Trauma Research

Racial Trauma

Racism and discrimination have strong negative consequences upon those who are oppressed, and this continually occurs as part of mainstream American culture. Racism creates barriers to health care, as well as negative physical and mental health outcomes among people of color. In African Americans, Hispanic Americans, and Asian Americans, there is a documented relationship between racial discrimination and increased psychological disorders. Racial trauma, or race-based trauma, consists of the mental health symptoms a person experiences as a result of racism or discrimination, which has often been compared to Posttraumatic Stress Disorder (PTSD).

The prevalence rates of race-related PTSD are unknown. While it is clear for researchers and clinicians to understand a discrete violent act as a precipitating event for PTSD, vicarious experiences and racial microaggressions are usually overlooked as contributing factors. Frequently, people of color experience cumulative racism, which can lead to a minor event triggering the PTSD reaction (Carter, 2007). Regarding prevalence rates, what can be said is Latinos have higher rates of PTSD, they may experience PTSD symptoms of greater severity compared to non-Hispanic Whites, and discrimination certainly plays a role in this disparity.

Many clinicians only recognize racism as trauma when an individual experiences a discrete racist event, such as a violent hate crime. This is limiting given that many ethnoracial minorities experience cumulative experiences of racism as traumatic, with perhaps a minor event acting as “the last straw” in triggering trauma reactions. Additionally, minority patients may not link current PTSD symptoms to cumulative experiences of discrimination if queried about a single event. Thus, the conceptualization of trauma as a discrete event may be inadequate for diverse populations. For these reasons, it is crucial for clinicians and researchers to develop a more comprehensive understanding of trauma in ethnic and racial minorities. Our work in this area is focused on improved assessment of racial stress and trauma and culturally-informed treatment approaches.

We have developed a new semi-structured interview called the University of Connecticut Racial/Ethnic Stress & Trauma Scale (UnRESTS). This measure is offered in both English and Spanish, and provides a more comprehensive assessment of race-based trauma relative to the existing measures. Because it is an interview, it can facilitate the conversation between the client and clinician regarding the client’s experiences with racism and help the clinician build rapport with the client. This may be particularly helpful for clinicians who are unsure how or what to ask about racially-charged topics. The format of the UnRESTS is modeled after the DSM-5 Cultural Formulation Interview (APA, 2013). Unfortunately, neither the CFI nor its supplementary modules examine racism or discrimination despite that assessment is intended as a cultural assessment. Therefore, it is important for clinicians to also have access to an interview specifically for the assessment of discrimination and its impact.

Recent Papers

Williams, M. T., Pena, A., & Mier-Chairez, J. (2017). Assessing and Treating Racism-Related Stress and Trauma among Latinos. In L. T. Benuto (Ed.), Toolkit for Counseling Spanish-Speaking Clients. Springer. ISBN 978-3-319-64880-4.

Malcoun, E., Williams, M. T., & Bahojb-Nouri, L. V. (2015). Assessment of Posttraumatic Stress Disorder in African Americans. In L. T. Benuto & B. D. Leany (Eds.), Guide to Psychological Assessment with African Americans, New York: Springer. ISBN: 978-1-4939-1003-8.

Recent Poster Presentations

Williams, M. T., Printz, D. & DeLapp, R.C.T. (2017, November). Assessing Racial Trauma in African Americans with the Trauma Symptoms of Discrimination Scale. Poster to be presented at the 51st Annual Convention of the Association of Behavioral and Cognitive Therapies, San Diego, CA.

George, J. R., Williams, M. T., DeLapp,R.C.T., & Adams, T. (2017, November). Discrimination Anxiety Indirectly Effects Depression through Everyday Discrimination. Poster to be presented at the 51st Annual Convention of the Association of Behavioral and Cognitive Therapies, San Diego, CA.

Williams, M. T. & Kanter, J. W. (2017, November). Psychometric Properties of the Anxiety Symptoms of Discrimination Scale in Black and White Students. Poster to be presented at the 51st Annual Convention of the Association of Behavioral and Cognitive Therapies, San Diego, CA.

Measures

Refugee Mental Health

We have done a great deal of work toward the development of a mental health clinic for refuges in partnership with the Global Health Initiative in the UofL School of Medicine. In the initial phase, we identified the most appropriate measures to assess the mental health needs of our target population. These measures were made available in English, Spanish, and other languages as needed to facilitate use by bilingual clinicians and interpreters. Measures translated by the bilingual team into Spanish include the Hopkins Symptom Checklist, the Modified PTSD Symptom Scale, and the ADIS.

Designated psychology faculty trained and supervised clinical graduate psychology students to enable them to conduct culturally appropriate psychopathology assessments of refugees. Those with a diagnosis of PTSD were then offered empirically-supported treatment for their trauma by advanced graduate student clinicians. The clinical work conducted by the graduate students was facilitated via individual and group supervision and related graduate coursework. At the University of Louisville, Dr. Williams developed a series of courses to provide the necessary training for students participating in this project, including Culture & Diversity in Psychology, Treating Trauma in Diverse Populations, and Multicultural Counseling Skills.

We have also been conducting research on effective methods of assessing trauma in Hispanic (primarily Cuban), Middle Eastern (primarily Iraqi and Syrian), and African refugees. All patients receive the RHS-15, as well as gold-standard measures of trauma, culture, and psychopathology. Once we have collected data from an adequate numbers of patients, we will be able to conduct a psychometric investigation to determine how well the RHS-15 is able to identify trauma in each of the populations of interest.

Project Team: Monnica T. Williams, Adriana Pena, Victoria Schlaudt

Recent Presentations

Schlaudt, V., Bosson, R., & Williams, M. T. (2017, November). Treatment Acceptance Level in Refugees by Country of Origin. Poster to be presented at the 51st Annual Convention of the Association of Behavioral and Cognitive Therapies, San Diego, CA.

Pena, A., Mier-Chairez, O., Bosson, R., Exposito, A., Ford, R., Diaz, Y., Carrico, R., & Williams, M. T. (2016, September). Validation of the Refugee Health Screener-15 (RHS-15) for Cuban Refugees/Entrants. Poster presented at the National Latino/a Psychology Association Conference, Orlando, FL.

Recent Papers

Bosson, R., Williams, M. T., Schlaudt, V., Carrico, R., Peña, A., Ramirez, J., & Kanter, J. (2017). Evaluating mental health in Cuban refugees: The role of the Refugee Health Screener-15. Journal of Refugee & Global Health, 1(1), 15-23. doi: 10.18297/rgh/vol1/iss1/4.

Bosson, R., Williams, M. T., Lippman, S., Carrico, R., Kanter, J., Pena, A., Mier-Chairez, J., & Ramirez, J. (2017). Addressing refugee mental health needs: From concept to implementation. The Behavior Therapist, 40(3), 110-112.

Addressing PTSD in African Americans

Posttraumatic stress disorder (PTSD) is a highly disabling disorder, afflicting African Americans at disproportionately higher rates than the general population. Findings from the National Comorbidity Survey-Replication (NCS-R) and National Survey of American Life (NSAL) indicate that, while African Americans have a lower risk for many anxiety disorders, they have a 9.1% prevalence rate for PTSD, compared to 6.8% in European Americans. African Americans with PTSD also have significantly more impairment than traumatized European Americans in productivity and out of role domains, indicating greater difficulty carrying out daily activities.

When receiving treatment for PTSD, cultural mistrust and social factors may cause African Americans to feel differently towards a non-Black clinician. Furthermore, racism and discrimination experienced before or during the traumatic event may compound posttrauma reactions, impacting the severity of symptoms. Failure to adapt treatment approaches to encompass cultural differences and racism-related traumas may decrease treatment success for African American clients. Cognitive behavioral treatment approaches are highly effective, and Prolonged Exposure (PE) in particular has the most empirical support for the treatment of PTSD.

We wrote an article discussing culturally-informed adaptations of PE that incorporates race-related trauma themes specific to the Black experience. These include techniques to better establish rapport, asking directly about race-related themes during the assessment process, and deliberately bringing to the forefront race-related experiences and discrimination during treatment when indicated. Guidelines for assessment and the development of appropriate exposures are provided. Case examples are presented demonstrating adaptation of PE for a survivor of race-related trauma and for a woman who developed internalized racism following a sexual assault. Both individuals experienced improvement in their posttrauma reactions using culturally-informed adaptations to PE.

Recent Papers

Sawyer, B., Williams, M.T., DeLapp, R. C. T., & Davis, D. M. (2016). Posttraumatic Stress Disorder. In A. Breland-Noble, C. S. Al-Mateen, & N. N. Singh (Eds.), Handbook of Mental Health in African American Youth. Springer. ISBN: 978-3-319-25501-9.

Malcoun, E., Williams, M. T., & Bahojb-Nouri, L. V. (2015). Assessment of Posttraumatic Stress Disorder in African Americans. In L. T. Benuto & B. D. Leany (Eds.), Guide to Psychological Assessment with African Americans, New York: Springer. ISBN: 978-1-4939-1003-8.

Williams, M. T., Malcoun, E., Sawyer, B., Davis, D. M., Bahojb-Nouri, L. V., & Leavell Bruce, S. (2014). Cultural Adaptations of Prolonged Exposure Therapy for Treatment and Prevention of Posttraumatic Stress Disorder in African Americans. Behavioral Sciences — Special Issue: PTSD and Treatment Considerations, 4(2), 102-124. doi:10.3390/bs4020102