term that carries exaggerated negative connotations. He claims that culture shock is not a one-sided coin: hostcountry nationals can experience it, too, although they are less likely to be affected by it.

Effects of cultural shock
As noted, the symptoms of culture shock have been discussed at length in the literature. In this review, the word "effects" will be preferred instead. Oberg (1960: 142) lists effects of culture shock including "...the absent-minded faraway stare; a feeling of helplessness and a desire for dependence on long-term residents of one's own nationality…" He observes that individuals undergoing culture shock often develop a heightened sense of hygiene, paranoia and tendency towards hypochondria. They lose their temper at trivial disturbances such as postponement of meetings, and they reject the language spoken in the host country. Finally, they have "...that terrible longing to be back home... " (1960: 143) and experience severe nostalgia for the familiar.
Many researchers (Andrade 2006, Church 1982, Furnham 2010, Mesidor & Sly 2016, Winkelman 1994, Yan & Berliner 2011 have supported the view that individuals undergoing culture shock feel homesick and long to return home. That said, not all individuals are likely to feel homesick to the same extent (see, e.g., Furnham 2010). Furnham theorizes that anxiety-prone, reticent people with poor communication skills and low self-confidence are more prone to homesickness.
Culturally shocked people may face the problem of "overlapping membership conflict" (Church 1982: 553): i.e., extreme attempts to relate to the host culture, combined with a sudden and complete rejection of one's own culture in favor of even seemingly negative customs of the host culture. It can be manifest in one's dress, manner of speech, choice or spelling of one's name, etc.
Individuals undergoing culture shock are likely to suffer from upset stomachs, fatigue, skin problems and headaches (Furnham 1984). They almost always face communication problems from not knowing the language spoken in the host country. Even if they have sufficient proficiency in the language, nonverbal customs of communication can still pose a major obstacle: e.g., whether and when to bargain, what to use for table manners, what counts as being punctual, and how assertive one can be within the bounds of politeness.
Winkelman (1994: 123) discusses the vicious cycle of psychological and biological stress that accompanies culture shock. Anxiety leads to biological upset, which aggravates the anxiety, which exacerbates the physiological symptoms, and so on. Culture shock may weaken one's immune system. Winkelman cites cognitive fatigue as a further consequence. When one is surrounded by people who do not share the same assumptions and world view, one must make a conscious effort to keep communication running smoothly. This continuous exertion takes a toll. It may lead to headaches, especially as the day progresses and communication overload increases. A change in one's role (professionally or socially) can be distressing and cause "role shock" when one is unsure of one's responsibilities and rights. Culture shock may shake one's psyche to its foundations. Winkelman writes (1994: 123), "one's psychological disposition, self-esteem, identity, feelings of well-being, and satisfaction with life are all created within and maintained by one's cultural system." Individuals undergoing culture shock are likely to feel isolated, anxious, lonely, confused and ostracized (Ayyoub et al. 2019, Marsh 2012, Yan & Berliner 2011). Being exposed to a new cultural environment can influence one's ethnic identity (Furnham 2010). It can also make one feel angry, impatient, exhausted and rejected (Samovar et al. 2013). Culturally displaced people tend to feel both homeless and identity-less, as if they do not belong anywhere (Hailu & Ku 2014). When they are in the host country, they feel they do not belong there but rather in their home country. When they visit or return to their home country, they feel they belong in the host country instead.
Sandhu (1994( , as cited in Furnham 2010 observes that culturally displaced people feel as if they have lost their family and friends and even feel guilty about it. They may be frightened, stressed, and unsure about what will happen next. Foreigners, especially those in the US, are likely to feel inferior. Hailu and Ku write (2014: 2) "immigration has different effects on different ethnic and age groups of people". Lombard (2014: 176) of depression, "emotional suppression and dysfunctional coping such as denial, substance use, self-blame, and disengagement" (see also Khawaja & Dempsey, 2007. Lastly, Culture shock may cause people to become distrustful, disobliging and indifferent toward their objectives (Mesidor & Sly 2016).

International students: cultural misfits
There is agreement (see, e.g., Ayyoub et al. 2019;Church 1982;Furnham 2010;Ward, Bochner & Furnham 2001) that international students experience some of the same problems as host-country students while facing additional, more serious problems. Issues might be academic, social, housing-related, physical complaints or administrative problems.
Academic problems include not understanding or agreeing with course contents (Furnham 2010), not being made aware of institutional rules (Hailu & Ku 2014;Mesidor & Sly 2016;Popadiuk & Arthur 2004;Ward, Bochner & Furnham 2001), and lacking access to or encountering misbehavior from teachers. Dissatisfaction with course contents can result from unmet expectations. Course titles are often generic, whereas course contents vary from institution to institution. International students may find that teachers are often unavailable or are not as supportive as expected because the teachers have culturally different understanding of the teacher/student relationship or of teaching styles. Generally speaking, teachers in Western cultures are very friendly with students; in some cases, students can refer to them by first name. Asian students are accustomed to strict and reserved teachers, whom they must always refer to using title and surname. Teaching styles vary (Hailu & Ku 2014;Ward, Bochner & Furnham 2001;Xiaoqiong 2008). While teachers in some cultures spoon feed their students, those of other cultures challenge students to learn independently. Students from collectivist cultures with great power distance between teachers and learners (Hofstede 2011) could be perceived as reserved or even dull by host-country classmates and teachers alike if the host culture is individualist with low power-distance. (Ward, Bochner & Furnham 2001).
Kelly, Moores and Moogan (2012) studied international students' adjustment in higher education. International students have to cope with the demands of studying in a radically different educational system, of which many aspects may differ from the system to which they are accustomed. Differences may exist in how many courses or years are required to attain a degree, number of credit hours required, interaction patterns in the classroom, teachers' expectations, skill set required to prepare for an exam, kinds of responses required in examinations, passing grade, etc. The researchers cite evidence that international students are likely to plagiarize, not deliberately but because their teachers assume they have been taught proper referencing back home. Language barriers may also cause unintended plagiarism.
Language is crucial and the key to understanding in the classroom. Language barriers are often cited as a source of trouble (Ayyoub et al. 2019;Church 1982 (2011) found that Chinese students studying in the US cited language as one of the greatest causes of distress in adjustment. Andrade writes (2006: 135), "academic adjustment problems for international students tend to focus on language issues". Even when international students understand the medium of instruction, the dialect spoken might be different in terms of accent, idioms or colloquialisms (Hailu & Ku 2014, Mahmud et al. 2010. In Yan and Berliner's (2011) study, participants claimed that even those among them who performed well on standardized English tests such as the TOEFL had language problems because of the cultural gap in the English usage between China and the US, and lack of training in academic American English. If the medium of instruction is not the teacher's mother tongue nor that of the host-country students, the teacher might code switch, which international students may not be able to follow. Body language varies greatly from culture to culture, which may cause problems even when international students speak the language fluently (Popadiuk & Arthur 2004;Ward, Bochner & Furnham 2001).
Social issues may likewise trouble international students. They can be especially challenging to overcome if students cannot speak the host-country language fluently (Furnham 2010). Perhaps the most devastating is the experience of racial discrimination (Church 1982;Furnham 2010;Pandian 2008;Popadiuk & Arthur 2004;Ward, Bochner & Furnham 2001) in the form of name-calling, avoidance, snide comments or rudeness. Students studying abroad often complain that they do not fit in (Furnham 2010). Pandian (2008) reported students finding it difficult to make friends or just interact with local students, who rarely took the lead in initiating contact. Ward, Bochner & Furnham (2001) cite literary evidence that international students rarely make close friends among the locals.
International students are observed to often seek medical assistance (Furnham 2010) in part due to physical effects of culture shock like food poisoning, ulcers or headaches (Befus 1988). Denial of the need for psychological help makes them vulnerable to illness. Furnham credits Ward (1967, as cited in Furnham, 2010 for having first proposed this idea in his Foreign-student Syndrome theory, adding the observation that foreign students are often unable to identify the cause of their physical discomfort and just seem inert, reserved and unkempt. In extreme cases, students may even experience nervous breakdowns or, worse, attempt suicide.

Recovering from culture shock
There are measures students can take to enable their own adjustment. This involves examining the role played by the institutions in which they study. Solutions common to multiple researchers are discussed first, followed by thematically and chronologically sequenced recommendations. Finally, proposed therapeutic treatments are critiqued.

Education and administration
Many researchers (Hailu & Ku 2014;Kelly, Moores & Moogan 2012;Mahmud et al. 2010;Marsh 2012;Oberg 1960;Samovar et al. 2013;Winkelman 1994;Yan & Berliner 2011;Zapf 1991) espouse the view that learning the local language is the first step towards cultural adjustment. After all, it is through language that one encounters culture.
Much research (Andrade 2006, Furnham 2010, Hailu & Ku 2014, Marsh 2012, Mesidor & Sly 2016, Pantelidou & Craig 2006, Winkelman 1994 emphasizes the role of social bonds, both those back home as well as those in the new setting, in alleviating cultural distress. Friends and family are not only a means of tangible help but can also alleviate stress simply by providing an ear to listen and giving the secure feeling that someone cares. Oberg (1960) suggests that visitors take part in the host country's cultural festivals and voice their discomfort with both the locals and fellow nationals alike. Having friends can regulate one's self-esteem (Ward, Bochner and Furnham 2001). Pantelidou and Craig (2006) showed that the diversity and quality of social networks plays a large role helping students recover from culture shock; they, too, recommend the deliberate cultivation of strong social bonds. Furnham (2010, citing Bochner et al. 1977) writes that international students should maintain three social circles. The first should comprise fellow nationals whom they can relate to and who can help each other to preserve their ethnic identities. The second should comprise local students, teachers and foreign student advisers who can help them in practical ways toward achieving their foreign-study goals. The third should simply be for good company and recreation. Yan and Berliner (2011) & Furnham 2001) advocate the use of the pair/buddy system. This pairs international students with local ones: e.g., to socialize on or off campus. They note that earlier studies have demonstrated the benefits of this strategy toward easing cultural adjustment. Furnham (2010) notes that the buddy system has proven successful for many years in the US military.
Researchers (e.g., Samovar et al. 2013, Stewart & Leggat 1998, Zapf 1991) advise those undergoing culture shock to get in touch with others of their own community who have already adjusted to the new country. Stewart and Leggat (1998) propose trying to find residence in one's own ethnic community, so that one has a safe haven to retreat to, one in which one need not feel culturally alien or inept. This does not mean that foreigners should retreat into a shell of their own culture, but rather that they locate an environment in the new culture in which they do not feel that their world views are threatened. David (1971) and Yan and Berliner (2011) point out that withdrawing into one's own culture in a foreign country, avoiding contact with the locals, can do more bad than good. It may lead to isolation and stereotyping, and rob the visitor of the opportunity to learn and grow from the experience abroad.
Researchers (e.g., Furnham 2010; Mahmud et al. 2010;Mesidor & Sly 2016;Pandian 2008;Samovar et al. 2013;Ward, Bochner & Furnham 2001;Winkelman 1994;Yan & Berliner 2011;Zhou et al. 2008) recommend that international students actively try to learn about the new culture by, e.g., reading up on it. Winkelman (1994) suggests mentally preparing oneself beforehand for obstacles one is likely to face in the host country. This can be done by learning about the general problems encountered during cross-cultural communication, as well as training oneself up on the social environment, values and ideologies espoused by members of the new culture. Zhou et al. (2008) propose that culture shock can be prevented by reading up on the new culture beforehand and trying to master the cultural skills required. Levy (2000) advises students to travel on their own in the host country, to get to know the culture on a deeper level. Ward, Bochner and Furnham (2001) suggest that those expecting to go abroad, as well as those already living in intercultural communities, practice culture training. Training sessions can involve cultural role-playing, culture-based activities, exercises and games designed to teach desired behaviors and crosscultural communication skills. Yan and Berliner (2011) and Furnham (2010) recommend watching English films. Furnham reported honing his own host country social skills by watching children's cartoons when he went to England in his 20s, which is the most common age group for international students. Such cartoons clearly lay out social values.
Researchers (e.g., Church 1982, Furnham 2010, Mesidor & Sly 2016, Pantelidou & Craig 2006, Popadiuk & Arthur 2004) discuss the role of counselors in helping international students cope with cultural concerns. Mesidor and Sly (2016) strongly encourage students to seek medical therapy if they are upset. They feel it is imperative that culturally-aware therapists be available for international students, on campus. Popadiuk and Arthur (2004) likewise encourage students to seek professional help and suggest that counsellors be made available on campus; students should be assured through multiple media outlets that turning to a professional counsellor for help is not shameful but normal and healthy. Furnham advises that, instead of waiting for students to come to them, counsellors make an active effort to find international students going through culture shock. Popadiuk and Arthur (2004) recommend that counsellors practice cultural empathy: e.g., by visiting other countries and trying to learn the language. They recommend that group sessions can be especially helpful because international students tend to feel alone in their cultural discomfort. Zapf (1991) offers suggestions for counsellors to help clients deal with culture shock. His first suggestion is to explain the concept of culture shock. This seems wise, considering that people tend to blame themselves for their adjustment problems. Next, foreigners should be warned about behaviors that could indicate that a visit to the psychologist is due, such as overdrinking, ruminating, cynicism and loneliness. They should be asked to recount specific incidents that caused distress, to isolate the problem so that it can be worked upon. He advises that all these suggestions are best if practiced in group counselling sessions, as corroborated by Egenes (2012). Working in partnership with others undergoing similar experiences helps reinforce the idea that the feeling of shock is quite natural.

Suggestions for institutions
Less intensive therapeutic treatment can be arranged for students who are not comfortable with counselling (Furnham 2010). They can be encouraged to join special interest groups or attend communication workshops. International students should be given ongoing guidance, unlike local students, for whom an initial orientation usually suffices.
Educational institutes need to take an active role in helping their international students adjust, rather than leaving the burden on the students themselves. Andrade (2006) and Mahmud et al. (2010) feel that it imperative for international students' support personnel to learn about the adjustment issues their students face. Andrade (2006) writes that it is not enough for foreign student affairs staff simply to keep track of their scores and dropout rates; they should administer questionnaires and interview them to gain a more comprehensive, first-hand account of the difficulties and what students do to overcome them; teachers should be trained to deal with students from diverse backgrounds so as not to stereotype learners' cultural backgrounds.
Kelly, Moores and Moogan (2012) write that international students should be provided language classes to help them overcome the language barrier, along with provision of communication and teamwork exercises. Smaller class sizes enable better student/teacher interaction. Teachers should ensure a multiculturally themed classroom environment during the first semester to set international students at ease.
Teachers should play an active role in stabilizing students (Egenes 2012). On brief exchange programs, one teacher should be responsible for accompanying students while a second teacher back home serves as a confidante so that students may share their frustrations during their stay. Some of the assignments given to students should be based on their experience studying abroad, allowing them to focus attention on the foreign country's culture.
For teachers to better empathize with their international students, understanding their initial level, traits in common and learning preferences, Hailu and Ku (2014) suggest conducting a needs analysis. The host community needs to feel hospitable so they do not feel as though they are only providing revenue, but also culturally enriching the local community. This could be done by conducting awareness seminars. Mesidor and Sly (2016) offer advice for universities aspiring to attract international students. They should ensure that international students are well-informed of institutional policies regarding enrolment, course contents and assessment to help reduce their stress. They should provide students with easy online access to information regarding the country and local environment, climate, culture and education systems. New international students should be assigned mentors from among the older international students. Each international student should their own adviser. They should create career opportunities for their international students by offering them jobs on campus, as Hailu and Ku (2016) also note. This can help alleviate students' familiar financial issues. Finally, the researchers highlight the role of teachers in encouraging international students: if teachers have high expectations of students, it motivates students to work to the best of their ability. Winkelman (1994) writes that the two basic steps for recovering from culture shock are learning that the experience of culture shock while abroad is quite ordinary and learning to recognize culture shock, the better to be prepared. One must accept that one is in an environment where old ways will not work and concede that one needs to change to function in the new society, because the society is obviously not going to change to suit one's needs.

Suggestions for students
One must develop an open mind toward culture: that is, "cultural relativism" (Winkelman 1994: 123). One should be mentally prepared to face racism. If lodging, food and transportation arrangements can be fixed beforehand, one can free oneself to focus on cultural training and stress management. One should make active efforts to be flexible in feeling, thinking and behaving. Winkelman writes that, while learning the host-country language is vital, learning about nonverbal language is almost equally crucial. A nod means different things in different cultures; conventions for duration and intensity of eye contact vary from culture to culture, as do physical proximity and seating arrangements. Winkelman suggests that the individual undergoing culture shock identify causes of communication distress, contemplate ways to minimize the distress and then put those plans into action. Levy (2000) bases her suggestions on a first-hand account of her experience as an international student in London. Rich with descriptions, her findings are not scientifically based, yet they appropriately capture the subjective nature of her data. Student travelers need to be given orientation lessons to prepare them for the new culture. She suggests that students be made aware of ethnocentrism and cultural relativity. One of her more practical suggestions is that students keep a journal to help them keep track of their progress in cultural adjustment, an idea supported by Egenes (2012). Ward, Bochner and Furnham (2001) and Bochner (2003) attempt to explain culture shock from three dimensions: affect, behavior and cognition (ABC), with suggestions how to deal with each dimension. Befriending people of the host culture is very useful in ameliorating the negative effects of culture shock and quickening the pace of adjustment. One can avoid negative culture shock if trained to expect cultural diversity and relativity rather than homogeneity and conformity. One must actively try to reduce stress and increase selfreliance. Bochner (2003: 8) suggests that it is much easier to learn culturally appropriate behavior than to adapt one's personality to the host culture.
The guidelines that control social behaviour are largely taken for granted, rather like the presence of oxygen in the air. Only when the oxygen is reduced or missing, as in smog or carbon dioxide emissions, do we take notice of it. And the same is true in our social world, we really only become aware of the presence of a behavioral imperative when it is infringed or disregarded.
The ABC model, originally proposed by Ward, Bochner and Furnham (2001) in their seminal book on culture shock, finds support as well from Zhou et al. (2008). Zhou examines the pedagogical implications for international students. An affective theory, the "stress and coping" model sees culture shock as psychologically stressful and requiring active stress management. Zhou considers how the ABC model and related models of culture shock can contribute to better teaching and improved understanding between teachers and international students. Both parties need to be made culturally aware, and the students need easy access to guidelines and social support. Van der Zee and van Oudenhoven (2013: 936-937) suggest that individuals planning to move, study, stay or work abroad be given training to enhance characteristics that their study found to have a strong connection to intensity of culture shock: cultural empathy, openmindedness, social initiative, flexibility and emotional stability.
Cultural empathy implies taking the perspective of the culturally different, openmindedness implies postponing one's judgment, and social initiative encompasses social behavioral acts such as asking questions, starting a conversation, or invitations to common activities. Intercultural trainers will not find it difficult to give examples of relevant intercultural behavior referring to cultural empathy, open-mindedness, and social initiative.
Students can do a number of additional things to help themselves. Hailu and Ku (2014) write that international students benefit from fostering bonds with their teachers. Their participants suggested ignoring discriminatory acts that cause distress; while helping their host-country classmates with studies was a good way to bond and ensure help in return, especially regarding the medium of instruction. Mesidor and Sly (2016) suggest that students ensure they get adequate sleep, exercise (e.g., meditation and deep breathing) and a balanced diet. They advise students to prioritize and manage time.

Two unique remedies
For Befus (1988), culture shock has physiological, behavioral, emotional and intellectual manifestations. She proposes treatments for each aspect. To alleviate physiological stress, she suggests that one practices deep breathing, exercises, takes care of one's diet, and engages in healthy recreation. Behavioral stress can be combated by systematically recalling past hobbies and noting which of them can be practiced in the new environment, then imagining new hobbies offered by the new environment. It helps to talk about one's adverse experiences in the host country and attempt to rationalize them. Emotional stress can be dealt with by "thought-stopping" and "thought-substitution" (1988: 389), both of which involve identifying one's pessimistic sentiments and reorienting oneself to a more optimistic approach. For intellectual trauma, Befus suggests that students actively contemplate their own culture then compare it with the host country's culture. Despite her comprehensive attempt to combat her participants' culture shock, her study has shortcomings: sampling was volunteer driven, a limitation she herself outlines in her paper. The treatments described are easier said than done and would be difficult to realize without a trained facilitator. They are neither generalizable nor easily replicable. The design of the study does not rule out the possibility of the results being a manifestation of the Hawthorne effect.
Lombard (2014) offers a radical solution. She studied the effects on nine international students studying in the Netherlands of a psychosynthetic approach to managing crosscultural adaptation. Her sample comprised a culturally diverse group of students aged 25 to 36 who had sought counseling for cultural difficulties. Lombard discusses two methods within the psychosynthetic approach: the self-identification exercise and the sub-personality model, which together counter the affective, behavioral and cognitive problems of culture shock. The self-identification exercise is meditative, helping cope with the affective aspect of culture shock. Individuals focus attention on their body, feelings and then thoughts, scrutinizing each in detail, then rejecting the notion that they consist of their body, emotions or thoughts. The point of the exercise is to embrace the idea that one has the capacity for unadulterated awareness and self-control. The sub-personality model aids in coping with the cognitive aspect. One assumes the role of observer with regard to aspects of one's personality that surface during certain interactions and in certain roles. The idea is to distance oneself from dimensions of one's personality to analyze them objectively. The aim is to facilitate a more harmonious interpretation of oneself as an amalgamation of various sub-personalities.
The approach seems to have great merit and the results affirmed Lombard's expectations. All but one of her participants claimed better self-understanding and better understanding of others and the host-country society at large following the counseling sessions. That said, one cannot be sure that participants' claims to greater understanding were a direct result of psychosynthetic counseling because of other variables influencing their cultural adjustment.

Conclusions
This review demonstrates that culture shock is no longer viewed as negatively as it once was, even though it may cause anxiety, homesickness, distress and loneliness in the short term. Researchers have become increasingly optimistic about long-term effects such as personal growth and cultural tolerance. International students usually undergo culture shock, plagued by academic problems, social issues, medical issues and language. Language has a profound effect on culture shock; it is highly recommended that international students familiarize themselves with the language of their host country, ideally before travelling there. They should proactively manage their culture shock by reading up on the host culture beforehand, being open to seeking professional help and therapeutic treatments, and taking part in a buddy/mentor system. They should ensure network with people from their own country as well as host-country nationals. Educational institutions should actively aid their international students and help them get through their culture shock.
Although culture shock is well-researched, what remains to be investigated is whether the presence of international students causes some form of culture shock among local students or other local residents. Another avenue for future research is to determine whether culture shock is inevitable or can be absolutely avoided if institutions, teachers and students implement the suggestions discussed in the literature.

About the author
Yusra Mustafa is a linguist and dedicated ELT professional with seven years' experience teaching English and linguistics. She was first in her master's class (English), going on to enroll in an MPhil program (English linguistics), which she completed in 2019. Yusra has publications in Critical Discourse Analysis, ELT and sociolinguistics, but her main areas of interest are cross-cultural communication and education-abroad programs. The former is the topic of her MPhil dissertation. She has presented her papers in international conferences.
As part of her current job as lecturer at COSTI, she is among the frontline workers who help newcomers adjust to life in Canada.