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. Our center recently 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.
Project Team: Monnica T. Williams, Broderick A. Sawyer
Learn more: Understanding Race-Based Trauma.
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.
Our work in this area is focused on improved assessment of race-based stress and trauma, culturally-informed treatment approaches, and training of clinicians to better recognize race-based stress and trauma. The CMHD is also partnering with other organizations to conduct PTSD clinical studies with more diverse samples, including the Multidisciplinary Association for Psychedelic Studies (MAPS) for their Phase 3 PTSD-MDMA clinical trials.
Learn more: Williams, M. T., & Leins, C. (2016). Race-Based Trauma: The Challenge and Promise of MDMA-Assisted Psychotherapy. Multidisciplinary Association for Psychedelic Studies (MAPS) Bulletin, 26 (1), 32-37.
The CMHD was instrumental in the development of a mental health clinic for refuges in partnership with the Global Health Initiative in the UofL School of Medicine. This project includes three phases. 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 (PSYC 792: Culture & Diversity in Psychology, PSYC 791: Treating Trauma in Diverse Populations, and PSYC 793: Multicultural Counseling Skills).
Future plans include introducing additional mental health services to patients, including therapy for acculturative stress, family counseling, group therapy, and medication services, in partnership with the department of Psychiatry.
We will also be conducting research on effective methods of assessing trauma in Hispanic (primarily Cuban), Middle Eastern (primarily Iraqi and Syrian), and African refugees. All patients will 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, Judy Mier-Chairez, Victoria Schlaudt, Marlena Debreaux
Presentations: 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.