A CBT Approach to Internalized Racism among African Americans

An Evidence-Based Approach for Treating Stress and Trauma due to Racism

Racism can be stressful or even traumatizing. Psychological unwellness emerges out of the confluence of historical, cultural, and individual experiences, and resulting syndromes may or may not fit into a DSM-5 PTSD diagnostic framework. Although racial stress and trauma are common presentations in therapy, few therapists have the resources or training to treat these issues. Based on the empirical evidence to date, this article describes the essential components of treatment for racial stress and trauma from a cognitive-behavioral perspective, called the Healing Racial Trauma protocol. Each technique is described with reference to the literature supporting its use for racial stress and trauma, along with guidance for how therapists might implement the method with clients. Also provided is information about sequencing techniques for optimal outcomes. Critical therapist prerequisites for engaging in this work are also discussed, with an emphasis on an anti-racist, empathy-centered approach throughout.

A pilot study of experiencing racial microaggressions, obsessive-compulsive symptoms, and the role of psychological flexibility

BACKGROUND

Experiencing racial microaggressions has clear effects on physical and psychological health, including obsessive-compulsive disorder symptoms (OCS). More research is needed to examine this link. Psychological flexibility is an important process to examine in this work.

AIMS

This study aimed to examine if, while controlling for depression and anxiety, experiences of microaggressions and psychological flexibility helped explain OCD symptoms within a university-affiliated sample (undergraduate, graduate and law students). This was a pilot exploration of the relationships across themes.

METHOD

Initial baseline data from a longitudinal study of psychological flexibility, OCD symptoms, depression, anxiety and experience of microaggressions was utilized. Correlations and regressions were utilized to examine which OCD symptom dimensions were associated with experiencing racial microaggressions in addition to anxiety and depression, and the added role of psychological flexibility was examined.

RESULTS

OCD symptoms, experiences of microaggressions and psychological flexibility were correlated. Experiences of racial microaggressions explained responsibility for harm and contamination OCD symptoms above and beyond psychological distress. Exploratory results support the relevance of psychological flexibility.

CONCLUSION

Results support other work that experiences of racial microaggressions help explain OCS and they add some support for psychological flexibility as a relevant risk or protective factor for mental health in marginalized populations. These topics should be studied longitudinally with continued consideration of all OCD themes, larger sample sizes, intersecting identities, clinical samples, and continued exploration of psychological flexibility and mindfulness and values-based treatments.

Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members

Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW's mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW's health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study's findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW's diverse gender identities and expressions; (2) focusing on SMW's nonbinary stressors; (3) formulating SMW's gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW's lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.

Pathways from exposure to racial/ethnic discrimination to depression: Testing a social-cognitive model

RATIONALE AND OBJECTIVE

Interpersonal racial/ethnic discrimination is a risk factor for depression across the lifespan in minoritized racial/ethnic groups. This study tests a model proposing that social cognitive processes, including relational schemas, mediate the link between discrimination and depression. Relational schemas enable individuals to form mental representations of others, reflecting prior social learning and generating expectations about future social relations. Racism-related relational schemas include, among others, concerns about being rejected or invalidated, concerns about confirming negative stereotypes held by others, and cynical mistrust of others. Prior studies have typically examined the mediating role of one or two relational schemas in the association between discrimination and depression; less is known about the unique and combined effects of multiple dimensions of racism-related social cognition.

METHODS

The model was tested in a convenience sample of ethnically diverse, non-white participants recruited from two sites, a community medical center (N = 136; M_age = 38, SD = 13.0) and a private university (N = 120; M_age = 19.4, SD = 1.3), yielding a consolidated sample of 256 participants (64% women). Data were collected between September 2016 and April 2018. Participants completed paper-and-pencil self-report measures of exposure to interpersonal discrimination, depressive symptoms, and eight measures of relational schemas.

RESULTS

Confirmatory factor analysis indicated that the eight relational schemas defined three primary dimensions: concerns about rejection and invalidation, social vigilance, and mistrust. A structural equation model in which the association between exposure to discrimination and depressive symptoms operates through latent factors representing three social-cognitive dimensions demonstrated adequate fit (CFI = 0.96, RMSEA = 0.06, SRMR = 0.04). A significant mediational effect was found only for concerns about rejection and invalidation.

CONCLUSION

The conceptual model supported by this study may help inform psychological interventions aimed at mitigating the detrimental effects of racial/ethnic discrimination on mental health.

The seemingly 'protective' effect of internalised racism on overall health among 780 Black/African Americans: the serial mediation of stigma consciousness and locus of control

OBJECTIVE

Internalised racism (IR) is associated with better and worse health outcomes among racial/ethnic minorities. However, the underlying mechanisms associating IR with either positive or negative health outcomes are not well understood.Design & main outcomes measures: To address this gap, this study investigated two pathways that associate increased IR with better self-reported overall health (OH; i.e. dental, mental, physical and vision health) among 780 Black/African American adults (mean age 37.68 years, 57.6% female): (1) via stigma consciousness and (2) via stigma consciousness and locus of control beliefs.

RESULTS

Consistent with predictions, stigma consciousness mediated the indirect effect of IR on OH, such that higher IR was associated with lower stigma consciousness, which was associated with better self-reported OH. Confirming predictions, this indirect effect was also carried through locus of control beliefs, such that higher IR was associated with lower stigma consciousness; lower stigma consciousness was also associated with internal locus of control beliefs, which were associated with better self-reported OH.

CONCLUSIONS

Although seemingly protective, this adaptive, strategic and short-term response to race-based threat in which group stereotypes are internalised can lead to negative health outcomes over time. These findings have implications for understanding IR and associated health disparities.