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An Evidence-Based Approach for Treating Stress and Trauma due to Racism
Abstract
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.
... RT is defined as experiences of discrimination, negative bias, or threats to one's well-being because of one's race that overwhelms one's internal resources due to either the severity of the incident or its frequency (i.e., microaggressions; Williams et al., 2023). Much of the research on RT in Black communities focuses on adult populations (Saleem et al., 2020). ...
... Given the ubiquity of RT within Black communities, and other racially minoritized populations, colleges of education need to train all school personnel in not only trauma-informed practices more generally but in modalities centered on the alleviation of RT (Comas-Díaz, 2015;Williams et al., 2023). Training programs for both SP and SC, and their accreditations, American Psychological Association, Council for Accreditation of Counseling & Related Educational Programs, and Masters in Psychology and Counseling Accreditation Council, should ensure that education moves beyond cultural and racial awareness to training in specific interventions to reduce the trauma of Black and other racially minoritized students. ...
... As Cénat (2023) has stated, to be a racially minoritized child or adolescent in the West is to be inundated with experiences of microaggressions, discrimination, and prejudice. Therefore, all SPs and SCs regardless of their race need to become proficient in recommended RT healing interventions that have been put forth by expert scholar-practitioners (Comas-Díaz, 2015;Williams et al., 2023). Furthermore, there is a need for all education departments to train future school staff in liberatory education practices (Friere, 2018). ...
The objective of this study was to examine the experiences and expertise of Black school mental health professionals (BSMHP; School Psychologists and School Counselors) who work with Black racial trauma (RT) of children and adolescents within K–12 school systems. A qualitative study with a critical ideological paradigm was used as the methodology of this study. Twelve BSMHP were interviewed about their experiences working with Black clients suffering from RT. Seven themes were identified in the analysis of the data: (a) the motivation for becoming school mental health professionals, (b) harm done to Black students in K–12 schools, (c) effects of RT on Black students, (d) ways BSMHP intervene to protect Black students, (e) how BSMHP advocate for Black students, (f) how BSMHP create a homeplace for Black students and staff, and (g) how BSMHP othnparent Black students. BSMHP report that much racial harm is done to Black students within K–12 schools. Their own work is characterized by expending energy trying to both protect Black students as well as advocate for change within their schools and school systems.
... Beyond increased risk for exposure to traumatic events, POC and SGM individuals experience ongoing external stressors, such as discrimination and microaggressions (Grant et al., 2011;Nadal et al., 2016Nadal et al., , 2019Moody & Lewis, 2019). Marginalized individuals may experience insidious trauma and oppressionbased stress as equally or even more high impact relative to Criterion A trauma, underscoring the significance of these stressors and their impacts in therapy (Cardona et al., 2021;Livingston et al., 2019;Williams et al., 2022). ...
... While interventions like these are not trauma-focused or PTSD-centered, PTSD treatments are well-suited for adaptations that can better meet the mental health needs of clients (Livingston et al., 2020), particularly given the overlapping impacts of trauma and oppression-based stress on marginalized people (Livingston et al., 2020;Salomaa et al., 2023;Arnett et al., 2019;Reisner et al., 2016;Szymanski & Balsam, 2011). Protocols and adaptations that address this overlap have begun to emerge, such as the Healing from Racial Trauma protocol (Williams et al., 2022) and culturally adaptive Prolonged Exposure for African Americans (Williams et al., 2014), but treatment outcomes have not yet been assessed. Regardless, it is clear that treatment adaptation is warranted when a marginalized group faces unique risk factors (Lau, 2006), such as the added burden of trauma and oppression-based stress. ...
... The Healing from Racism Trauma Protocol (Williams et al., 2022) and the Transcending Protocol (Ouellette et al., 2023) offer a unified cognitive-behavioral approach to address the effects of oppression-based stress on mental health among POC and transgender and gender diverse (TGD) people, respectively. These protocols include elements consistent with CPT, such as an impact statement and use of stuck points (Ouellette et al., 2023) as well as back and forth dialogue between clinician and client that helps the client challenge undue cognitions caused by their trauma(s), and make meaning of them (Williams et al., 2022). ...
Marginalized individuals are routinely subjected to oppression-based stress experiences, which are linked to negative mental health outcomes, including posttraumatic stress disorder (PTSD) and a myriad of interrelated psychiatric symptoms that exacerbate distress and complicate effective treatment. However, oppression-based stressors that do not fit Criterion A of PTSD in the Diagnostic and Statistical Manual of Mental Disorders-5 are routinely overlooked or not sufficiently incorporated in PTSD assessment or treatment, limiting clinicians’ ability to be responsive to these concerns and undermining affirming and patient-centered care. Recent scholarship highlights the need for principle-driven application of cognitive processing therapy (CPT) and other culturally responsive adaptations to this protocol to make it more effective for the range of presenting oppression-based stressors and interlocking concerns stemming from them when treating PTSD among marginalized people. In this chapter, we review literature that supports cultural adaptations to CPT and overview strategies for implementing these adaptations in patient-centered ways, particularly racial and ethnic minorities as well as sexual and gender minorities, and illustrate these recommendations in a case example.
... anti-Black violence, little scholarship has addressed clinical strategies for supporting individuals with this experience. Clinical models and modifications of existing trauma treatment protocols have been developed to address racial trauma in psychotherapy (Comas-Díaz, 2000, 2016Johnson & Melton, 2021;Lipscomb & Ashley, 2021;Metzger et al., 2021;M. T. Williams et al., 2023), but these have not been examined in the context of specifically addressing the emotional and psychological correlates of media exposure to anti-Black violence. Nonetheless, this scholarship provides an excellent foundation for potential interventions that various psychotherapists might use to support a client reporting distress related ...
... ive-behavioral and acceptance-based models for supporting client recovery from racial trauma emphasize sensitive and client-centered exploration of the client's beliefs about the event and its impact on their life and emotions as an essential first response to client disclosure of an experience of racism (Johnson & Melton, 2021;Mosley et al., 2021;M. T. Williams et al., 2023). M. T. Williams et al. (2023) foreground validation in their discussion of racial trauma treatment, noting that "As a rule, clinicians should accept that all experiences of racism shared by a client are real and not imagined or exaggerated" (p. 3). Lipscomb's (2021) Bonding through Recognition to promote Understanding and Healing approa ...
... T. Williams et al., 2023). M. T. Williams et al. (2023) foreground validation in their discussion of racial trauma treatment, noting that "As a rule, clinicians should accept that all experiences of racism shared by a client are real and not imagined or exaggerated" (p. 3). ...
Racial trauma refers to emotional injury from direct or vicarious exposure to racist violence. One responsibility for antioppressive psychotherapy is to effectively support Black clients coping with the impacts of police brutality and anti-Black violence, but little is known about how psychotherapists attempt to fulfill this responsibility in routine practice. This survey study investigated N = 91 psychotherapists’ (majority identifying as White, cisgender women) perceptions of five potential interventions that could be used to support Black clients experiencing racial trauma related to media coverage of anti-Black violence and the potential influence of professional characteristics on these perceptions. Psychotherapists completed an online survey that included a hypothetical client scenario. Psychotherapists rated their perceptions of intervention types, specifically the following: emotional expression, value-guided action, coping skills, cognitive restructuring, and self-disclosure responses. Psychotherapists rated the emotional expression response option as most helpful, followed by value-guided action and coping skills. Self-disclosure and cognitive restructuring were viewed as less helpful. Psychotherapists of color rated the use of self-disclosure more positively than White psychotherapists. Endorsement of being influenced by cognitive-behavioral therapy was significantly and positively associated with positive perceptions of the values, cognitive restructuring, and coping psychotherapist response options. In contrast, the degree to which one endorsed being influenced by psychodynamic psychotherapy was negatively associated with perceived helpfulness of values and coping-focused psychotherapist responses. Implications for psychotherapist training and continuing education are discussed. Additional research is needed to explore clients’ perceptions of the degree of support and helpfulness of varied therapeutic responses in these contexts.
... Racial stress is a psychological response to racism in the form of discrimination and bias against one due to their race and is often a precursor for racial trauma . Williams et al. (2021Williams et al. ( , 2023 explained that racial trauma is the cumulative effects of individual and systemic racism and discrimination on a historically minoritized person. Racism has been linked to a variety of mental health issues, particularly, posttraumatic stress disorder (PTSD; Williams et al., 2021). ...
... Over the past 20 years since Baldwin's work, many Black mental health professionals (BMHPs) have focused on more Afrocentric ways of working with Black clients. Williams et al. (2023) provided some guidelines for how therapists can support people of color who have racial trauma. Their racial healing protocol includes culturally adaptive cognitive behavioral interventions such as validating client's experiences; providing psychoeducation on the nature of systemic racism and internalized racism; assessing for strengths and resources; encouraging self-care and compassion; improving the quality of social support; mindfully addressing emotions; cognitive restructuring; skills building; and restorying (Williams et al., 2023). ...
... Williams et al. (2023) provided some guidelines for how therapists can support people of color who have racial trauma. Their racial healing protocol includes culturally adaptive cognitive behavioral interventions such as validating client's experiences; providing psychoeducation on the nature of systemic racism and internalized racism; assessing for strengths and resources; encouraging self-care and compassion; improving the quality of social support; mindfully addressing emotions; cognitive restructuring; skills building; and restorying (Williams et al., 2023). Comas-Díaz (2016) framed a therapeutic approach to racial trauma that includes five components: (a) assessment of racial stress/trauma; (b) desensitization, with the goal of self-regulation; (c) reprocessing, to aid in meaning-making and cultural resilience; (d) decolonization, to recover from internalized racism and facilitate personal transformation; and (e) social action, with the purpose of collective agency, social change, and racial equality (p. ...
Clinical Impact Statement
Question: This study examined how Black mental health professionals work to alleviate the racial trauma of their Black clients and what impacts if any this has on their own personal and professional well-being. Findings: We found that the work of healing racial trauma is deeply complex due to the personal resonance that many BMHPs have with anti-Black racism. Yet BMHPs often utilize their own experiences of racism as one intervention in the therapeutic process. Meaning: As a result of the pandemic and killings of Black persons that have gone viral on social media, Black mental health professionals experienced an increase in their workload related to working with Black persons suffering from trauma. This work often took a toll on Black clinicians, leaving them susceptible to feelings of exhaustion, burnout, and secondary traumatic stress which may impair their work with patients, clients, and students. Next Steps: Further work is needed to explore in more detail the interpersonal processes of therapy within Black clinician–client dyads to provide guidance for other BMHPs on how to alleviate racial trauma while protecting oneself from secondary traumatic stress.
... In addition to generally supporting mental health and well-being, a positive sense of ethnic identity can help young adults from minoritized groups to derive self-esteem, psychological adjustment, and social support from their ethnic communities [11,28]. These assets may help them to resist internalizing negative stereotypes and promote resilience when facing setbacks in life, including stigma and discrimination [29,30]. Studies have also found that ethnic identity development is associated with fewer mental illness symptoms among ethnic and racial minority young adults [14,31,32], suggesting it has protective effects in the context of clinical recovery [33]. ...
... Our findings also echo research showing how Black Americans cope with adversity through communalism and spiritual practices derived from African cultural traditions [61]. The church, in particular, is a trusted institution among Black Americans that promotes communalism, racial and ethnic pride, and social support [30,61]. The positive connections participants described between ethnic identity and psychological well-being suggest that a developed sense of ethnic identity is a competency or an asset that may facilitate processes of connectedness, hope, positive identity, and empowerment in personal recovery. ...
... Being able to access treatment and support for their recovery while they were exposed to racism and experiencing mental illness demonstrated that study participants were able to resist stigma and make effective use of the resources available to them. This is affirmed in research on ethnic identity development showing that adaptive coping skills, such as viewing marginalization as a function of external forces instead of inherent characteristics, are often cultivated through being sensitized to racism early in life (e.g., racial socialization) [30,61] and that these competencies are ultimately protective for ethnically and racially minoritized people throughout adulthood [11,15,29]. However, participants' experiences also demonstrate that stigma and structural racism can generally reduce opportunities to develop self-determination in mental health recovery. ...
Background/Objectives: Ethnic identity development is associated with positive mental health in young adults from ethnic minority groups. How a sense of belonging and attachment to one’s ethnic culture is related to personal mental health recovery remains unexplained. This study examines the experiences of ethnic minority young adults in the U.S. to understand the aspects of culture and identity development that are relevant to their recovery processes. Methods: Young adults who were living with chronic mental disorders were recruited from four rehabilitation programs. Interviews produced quantitative and qualitative data. An explanatory sequential mixed methods design was used to integrate the qualitative findings from a sub-group of young adults (n = 44) with the results from the quantitative study. Directed content analysis was used to analyze the qualitative data, and the integrated data were analyzed in joint displays. Results: The prominent themes characterizing ethnic identity development in personal recovery were (a) cultural history, traditions, and values; (b) mental illness stigma within the ethnic community; and (c) bias and discrimination in mental health services. Young adults with high ethnic identity development reported having more support from family, but they also described experiences with stigma and racism. Conclusions: The integrated results suggest that ethnic identity development promotes mental health recovery in minoritized young adults through social support and improved well-being and resilience. Experiences of intersectional stigma and structural racism associated with ethnic identity can interfere with self-determination and access to care among minoritized Hispanic/Latine, Black, and multiracial young adults in the U.S.
... Taken together, it may be helpful to scaffold coping strategies such that individuals strengthen their ability to use the strategies described first in this review (e.g., self-care, self-compassion, social support, mindfulness) before working on some of the more challenging strategies (e.g., expressive writing, social action, activism). This sequencing is consistent with Judith Herman's (2015) three-stage approach to trauma recovery (Safety, Remembrance-Mourning, Reconnection) and with racial trauma treatment approaches suggested in the extant literature (Chavez-Dueñas et al. 2019, Comas-Díaz 2016, Williams 2024, Williams et al. 2023a). ...
... One necessary step in repairing that mistrust is the adaptation of existing treatments and development of novel ones to adequately address the needs of clients of color, which requires explicitly addressing the role of systemic oppression in these clients' lives (Bartlett et al. 2022). With this goal in mind, we have developed a treatment protocol informed by the literature base summarized in this review (Williams 2024, Williams et al. 2023a). The treatment comprises approximately 12 sessions (11 distinct sessions with some that can repeated as needed) that span three stages-Stabilization, Healing, and Empowerment (Williams 2024, Williams et al. 2023a. ...
... With this goal in mind, we have developed a treatment protocol informed by the literature base summarized in this review (Williams 2024, Williams et al. 2023a). The treatment comprises approximately 12 sessions (11 distinct sessions with some that can repeated as needed) that span three stages-Stabilization, Healing, and Empowerment (Williams 2024, Williams et al. 2023a. The Stabilization stage includes three sessions in which the therapist provides psychoeducation about racism and its impacts (Session 1); assesses the client's strategies for self-care, reinforcing adaptive strategies and decreasing maladaptive strategies (Session 2); and works with the client to bolster their social support network (Session 3). ...
Racial stress and racial trauma refer to psychological, physiological, and behavioral responses to race-based threats and discriminatory experiences. This article reviews the evidence base regarding techniques for coping with racial stress and trauma. These techniques include self-care, self-compassion, social support, mindfulness, cognitive restructuring, cognitive defusion, identity-affirming practices and development of racial/ethnic identity, expressive writing, social action and activism, and psychedelics. These strategies have shown the potential to mitigate psychological symptoms and foster a sense of empowerment among individuals affected by racial stress and trauma. While the ultimate goal should undoubtedly be to address the root cause of racism, it is imperative to acknowledge that until then, implementing these strategies can effectively provide much-needed support for individuals affected by racism.
Expected final online publication date for the Annual Review of Clinical Psychology, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... Dies hat zur Folge, dass rassismusbasierte Trauma-und Stressreaktionen nicht bzw. nicht-adäquat behandelt werden (Carter & Pieterse, 2020;Williams et al., 2018;Williams, Holmes, Zare, Haeny & Faber, 2023). Um rassismusbasierte traumatische Stressreaktionen, die nicht ausschließlich auf körperliche Verletzungen und Lebensbedrohungen, sondern auch auf psychische Verletzungen und Existenzbedrohungen zurückgehen, erfassen zu können, entwickelten Carter et al. (2007) das Rahmenmodell des race-based traumatic stress -RBTS: 5 Als Reaktion auf rassistische Ereignisse, die von der betroffenen Person als emotional sehr schmerzhaft, in ihrem Auftreten als plötzlich und unerwartet sowie als unkontrollierbar erfahren werden, 5 Im englischsprachigen, auch rassismuskritischen, Diskurs wird der Begriff "race", basierend auf einer kritischen Auseinandersetzung mit Rassismus, als eine soziale Konstruktion verstanden, mittels derer gesellschaftliche Phänomene, "die menschengemacht sind und von Institutionen aufrechterhalten werden", beschrieben und analysiert werden können (Gasser & Rath, 2021, o. ...
... Stattdessen wird hier der Begriff "race-based" mit "rassismusbasiert" übersetzt, zu dem die Begriffe "rassismusbedingt" oder "rassismusbezogen" synonym genutzt werden -ebenfalls in Anlehnung an die englischsprachige Terminologie. (Nadal, 2018;Sue et al., 2007;Sue & Spanierman, 2020;Williams, 2020) Cénat (2023) (Williams et al., 2023). Des Weiteren können frühere Versuche, Rassismuserfahrungen anzusprechen, invalidiert worden sein -auch im Rahmen therapeutischer Gespräche, weshalb sie diese nicht mehr thematisieren (Aikins et al., 2021;Constantine, 2007;Otyakmaz, 2024 (Williams et al., 2023, S. 572 Williams et al., 2023). ...
... (Nadal, 2018;Sue et al., 2007;Sue & Spanierman, 2020;Williams, 2020) Cénat (2023) (Williams et al., 2023). Des Weiteren können frühere Versuche, Rassismuserfahrungen anzusprechen, invalidiert worden sein -auch im Rahmen therapeutischer Gespräche, weshalb sie diese nicht mehr thematisieren (Aikins et al., 2021;Constantine, 2007;Otyakmaz, 2024 (Williams et al., 2023, S. 572 Williams et al., 2023). In klassisch kognitivverhaltenstherapeutischer Vorgehensweise können auch rassismusbedingte Grundannahmen identifiziert, mit kognitiven Disputationstechniken auf ihre Realitätsangemessenheit geprüft und in Beziehung zu ihrem Ursprung, dem Rassismus, gesetzt werden. ...
Die negativen Auswirkungen von Rassismus auf die psychische Gesundheit der Betroffenen sind mittlerweile evident. Da viele der Symptome rassismusbedingter Beschwerdebilder Übereinstimmungen mit der Symptomatik der PTSD aufweisen und gleichzeitig eine Spezifität bezüglich der Auslöser vorliegt, wird derzeit von Expert*innen diskutiert, wie diese diagnostisch erfasst und eingeordnet werden können. Neben der Darstellung dieser Überlegungen stellt der Beitrag einen kognitiv-verhaltenstherapeutischen Ansatz zur Behandlung rassismusbedingter Stress- und Traumareaktionen, das „Healing Racial Trauma protocol“ dar, der orientiert an der Behandlung anderer Traumafolgestörungen, die spezifische Charakteristik von Rassismus als Auslöser berücksichtigt.
... A great deal of work has been done to develop and research concepts of racial stress and racial trauma, detailing the effects of racism as daily and cumulative stressors (Carter and Pieterse 2020;Williams et al. 2023). Their work has highlighted the inadequacy of the DSM-V concept of trauma, namely, that it requires exposure to an event of potentially life-altering or ending physical harm. ...
... Therapeutic approaches to dealing with racial stress and trauma have been developed as well, and include racial selfcare, strengthening ethno-racial identities as a protective factor, and the critical conscious component of anti-racism social action (Chavez-Dueñas et al. 2019;Williams et al. 2023). Menakem (2017) developed a theory of White supremacy as the result of unhealed trauma originating in medieval Europe, and a complex, collective intervention for the subjugated and the privileged to interrupt its transmission to others. ...
This article explores the use of location of self (LOS) in the years since the initial publication in 2010 and represents a collaboration of five family therapists. The initial part of the paper underscores LOS as both a clinical dialogic tool and conceptual framework, reviews the relevant literature during the time interval, and reflects on the core tenets of LOS, as well as emergent ideas, practices, and questions. The second part of the article presents the clinical work of four co‐authors, illustrating their unique and creative use of LOS. Specifically, it discusses dialogue about the interplay of social locations in therapy, a form of use of self, a social location‐self of the therapist awareness, and a conceptual frame for recognizing supremacy as an in‐here phenomenon. That is, one embedded in social locations, which all people occupy, thus directing our attention to supremacy systems inside of us. LOS also underscores supremacy as a clinical issue, heightens attunement to the ways it can appear among the privileged and the subjugated, and increases attention to expanded ways of addressing it in therapy. We suggest that LOS dialogue tends to be most generative and easeful among therapists and clients who share multiple or similar subjugated locations, but it can also occur in the multi‐privileged therapy relationship, depending on the awareness and comfort with such material. The reviewed literature suggests that LOS is used more often with multi‐subjugated clients than those who are multi‐privileged. We pose the question as to whether the power of the latter is a driving factor in this, given the challenges of addressing supremacy. We present the multiple perspectives within a single paper based on the unitary process of internal reviews and discussions of all co‐author sections.
... Whilst somewhat deviating from Laidlaw et al.'s (2003) protocol [45], this was prioritized, as research suggests that discussing racism improves CBT efficacy [49,50]. Discussing the origin and utility of his high standards was described as "validating," perhaps because it cast doubt on his assumption that he was responsible for his difficulties by externalizing the responsibility for his (now maladaptive) high standards to systemic racism [51,52]; this appeared to reduce self-blame and promote self-compassion 9 [53]. ...
... However, there are alternative explanations of the results. Formulating racism may have externalized the responsibility of Nicholas' difficulties to prejudicial, subjugating racist societal narratives [51,58], promoting self-compassion [53]. Consistent with this, Nicholas showed improvements in idiographic measures following session 3, during which the effect of racism was formulated. ...
... Additionally, a tool like the Cultural Formulation Interview (Jarvis et al., 2020) can provide more nuanced, critical information about intersectional identities and cultural supports and strengths. Likewise, existing internalized stigma treatments may need to be adapted to meet the needs of diverse patients with intersectional stigma experiences, such as James (e.g., specific psychoeducation and cognitive restructuring for racial trauma and internalized racism; Williams et al., 2022b). ...
... In our clinical experiences running and supervising NECT groups, patients have brought up other forms of stigma and stress (e.g., experiences of internalized racism and heterosexism) and have been able to apply the general skills learned to these concerns. Nonetheless, future internalized stigma programs will likely benefit from explicit discussions of intersectional stigma and potential "modules" that employ evidence-based strategies from other interventions (e.g., racial trauma; Williams et al., 2022b). ...
Young people who first meet criteria for a schizophrenia-spectrum disorder are considered by the field to be experiencing first-episode psychosis (FEP). Early intervention for psychosis saves lives, and specialized early intervention programs have proliferated over the past two decades. However, critical gaps in such care related to access, equity, and inclusion are still being addressed. Within this article, we first provide a composite clinical vignette from our clinical and research experiences, followed by background and history on the early-stage psychosis field. We then focus on discussing evidence-based clinical practices in this area and gaps in current services—especially related to targeting intersectional stigma and related stressors in care. Psychosis is among the most stigmatized and misunderstood health conditions in the world and many young people diagnosed with FEP experience internalized (or self-) stigma (i.e., incorporating negative mental illness stereotypes into one’s identity). Internalized stigma can prevent youth from fully engaging in care and has been consistently associated with a host of negative outcomes, including symptom severity, social isolation, suicidality, and functional deficits. Specific assessment and intervention tools are shared and discussed throughout.
... To help promote civic action among IYOC, those working with them should integrate activities and conversations that facilitate youth's exploration of who they are in relation to their ERIs. This may include ethnic-racial, cultural and/or political socialisation and is in line with the integration of racial socialisation into interventions for racial trauma (Williams et al. 2023). Data from this investigation suggest that ERI exploration can promote conventional political action and community service and can affect the relations between structural discrimination concern and activism. ...
Marginalised social identities and discrimination based on these identities often shape civic action among immigrant‐origin youth of colour (IYOC). This study examined unique and interactive effects of both interpersonal (ethnic‐racial) and structural discrimination and two dimensions of ethnic‐racial identity (ERI; exploration and commitment) on three types of civic action: conventional political, activism and community service among IYOC. Participants were 198 emerging adults (Mage = 19.71) residing in the state of Georgia. Most participants were second‐generation immigrants (79%), female (73%) and of Black/African descent (35%). Participants completed self‐report measures of interpersonal discrimination, structural discrimination concern, ERI and civic action. Results revealed unique effects of interpersonal discrimination on all three types of action as well as ERI exploration on conventional political action and community service. Moderation analyses revealed a significant interaction between structural discrimination concern and ERI exploration explaining added variance in activism: structural discrimination was positively related to activism only at high levels of exploration. Findings underscore the importance of investigating the interplay between individual and sociopolitical factors when examining IYOC's active participation in their communities and in society at large.
... In the United States race is a social caste system that is constantly evolving and is used to categorize people based on similar physical and social characteristics. It also refers to an ideology that assumes the superiority of White people over People of Color(Williams et al., 2023).Racism can cause stress and trauma reactions related to race, affecting marginalized individuals. Understanding these manifestations is crucial for developing effective treatment strategies. ...
... 3). 76 Yet racism is foundationally embedded in institutions and systems across Canada, including services in public health, mental health, and substance use health. ...
... Parents and community leaders can be engaged and, likewise, these principles can be incorporated into schools and workplaces to provide more empathetic understandings of masculinity. These changes can contribute to improved mental health, stronger interpersonal relationships and greater gender equality within society (Williams et al., 2023). Challenging norms, supporting diverse media depictions and adopting educational interventions can reshape masculinity stereotypes all together by promoting a broader, more inclusive understanding of what it means to be a man. ...
This article examines the application of proverbs and idioms in perpetuating male stereotypes, seeking their cultural and historical origins and societal perceptions of masculinity. It traces the evolution of Western masculinity in relation to the labour market, family, and gender roles through the Industrial Revolution and feminist movements. By considering proverbs and idioms as storehouses of collective knowledge, the research determines the impact of such stereotypes on the performances and possibilities of men and women. The study employs the theory of hegemonic masculinity, and its extension by R.W. Connell, and examines gender stereotypes in the culture of the AmaXhosa, where traditional gender roles are strongly defined. This cultural lens allows for an examination of how such stereotypes impact men’s professional choices, mental health, and overall well-being. Through a qualitative methodology, the study analyses proverbs from Mesatywa and Jordan’s ‘Izaci Namaqhalo EsiXhosa’ (1971) and Makuliwe’s ‘Ingqokelela Entsha Yezaci Namaqhalo EsiXhosa’ (1997), contrasting old and modern idioms to identify cultural continuity and shifts in social norms. Selecting on some of the isiXhosa proverbs like ‘Ubuhle bendoda zinkomo zayo’ (A man’s beauty is his wealth) and ‘Akukho kwayama ngomfo olambayo’ (You cannot trust a poor man), the article critically explores what they mean in relation to men’s self-perception and societal expectations and their role towards gender discrimination. The findings indicate that masculine stereotypes have the effect of privileging men in working environments and undermining women, reinforcing gender inequality. The article demands the transformation of conventional masculine stereotypes in the interests of inclusivity, healthy role models of masculinity, education, and challenging outdated societal norms. It attempts to contribute, ultimately, to the construction of a fairer and healthier society that embraces different definitions of masculinity.
... As a transformative approach, a VR-based therapy allows patients to confront fears in a controlled and safe virtual environment under the guidance of a therapist. The VR environment is designed to help patients confront and process their memories safely, which can reduce the power of those memories to trigger distress 75 . The controlled setting also helps therapists to carefully manage the exposure, ensuring the patient is not overwhelmed. ...
The metaverse, defined as a collective virtual shared space created by the convergence of augmented reality (AR), virtual reality (VR), and the Internet, offers new opportunities for mental healthcare by delivering immersive and engaging digital therapies. This study examines the current landscape of metaverse-based mental healthcare applications, analyzing their effectiveness and potential risks. Using a systematic literature review (SLR) and case study research, four digital therapeutic applications—NightWare, Freespira, EndeavorRx, and Sleepio—were evaluated for their ability to address conditions such as PTSD, anxiety, and ADHD. The results indicate that metaverse-based therapies can provide significant benefits, with clinical validation supporting their effectiveness. However, concerns around user privacy, accessibility, and long-term efficacy remain challenges. Overall, metaverse-based digital therapies represent a promising shift in mental healthcare, offering innovative, personalized, and scalable solutions. Further research is needed to address ethical issues, improve accessibility, and confirm the long-term impact of these interventions.
... These differences may reflect variability in the degree to which therapists emphasize cognitive skills (Ezawa & Strunk, 2022a, 2022b, given that cognitive restructuring can feel invalidating when applied to experiences of prejudice (M. T. Williams et al., 2022). ...
... ed that one must acknowledge that racial discrimination has occurred and discuss the incident with others to achieve catharsis, reduce anxiety, and facilitate emotional recovery (Bryant-Davis & Ocampo, 2006). Discussing racial discrimination can be empowering and provide a sense of control over the traumatic experience (Bryant-Davis & Ocampo, 2006;M. T. Williams, Holmes, et al., 2022). In a systematic review of the impact of alexithymia in response to treatment of mental health disorders, Pinna et al. (2020) postulated that alexithymia could influence a client's ability to benefit from treatment as therapy requires one to share their feelings. The process of psychotherapy, wherein time is set aside with a nonjudgment ...
Objective: Racial trauma is, understandably, associated with negative emotionality and particularly depression and anxiety for Black Americans. To inform trauma-related intervention, insights into mechanisms associated with racial trauma, depression, and anxiety are paramount. One potential mechanism is alexithymia, or one’s capacity to identify and describe emotions. The purpose of this study was to examine alexithymia as a possible influence in the association of racial trauma and negative emotionality among Black adults. Method: Study participants were 133 Black American adults (M = 35.02 years; SD = 14.43 years) who reported at least one racially traumatic event. Participants completed a self-report questionnaire battery. Results: As predicted, the association of racial trauma and negative emotionality was statistically significant though only for respondents who reported heightened levels of alexithymia. Conclusion: These findings provide insights into the importance of emotional expression for influencing responses to race-based traumatic events.
... As avoidant coping may be a risk factor for pain in racially minoritized individuals, chronic pain treatments with an increased focus on exposure and adaptive coping techniques, such as Cognitive Behavioral Therapy (CBT) for Chronic Pain [91][92], may benefit this population. Additionally, approaches that reduce avoidance specific to discrimination, such as Williams' CBT 12-session protocol for racial trauma may be useful for this demographic, as it employs skills training and gradual exposure to confronting racism in a healthy empowered manner [93][94]. Providers should also be cognizant of their rapport with racialized patients, as those who have experienced discrimination and cope with avoidant strategies may not be as forthcoming about their concerns or pain experiences. ...
Objective
This study examines the relationship between racial discrimination and physical pain outcomes.
Methods
A geographically representative sample of 887 individuals was recruited online through CloudResearch from diverse racial backgrounds, including Black/African American, Latine/Hispanic American, Asian American, and White/European American adults. Participants completed measures on racial and ethnic discrimination, racial microaggressions, pain severity, depression symptoms, and coping styles. Statistical analyses included multiple regression and mediation models.
Results
Our findings indicate that racialized participants experienced greater ethnic discrimination and racial microaggressions compared to their non-Hispanic White counterparts. Hispanic/Latine participants also reported greater pain severity than other groups. Lifetime experiences of discrimination, depression symptoms, avoidant coping style, and age emerged as significant predictors of pain severity, while mediation analyses revealed that lifetime discrimination partially mediated the relationship between race/ethnicity and pain severity for racially marginalized participants, compared to non-Hispanic White participants. Furthermore, greater reliance on avoidant coping combined with greater lifetime discrimination experiences was associated with increased severity of pain.
Conclusions
The findings indicate how racism may result in worse pain outcomes in people of color, with potentially amplified adverse effects for those who engage in avoidant coping. While therapeutic interventions targeting avoidance may benefit racialized individuals, ultimately, the results highlight the critical need for large-scale policy interventions targeting racial discrimination to improve health equity and reduce the burden of pain among racialized populations.
... Research has shown that such safe spaces play an important role in healing internalized racism. 3,4 This is the main reason why some colleagues and I formed a group of BIPOC NDs who meet virtually, every month, to talk about these issues. We provide support and encouragement as well as a safe space to discuss our experiences. ...
... In addition, the explicit bridging of the personal and therapist selves may offer therapists from minoritised ethnicities a unique opportunity to explore the personal and professional impact of their ethnicity and to develop a positive sense of their ethnic identity (for example, through developing a timeline of their relationship with their ethnic identity or identifying strengths associated with their own ethnic identity). A positive ethnic identity is understood to be a likely protective factor for ethnically minoritised individuals against the impacts of racism (Chang, 2022;Neblett Jr et al., 2012;Williams et al., 2020a;Williams et al., 2020b, Williams et al., 2022Umaña-Taylor, 2011). Therefore, such a programme may support both the ethnic identity development and wellbeing of therapists from minoritised ethnic backgrounds. ...
There has been limited consideration of the training and support needs of therapists from minoritised ethnic backgrounds. This study quantitatively evaluates a novel application of self-practice/self-reflection (SP/SR) to CBT therapists from minoritised ethnic backgrounds. The study aimed to explore the impact of the SP/SR programme on (1) therapists’ skills in working with ethnicity in their clinical practice; (2) their ethnic identity development; and (3) their perceived levels of personal and professional wellbeing, during the intervention and at follow-up. A multiple baseline single case experimental design was adopted. Measures were developed and adapted for this evaluation and weekly outcomes relating to therapist skill development, ethnic identity development, and personal and professional wellbeing were collected. The outcomes of six participants were analysed using visual and statistical analysis. The results indicated that the SP/SR programme significantly improved therapist skills in identifying and addressing similarities and differences in ethnicity within therapy during the intervention. Improvements were also seen across other skills, ethnic identity developmental and wellbeing outcomes between the baseline and SP/SR phases, with some participants showing significant improvements. Outcomes from the follow-up phase presented a more mixed picture. Therefore, the findings give some support for the SP/SR programme in developing therapist skills in working with ethnicity, as well as highlighting differential outcomes for participants related to their levels of experience and engagement. The findings may have possible implications for the personal and professional development of ethnically minoritised therapists, as well as future quantitative SP/SR research.
Key learning aims
• (1) To provide an overview of self-practice/self-reflection (SP/SR) and its theoretical underpinnings.
• (2) To summarise the current issues around the development of cultural competence, particularly for therapists from minoritised ethnic backgrounds.
• (3) To introduce and describe a novel SP/SR programme for CBT therapists from minoritised ethnic backgrounds.
• (4) To highlight the importance of considering ethnicity within clinical practice, both in terms of the provision of culturally competent therapy as well as to support the personal and professional development of therapists from minoritised ethnic backgrounds.
... Without this focus, racial trauma will remain inadequately addressed, leaving these populations underserved. 55,56 Ultimately, this review highlights the pressing need for more targeted research on the mental health patterns of African immigrant university students in Germany. Such research deepens our understanding of the complex relationship between migration, culture, and mental health and provides the foundation for creating tailored interventions and support networks. ...
Introduction: The increasing globalization of higher education has led to a rise in African international students studying at German universities. Mental health issues such as depression and anxiety are prevalent among this group, and understanding the factors that influence their sociocultural and psychological adaptation is critical. This review aims to explore the mental health patterns of African international university students in Germany, focusing on the challenges they face, their psychological adaptation, and access to culturally sensitive mental health services. Methods: The search followed the PRISMA guidelines. A comprehensive search was conducted in PubMed and Google Scholar using specific keywords, including "mental health," "anxiety," "depression," "African international students," and "Germany." Studies that were peer-reviewed, focused on African international students in Germany, and had a social epidemiological emphasis on mental health were included. Results: African students face higher levels of anxiety compared to students from other regions, mainly due to cultural distance and experiences of racism. Despite their significant presence, mental health services tailored to their needs are limited. Due to a shortage of relevant articles, a detailed analysis of African students’ mental health could not be conducted. Conclusion: African international students in Germany may face unique mental health challenges, including heightened anxiety and significant difficulties adapting to their new environment. These challenges are compounded by a lack of culturally tailored mental health services. Addressing these issues requires targeted studies to understand their unique needs and the development of a more inclusive academic environment that supports the specific needs of African students.
... The diagnostic criteria for PTSD as written in the DSM-5 is primarily interpersonal and physical, and thus it discounts systemic, institutional, and psychological trauma (Cassiman, 2005;Holmes et al., 2016). Recognizing the substantial and growing body of research that shows racial trauma results in PTSD symptoms (Carter et al., 2020;Cheng & Mallinckrodt, 2015;Sibrava et al., 2019;Williams et al., 2018), many authors have suggested the DSM include a diagnosis that includes traumatization from the experience of oppression and racism (Holmes et al., 2016;Williams et al., 2023). This de-contextualized diagnosis of PTSD essentially misses the sources of trauma and harm that are environmental. ...
Black Americans with Posttraumatic Stress Disorder have less access to mental healthcare compared to White Americans. Many factors contribute to this inequity, including broader disparities within the healthcare system driven by systemic racism, and an underutilization of mental health services by Black Americans due to provider bias and stigma around mental health care. These disparities are rooted in a racist historical context of exclusion and abuse of the Black community by the White psychiatric establishment, and a perpetration of further trauma on Black clients, a context that is largely missing from traditional mental health education and literature on Black mental health today. This article aims to provide a necessary historical context of how the U.S. mental health care system has excluded Black Americans from trauma treatment. We use a contemporary trauma lens to demonstrate the ways in which Black trauma has existed throughout U.S. history, but how White psychiatry has cast trauma symptoms as evidence of racial inferiority, has excluded Black individuals from treatment, and has abused Black patients, thereby increasing Black trauma. The purpose of this review is to inform and educate mental health providers about our collective history, to counter a narrative of amnesia which identifies Black underutilization of services but forgets the exclusion from and abuse of Black people within the mental health system. We conclude with recommendations that providers can utilize to engage in antiracist practice and create an affirmative space for Black Americans to utilize trauma treatment and mental health care freely.
... Although the aforementioned race-based trauma models are helpful in counselors clinical work among clients, this article does not present an exhaustive list of conceptual frameworks and/or therapeutic approaches to address race-based trauma among clients. In this way, systematically counter-storytelling hegemonic racial narratives (Quiros et al., 2020), the utilization of the transcultural Adlerian conceptualization and therapy (TACT) model (Lemberger et al., 2016), implementing a race-based stress and trauma intervention protocol within a group counseling (Carlson et al., 2018) and individual counseling (Williams et al., 2022) modalities are all viable approaches in addressing race-based trauma among racially diverse clients. ...
The area of trauma has been well researched within counseling literature; however, discussions around race-based trauma have been proportionately minimal. Given the physiological, psychological, and behavioral impacts of race-based trauma it is imperative that counselors and counselor educators are equipped to broach and address client's experiences. Therefore, this article provides a review of race-based trauma literature and models. In addition, this article calls counseling professionals to action on exploring and addressing their own attitudes, beliefs, and biases, along with informing clinicians on how to advocate for people of color and translate their knowledge into their work.
... Racial trauma and how to treat it has not been traditionally a part of the curriculum for European schools of therapy and only recently has a comprehensive treatment in the literature [98,99]. Mental health practitioners should understand and take note if they have the training required to be able to treat individuals who may have experienced trauma resulting from their skin colour, ethnic or national origins [96,98]. ...
As clinical trials for psychedelics move into phase III in the USA, Europe must address its lag in integrating professional education around psychedelic-assisted therapy (PAT) and supporting psychedelic drug research. This paper evaluates the necessary frameworks for implementing PAT in Germany, emphasizing the nation’s potential leadership role within the European Union. With Australia having already approved MDMA and psilocybin for mental health indications, the Ukrainian government exploring MDMA treatment for war-related PTSD, and initial clinical trials involving MDMA and LSD with patients in Switzerland which restarted the restricted medical use of these substances around 2014, the medical authorization of psychedelics in these countries establishes precedent showcasing both the promise and challenges of researching and implementing PAT in nations where the substances were formally scheduled as illicit substances. Key challenges include establishing rigorous standards for practitioner training, accessibility, and defining regulatory oversight. This paper focuses on the development of robust infrastructure in Germany, which will support the roll out of PAT, and details ethical considerations, training protocols, and governmental roles in the formulation of treatment frameworks. This approach aims not only to guide Germany in adopting PAT but also to influence broader European policy, ensuring that patients receive ethically sound and proficient care. The findings suggest pathways for Europe to reclaim its historical lead in psychiatric and therapeutic innovation.
... Thus, these findings emphasize that research, intervention, and programming for suicide prevention among Black emerging adults should prioritize culturally informed approaches that address racial discrimination and COVIDrelated stress within this population. For example, psychotherapists may use the Healing Racial Trauma protocol (Williams et al., 2023) or employ techniques from acceptance commitment therapy developed to target internalized racial oppression (Banks et al., 2021). Furthermore, critical consciousness, resilience, and racial identity may be important targets to consider when developing and implementing culturally mindful suicide prevention and intervention strategies. ...
Suicide is a leading cause of death among Black emerging adults. The concurrent effect of the COVID-19 pandemic and racial discrimination were projected to exacerbate suicide vulnerability for Black Americans. The purpose of the present study was to utilize a risk-resilience model to examine the effects of racial discrimination and COVID-related stress on suicide risk for Black emerging adults, as well as the moderating effect of three central components of radical healing: critical consciousness, resilience, and cultural authenticity. Study participants included 521 Black emerging adults between the ages of 18 and 29 (51.6% male; Mage = 24.6, SD = 2.6) who completed measures evaluating symptoms of racial discrimination, COVID-related stress, suicide risk, and psychological well-being. After controlling for age, gender, socioeconomic status, and general stress, structural equation modeling analyses revealed unique and interactive effects of racial discrimination, COVID-related stress, and culturally relevant protective factors on suicide risk for Black emerging adults. These findings provide preliminary insight into novel risk and protective factors that influence suicide risk for Black emerging adults.
... Moreover, post-hoc analyses suggest that SMM of color, particularly Indigenous, Black, and South Asian SMM, may be more likely to experience high levels of proximal stress and therefore may require greater support and targeted interventions that address their unique experiences and needs as SMM with multiple marginalized identities. Interventions might include adapted treatments that target stressors related to sexual orientation as well as those related to race/ ethnicity (e.g., protocols for racial trauma; Williams et al., 2022). ...
Objective: Sexual minority men (SMM) living with HIV report significantly greater methamphetamine use compared with heterosexual and HIV-negative peers. Greater use may be related to stressors (e.g., HIV-related stigma) faced by SMM living with HIV and subsequent psychological and behavioral sequelae. We tested an integrated theoretical model comprised of pathways between stigma, discrimination, childhood sexual abuse, psychological distress, sexual compulsivity, and cognitive escape in predicting methamphetamine use among SMM living with HIV.
Methods: Among 423 SMM living with HIV, we tested a structural equation model examining factors hypothesized to be directly and indirectly associated with methamphetamine use. Analyses were adjusted for demographic covariates and sampling bias.
Results: The model showed good fit (CFI = 0.96, RMSEA = 0.01). Heterosexist discrimination was associated with psychological distress (β=0.39, p < 0.001) and psychological distress was associated with sexual compulsivity (β=0.33, p < 0.001). Sexual compulsivity was associated with cognitive escape (β=0.31, p < 0.001), which was associated with methamphetamine use (β=0.51, p < 0.001). Psychological distress was associated with methamphetamine use via serial indirect effects of sexual compulsivity and cognitive escape (β=0.05, p < 0.05).
Conclusions: Heterosexist discrimination contributed to psychological distress among SMM living with HIV. Psychological distress is linked to methamphetamine use via sexual compulsivity and cognitive avoidance. Interventions seeking to reduce the likelihood that SMM living with HIV use methamphetamine should include coping strategies specific to heterosexism and related psychological distress.
... For clients who experience lasting distress due to coping with microaggressions in their daily lives, empirically supported treatment approaches are needed. Such clients may have uncertainty around how to manage these experiences, and although guidelines for assisting such clients are provided in several therapist manuals, more research is needed to ascertain the effectiveness of these recommendations (Williams et al., 2023b). Additionally, therapists often feel confused about how to respond when clients commit racial microaggressions, and these can be especially distressing to therapists of color. ...
... • Seek out antiracist and trauma psychology trainings trainings should consider including content on how providers can address their clients' experiences of racism in their everyday lives in therapy. Therapists should be able to help clients work toward responding effectively toward racism they experience in their daily lives (Williams, Holmes, Zare, Haeny, & Faber, 2022). Future training programs can be inspired by a module in the 'How to provide antiracist mental health care' training that teaches this approach by Cénat and colleagues at the University of Ottawa . ...
Racism has been shown to directly be deleterious to the mental health care received by minoritized peoples. In response, some mental health institutions have pledged to provide antiracist mental health care, which includes training mental health care professionals in this approach. This scoping review aimed to synthesize the existing published material on antiracist training programs among mental health care professionals. To identify studies, a comprehensive search strategy was developed and executed by a research librarian in October 2022 across seven databases (APA PsycInfo, Education Source, Embase, ERIC, MEDLINE, CINAHL, and Web of Science). Subject headings and keywords relating to antiracist training as well as to mental health professionals were used and combined. There were 7186 studies generated by the initial search and 377 by the update search, 30 were retained and included. Findings revealed four main antiracist competencies to develop in mental health professionals: importance of understanding the cultural, social, and historical context at the root of the mental health problems; developing awareness of individual biases, self-identity and privilege; recognizing oppressive and racism-sustaining behaviors in mental health care settings; and, employing antiracist competencies in therapy. Professionals who have taken trainings having the main components have developed skills on the interconnectedness between racialized groups' mental health and the cultural, religious, social, historical, economic, and political issues surrounding race, necessary for successful clinical practice and for providing anti-racist mental health care. This scoping review presents a summary of the essential antiracist competencies drawn from the literature which must be applied in a mental health care setting, to improve help seeking behaviors, and reduce distrust in mental health care professionals and settings.
... This finding has notable clinical implications, including emphasizing the importance of evidence-based approaches for targeting stress and/or trauma associated with exposure to discrimination for Black Americans. For example, psychotherapists may utilize the Healing Racial Trauma protocol (Williams et al., 2022) or implement techniques from Acceptance Commitment Therapy aimed at targeting internalized racial oppression (Banks et al., 2021), as these strategies could promote alternative ways of addressing perceived threat or safety concerns related to discrimination. ...
Objective
The present study sought to better understand the characteristics of those who own firearms in the Black community; and to understand how Black firearm owners differ from nonfirearm owning Black individuals on a variety of variables related to safety, threat concerns, and suicide risk.
Methods
Two samples were utilized in this study. The first was a subsample of those who identified as Black from a nationally representative sample (N = 502) seeking to understand firearm ownership within the United States. The second used a subsample of those who identified as Black (N = 1086) from a representative sample from New Jersey, Minnesota, and Mississippi. Variables related to safety and threat concerns were included in the second sample.
Results
In both samples, multiple demographic variables, such as being a woman and having higher education, predicted firearm ownership. In the second sample, experiences of everyday discrimination and crime experiences were associated with firearm ownership. Additionally, Black firearm owners reported significantly more suicidal ideation than Black nonfirearm owners.
Conclusion
The findings demonstrate the unique characteristics and experiences of Black firearm owners and show that firearm ownership is associated with increased suicide risk factors for Black adults. Findings should be used to advocate for the creation of more culturally relevant suicide prevention and firearm means safety strategies.
Mistakes in understanding perception result in gaps in thought patterns and behavior. The aim of this research is to determine the condition of behavior of victims of verbal bullying , to find out the stages of efforts of REBT-based individual counseling services in dealing with students due to verbal violence. This research is a type of qualitative research with a case study approach. Qualitative research is based on primary and secondary data. Primary data was obtained through participatory observation , in-depth interviews with three students who were victims of bullying and one guidance and counseling teacher, documentation in the form of counseling protocols and counseling record cards. This research shows that counseling (REBT) is effective in dealing with students who are victims of verbal bullying. Guidance teachers explore component A (events), component B (beliefs and thoughts), and components C/D/E (feelings, behavior and results). After students internalize REBT, there is a change in attitude and positive perception of the negative impacts they experience. This research found several changes in thought patterns, increased morality, solidarity and increased awareness of the strength of personal mentality due to verbal violence. Aspects of students' mental development become better after individual counseling.
Mass shootings are increasingly common in the United States and associated with a range of adverse mental health outcomes. In this article, we summarize the small but growing empirical literature on the mental health consequences of mass shootings, describing commonly examined post-shooting outcomes (e.g., posttraumatic stress disorder [PTSD] symptoms), risk factors for poor mental health (e.g., higher exposure), and protective factors associated with lower symptoms (e.g., social support). We then discuss key clinical and ethical challenges that can arise after mass shootings, such as those related to competence and confidentiality, and provide recommendations for evidence-based assessment and practice, including Psychological First Aid and empirically supported treatments for PTSD. The clinical case study of Jason and his therapist Margaret illustrates the article’s key themes.
This article addresses gaps in cognitive-behavioral therapy (CBT) when it comes to integrating racial issues that affect racialized patients’ mental health. Traditional adaptations of CBT focused on social, religious, and linguistic challenges but neglected the critical aspects of interpersonal, institutional and systemic racism, internalized racism and complex racial trauma. This oversight has resulted in less effective outcomes for racialized individuals. The article proposes clear, applicable guidelines for clinicians to provide anti-racist CBT interventions. They cover clinical self-development, re-design the CBT triangular (thoughts, feelings, behaviors) theoretical framework, provide practical tools and tips to facilitate antiracist CBT interventions. Clinicians are encouraged to engage in self-assessment to understand their own racial biases and develop competencies to address racial issues and dynamics in therapy. CBT theoretical framework is re-envisioned to include environmental factors that impact the lives of racialized people, acknowledging the pervasive effects of racism on mental and physical health. The article also highlights the importance of creating a culturally safe therapeutic environment for racialized children, adolescents, and families, and emphasizes the need for specialized training to effectively serve these groups. The proposed guidelines aim to transform CBT practice, increase confidence of racialized individuals in mental health care, and ultimately decolonize CBT interventions.
Racism-related experiences are a ubiquitous reality for youth of color, with research indicating that some youth may encounter as many as five incidents of racial discrimination daily.1 These experiences reinforce profound ethnoracial health disparities across the lifespan and have been linked to psychological symptoms including suicidal thoughts, depression, and anxiety.2 Further, racism exposure can trigger biological and psychological stress responses such as avoidance and hypervigilance, otherwise referred to as symptoms of racism-based traumatic stress (RBTS).3,4 Despite concerns regarding the impact of RBTS on development, RBTS has received limited recognition in clinical practice. We provide concrete recommendations for formally acknowledging the impact of RBTS on these populations, as failing to identify and address RBTS symptoms may compromise the quality of mental health services received by youth of color.
In the United Kingdom (UK), racially-minoritised (non-White) people are more likely to have poorer health outcomes and greater difficulties with accessing healthcare (Dyer, 2019). People face individual and societal adversity that can affect their physical and mental wellbeing (Gibbons et al ., 2012). There are clear mental health needs for racially-minoritised people, and we must go further in understanding the barriers to help to adequately meet the needs of diverse communities. The aim of this systematic review was to understand the barriers to accessing formal mental health support for racially-minoritised people within the UK. Qualitative empirical studies published between January 1970 to December 2020 were searched for using two databases: PsycINFO and Web of Science. Studies were searched for written in English, using a clinical or non-clinical population of adults with qualitative data collection and analysis methods. Database searches and reference mining gave a total of 283 studies, with 31 duplicates removed. Considering inclusion and exclusion criteria there were 15 final studies. A second researcher (S.O’H.) was used throughout, when selecting papers, quality assessment using the Critical Appraisal Skills Programme (CASP) checklist, coding and developing themes using thematic synthesis. The final four themes are ‘internal and external stigma’, ‘understanding of distress and coping’, ‘competence of professionals and services’ and ‘perception and accessibility’. There are various barriers making it harder for racially-minoritised people to access mental health support. Further research is needed with individual communities and action must be taken by commissioners, services, CBT practitioners, and others to eliminate barriers and improve mental health care.
Key learning aims
(1) To better understand the barriers to accessing mental health services, including Talking Therapies, for racially-minoritised communities.
(2) Low and high intensity CBT practitioners to better understand the factors that impact the wellbeing of racially-minoritised communities and how to better support different communities.
(3) Consider how to address these barriers to accessing support such as Talking Therapies services, with implications for practice and policy development.
Anti-racism approaches require an honest examination of cause, impact, and committed action to change, despite discomfort and without experiential avoidance. While contextual behavioral science (CBS) and third wave cognitive-behavioral modalities demonstrate efficacy among samples composed of primarily White individuals, data regarding their efficacy with people of color, and Black Americans in particular, is lacking. It is important to consider the possible effects of racial stress and trauma on Black clients, and to tailor approaches and techniques grounded in CBS accordingly. We describe how CBS has not done enough to address the needs of Black American communities, using Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) as examples. We also provide examples at the level of research representation, organizational practices, and personal experiences to illuminate covert racist policy tools that maintain inequities. Towards eradicating existing racism in the field, we conclude with suggestions for researchers and leadership in professional psychological organizations.
Young adults from minoritized racial and ethnic groups have lower rates of engagement in treatment for serious mental illnesses (SMI). Previous research suggests a relationship between ethnic identity development and engagement in mental health services, but it remains unclear how a sense of belonging and attachment to one’s racial and ethnic group influences participation in treatment among young adults with SMI.
Bivariate analyses and structural equation modeling (SEM) were used to examine whether ethnic identity was associated with treatment engagement (attendance and investment in treatment) and how ethnic identity might influence engagement through theoretical proximal mediators. Eighty-three young adults with SMI (95% from minoritized racial and ethnic groups) were recruited from four outpatient psychiatric rehabilitation programs and assessed at least 3 months after initiating services.
Stronger ethnic identity was associated with greater investment in treatment but not with treatment attendance. The SEM analysis indicated that stronger ethnic identity may improve investment in treatment by enhancing hope (0.53, p < .05) and beliefs that mental health providers are credible (0.32, p < .05), and by increasing self-efficacy (−0.09, p < .05). Proximal mediators of engagement were associated with investment in treatment (hope and credibility, p < .05, and self-efficacy p = 0.055).
Findings provide preliminary evidence of an empirical and theoretical relationship between ethnic identity development and engagement in treatment among young adults with SMI. Assessment and strengthening of a young person’s ethnic identity may be a promising approach for improving their engagement in services and reducing inequities in their care.
Background
Systemic racism and health inequality for Children and Adolescents of Color (CAoC) and their families need to be acknowledged and addressed in the provision of mental health treatment by child and adolescent psychiatrists. The lack of parity for behavioral health drives the lack of integration of “mental” health with overall health and the lack of funding, policy, planning, and practices to support the social and emotional health of children and their families. Additionally, the unequal treatment faced by Black, Indigenous, and People of Color (BIPOC) children and their families further impacts their overall health and mental health outcomes. Implicit biases, conscious and unconscious, influence clinical judgments, lead to errors in diagnostic and treatment decisions and impair child and adolescent psychiatrists’ ability to fully partner with families to treat, advocate for, and improve the clinical and life trajectories of this diverse group of young people and families that child and adolescent psychiatrists are called to serve.
Methods
Using a case vignette, this paper discusses historical examples showing how child and adolescent psychiatrists’ implicit bias may manifest when working with CAoC. Medical training and clinical practice have paid scant attention to the broader impacts of systemic racism and inequities in healthcare until recent years.
Discussion
This article provides clinical recommendations for clinicians to navigate these factors through trauma-centered and patient-centered care. Viewing through the lens of intergenerational racial trauma and acknowledging one’s own bias, clinicians can better help and support CAoC as they strive toward a brighter future.
To serve our diverse communities, clinicians must understand how racism shapes the lives of racialized people, affecting physical and mental health. Legha’s (2023) antiracist approach is an accessible guide that clinical supervisors and trainees can implement to reduce racism in mental healthcare. Supervisors and trainees learn to work toward identifying racism, understanding how Whiteness has shaped clinical care and supervision, and dismantling oppressive practices within (and outside of) clinical settings. This commentary builds on Legha’s approach by offering additional perspectives and directions, such as addressing cultural competence at a deeper level, increasing awareness of inequities, and treating racial trauma.
The Qur’an prohibits the use of intoxicants such as alcohol. However, the use of psychedelics falls somewhere in between social acceptance and outright prohibition among Muslim communities. Due to the cultural and religious stigma associated with the use of psychedelics among Muslims, it is difficult to encourage Muslim participation in psychedelic research and therapy, despite the increasing need to include diverse ethnic and religious groups in such endeavours. To pave the way in this regard, the present study explores the historical as well as the current perspective on the use of plant medicine in Muslim communities and cultures, specifically focusing on Sufism, a mystical branch of Islam, to shed light on the cultural considerations involved in employing psychedelic-assisted therapy with this population. Included are some history of plant medicine in Sufi rituals and cultural perceptions of the psychedelic plant Peganum harmala. Finally, the relevance of psychedelic-assisted therapy for Muslim women, in particular, to alleviate trauma resulting from a history of mistreatment, neglect, and discrimination in Western countries is discussed.
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.
The Centers for Disease Control and Prevention has identified racism as a serious threat to public health. Structural racism is a fundamental cause of inequity within interconnected institutions and the social environments in which we live and develop. This review illustrates how these ethnoracial inequities impact risk for the extended psychosis phenotype. Black and Latinx populations are more likely than White populations to report psychotic experiences in the United States due to social determining factors such as racial discrimination, food insecurity, and police violence. Unless we dismantle these discriminatory structures, the chronic stress and biological consequences of this race-based stress and trauma will impact the next generation's risk for psychosis directly, and indirectly through Black and Latina pregnant mothers. Multidisciplinary early psychosis interventions show promise in improving prognosis, but coordinated care and other treatments still need to be more accessible and address the racism-specific adversities many Black and Latinx people face in their neighborhoods and social environments.
Expected final online publication date for the Annual Review of Clinical Psychology, Volume 19 is May 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
This article reviews the current research literature concerning Black people in Western societies to better understand how they regulate their emotions when coping with racism, which coping strategies they use, and which strategies are functional for well-being. A systematic review of the literature was conducted, and 26 studies were identified on the basis of a comprehensive search of multiple databases and reference sections of relevant articles. Studies were quantitative and qualitative, and all articles located were from the United States or Canada. Findings demonstrate that Black people tend to cope with racism through social support (friends, family, support groups), religion (prayer, church, spirituality), avoidance (attempting to avoid stressors), and problem-focused coping (confronting the situation directly). Findings suggest gender differences in coping strategies. We also explore the relationship between coping with physical versus emotional pain and contrast functional versus dysfunctional coping approaches, underscoring the importance of encouraging personal empowerment to promote psychological well-being. Findings may help inform mental-health interventions. Limitations include the high number of American-based samples and exclusion of other Black ethnic and national groups, which is an important area for further exploration.
Racism has been linked to the development or worsening of mental health disorders. When posttraumatic stress disorder symptoms occur due to experiences of racism, it may be referred to as race-based traumatic stress or racial trauma. More work is needed to quantify the distress experienced by those affected. The present study aimed to assess the validity of the Racial Trauma Scale (RTS), a new clinical tool for the measurement of trauma-related symptoms arising from race-based maltreatment of people of color (POC). Using CloudResearch (formerly Amazon Mechanical TurkPrime), 941 diverse participants across the United States were included in the study—POC (n = 665) and non-Hispanic White participants (n = 276). The results validated a three-factor structure, with 10 items on each component, for a total of 30 items. The three components can be described as Lack of Safety, Negative Cognitions, and Difficulty Coping. Reliability of the RTS and the three subscales were excellent, and the RTS scale was positively correlated with other measures of mental health and trauma. Furthermore, there was a significant difference in RTS scores between POC and non-Hispanic White participants. Based on these findings, the RTS appears to be a valid means of quantifying racial trauma symptoms in POC. The ultimate goal of the RTS is to identify racial trauma to improve the mental health of marginalized racial/ethnic groups. The RTS can be used in clinical or research settings to ascertain racial trauma in clients and inform treatment.
In this article, we discuss the developmental aspects of students’ experiencing and making meaning of racism and propose that such processes parallel how trauma has been shown to impact development. More specifically, we name racism as a form of trauma with developmental consequences.
In racialized societies, race divides people, prioritizes some groups over others, and directly impacts opportunities and outcomes in life. These missed opportunities and altered outcomes can be rectified only through the deliberate dismantling of explicit, implicit, and systemic patterns of injustice. Racial problems cannot be corrected merely by the good wishes of individuals—purposeful actions and interventions are required. To create equitable systems, civil courage is vital. Civil courage differs from other forms of courage, as it is directed at social change. People who demonstrate civil courage are aware of the negative consequences and social costs but choose to persist based on a moral imperative. After defining allyship and providing contemporary and historical examples of civil courage, this paper explains the difficulties and impediments inherent in implementing racial justice. To enable growth and change, we introduce ten practical exercises based on cognitive-behavioral approaches to help individuals increase their awareness and ability to demonstrate racial justice allyship in alignment with valued behaviors. We explain how these exercises can be utilized to change thinking patterns, why the exercises can be difficult, and how psychologists and others might make use of them to expand the capacity for civil courage in the service of racial justice.
Objectives: Racism is a key determinant of mental health for African Americans. Although research has started to uncover moderators and mediators of the racism-health link, additional research in this area is warranted. Constructs that have yet to be examined in this link are self-compassion and self-coldness—two distinct ways of relating to oneself during adversity. Method: Data from 133 African American college students were used to assess parallel mediation models in which the frequency and stress appraisal of racism were the predictor variables, psychological distress was the outcome variable, and dimensions of self-compassion and self-coldness were treated as mediators. Results: Neither frequency nor appraisal of racism were related to the three types of self-compassion (i.e., self-kindness, common humanity, and mindfulness); yet, both racism frequency and appraisal were related to the three types of self-coldness (i.e., self-judgment, isolation, and over-identification). However, only self-judgment emerged as a significant mediator in the links between both frequency and appraisal of racism and distress, respectively. Conclusions: Reducing self-coldness in the face of racism can be a promising, individual-level wellness strategy for African Americans.
Harmful and inequitable curricular and pedagogical practices in US schools are detrimental to Black students. School discipline disproportionality, low expectations, and deficit perspectives of Black students and their achievement often lead to school-based trauma and psychological distress. Subsequently, discussions regarding school-related mental health issues in the Black community have increased. There has also been a growing body of research on the socioemotional well-being of Black students in regard to racial trauma and other adverse experiences related to school and home life. In light of these developments, this article applies the theoretical framework of critical race structuralism (CRS) as it investigates schooling experiences and overall health and wellness among African Americans.
Objective:
Empirically supported treatments (ESTs) have been criticized for lack of ethnoracial representation, which may limit the generalizability of findings for non-White patients. This study assessed ethnoracial representation in United States-based randomized controlled trials (RCTs) for three evidence-based treatments for posttraumatic stress disorder (PTSD)-Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye-Movement Desensitization and Reprocessing (EMDR).
Method:
Representation was measured by explicit inclusion of people of color in published PTSD RCTs. Follow-up emails were sent to corresponding authors if full demographic information was not included in the reviewed manuscripts. Information concerning participant remuneration was collected for descriptive purposes.
Results:
All three treatment modalities reported White participants as the majority in their sample. PE and CPT trials reported similar levels of ethnoracial diversity, while EMDR efficacy studies reported the least ethnoracial diversity. Across the reviewed studies, with few exceptions, we found low numbers of non-White participants in the majority of reviewed studies, which was compounded by poor or unclear methods of reporting ethnoracial information.
Conclusions:
This study demonstrates that the ESTs for PTSD are not adequately representative of the majority of non-White participants. Future RCTs should place a stronger emphasis on broad ethnoracial diversity in study participants to improve generalizability of findings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Secondary microaggressions refer to the ways in which people of historically dominant groups negate the realities of people of marginalized groups. Gaslighting describes the act of manipulating others to doubt themselves or question their own sanity; people confronted for committing microaggressions deny the existence of their biases, often convincing the targets of microaggressions to question their own perceptions. ‘Splaining (derived from mansplaining/Whitesplaining) is an act in which a person of a dominant group speaks for or provides rationale to people of marginalized groups about topics related to oppression or inequity. Victim blaming refers to assigning fault to people who experience violence or wrongdoing and is used as a tool to discredit people of marginalized groups who speak out against microaggressions or any injustices. Finally, abandonment and neglect refer to a bystander’s failure to address or acknowledge microaggressions. Although these terms are commonly known among marginalized communities (and frequently used in popular media), there is a dearth in academic literature that substantiates these phenomena and relates them to microaggressions. The purpose of this article is to review these concepts in the psychological literature and to demonstrate the psychological harm caused by these behaviors on interpersonal and systemic levels.
Purpose of Review
Racial trauma is a severe psychological response to the cumulative traumatic effect of racism. This review synthesizes emerging theoretical and empirical evidence of racial trauma, outlines the mechanisms, and lists available assessment and treatment options for racial trauma.
Recent Findings
Emerging evidence illustrates that these cumulative experiences can result in the cognitive, behavioral, and affective presentations of PTSD in people of color. As a result, the evidence to inform the assessment, treatment, and implications of racial trauma has grown exponentially. There are several validated interview and self-report instruments for clinicians to better understand client’s experiences of racism, discrimination, and traumatic stress. There are several emerging treatment options for people of color experiencing racial trauma. However, given the scarcity of literature, we need more studies to establish the validity and efficacy of available assessment and treatment options.
Summary
Emerging and promising advancements can extend our knowledge on racial trauma, including incorporating the cumulative and lasting negative impacts of racism on people of color in how we define PTSD. Additionally, strengthening clinical training and continued education programs for professionals to hone their capacity to discuss the impact of racism effectively administer appropriate assessment tools and implement interventions specific to racial trauma.
Due to severe traumatization, the narrative meaning-making processes of asylum seekers are often disrupted. However, the ability of asylum seekers to integrate trauma into their personal narratives has strong implications on their mental health as well as on their asylum claim.
Objective:
Starting with the presentation of a new method, the Asylum Seekers Photographic Interview (ASPI), developed through participatory processes and aimed to increase meaning-making processes, the article evaluates the effects of the ASPI on asylum seekers' narrative organization.
Method:
A quasi-experimental research design was carried out. The posttraumatic symptomatology of 36 Nigerian asylum seekers hosted in Italy was assessed. Participants were then randomly divided into two groups: an intervention group assessed by the ASPI and a control group assessed by a non-image-mediated narrative interview. Quantitative data were analyzed through a descriptive analysis, and the interviews were analyzed according to various dimensions of narrative meaning-making processes. A multivariate analysis of variance (MANOVA) was then carried out to evaluate the significance of eventual differences of narrative indexes between the groups.
Results:
The MANOVA showed statistically significant differences of narrative indexes in the intervention group in the Word Count, Internal States, and Coherence categories, caused by the only effect of "intervention vs. control group," F(8, 25) = 5.902, p = .000, η² partial = .65).
Conclusion:
The results showed the effectiveness of the new methodology in increasing the narrative organization of experiences, contributing to the research on trauma and narratives in the context of forced migration. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Importance
Adolescents frequently encounter racism vicariously through online news and social media and may experience negative emotional responses due to these exposures. To mitigate potential adverse health impacts, including negative emotional health, it is important to understand how adolescents cope with these exposures.
Objectives
To examine adolescents’ responses to online and media-based vicarious racism exposure and to explore coping strategies, particularly positive coping strategies, that may be used to combat negative emotions.
Design, Setting, and Participants
This qualitative study rooted in phenomenological research methods conducted 4 semistructured focus groups, with 3 to 6 English-speaking adolescents (aged 13-19 years) in each group, between November 2018 and April 2019. Focus groups were facilitated by 2 research team members. The study was conducted at community sites and youth organizations in the greater Chicago, Illinois, area. Interview transcripts were analyzed thematically.
Exposures
Lived experiences of media-based vicarious racism.
Main Outcomes and Measures
Focus group participants shared their experiences with media-based vicarious racism online, including their responses to exposure and the coping strategies used.
Results
Four focus group sessions were conducted with a total of 18 adolescents. Participants had a mean (SD) age of 16.4 (1.6) years. Overall, 7 participants (39%) self-identified as Black/African American, 8 (44%) as Hispanic/Latinx, and 3 (17%) as White individuals; 7 (39%) were in grades 7 to 9, 8 (44%) in grades 10 to 12 grade, and 3 (17%) at the college or university level. Central themes emerged related to adolescents’ experiences, including their emotional and coping responses to media-based vicarious racism. Many participants reported helplessness as a major negative emotion associated with these exposures. Activism was endorsed as a key positive coping strategy that participants used, including online and in-person modalities.
Conclusions and Relevance
The findings from this qualitative study suggest adolescents may experience helplessness as a primary negative emotion after exposure to media-based vicarious racism and activism may serve as a coping mechanism. Activism may represent an important and constructive means by which adolescents cope with and combat structural racism, mitigate negative emotions, and potentially prevent adverse health effects.
Extant research has shown that racial discrimination and microaggressions can have negative effects on anxiety and depression among Asian Americans. However, not much has been published regarding how to process and integrate experiences of racism into culturally attuned behavior therapy specifically for Asian Americans. In this article, I describe the process of culturally attuned behavior therapy for two Asian American clients, with an emphasis on integrating racial microaggressions into exposures for social anxiety, and deconstructing the model minority stereotype through value-driven behavioral activation for depression. Cultural attunements common to both case examples are then summarized, alongside practical recommendations for clinicians. Limits to generalizability are also discussed. Finally, the article closes by addressing the importance of cultural humility in effective culturally attuned behavior therapy with Asian Americans.
Being a White ally goes beyond being merely “non-racist” and having good intentions. Meaningful allyship is behavioural and requires active participation in dismantling systems of oppression. The objective of this study was to ascertain the degree to which White individuals behave in an allied manner when provided the opportunity to do so by comparing observed racial justice allyship behaviour to self-reported allyship behaviours. Using a subsample (N=31) from a larger study, White participants took part in a laboratory behavioural task where they engaged in three 5-minute discussions with another White participant (a confederate) about racially-charged news stories in the United States while knowingly being watched by a Black RA via live recording. Stories represented different forms of racism towards Black people: the removal of a Confederate monument; the killing of an unarmed Black male college student by police after a car accident; and a fraternity party where members dressed up as Black stereotypes. Coders were asked to rate how they believed a Person of Colour would feel interacting with that participant using a 4-point Likert scale: 0 (absence of any supportive comments) to 3 (very explicit, unwavering support for non-racist and equity values and behaviour). Furthermore, a newly developed self-report questionnaire indicating interpersonal allyship (IRAS) was used to ascertain self-reported allyship. Results showed that when using a mean cut-off score of 2 as an indicator of allyship for each laboratory scenario (consistent support throughout the interaction), only 6.4% of participants met these criteria. Furthermore, only 3.2% of the participants were allies in all 3 scenarios, 9.7% were allies in 2 scenarios, and 16.1% were allies in 1 scenario. The results indicated that White people consistently showed a lack of allyship towards Black people. We discuss the challenges of allyship, and the difference between White allies and White saviors. Future research should expand on and explore the complexities and nuances of meaningful White allyship.
Butts (2002) was the first to draw attention to what we now call racial trauma, or race-based trauma, in the mental health literature. Racial trauma can be defined as the cumulative traumatizing impact of racism on a racialized individual, which can include individual acts of racial discrimination combined with systemic racism, and typically includes historical, cultual, and community trauma as well. Helms, Nicolas, and Green (2012) argue that acts of racial and ethnic hostility can trigger trauma reactions due a person’s own past experiences or historical events, even when there is no recent or direct evidence of threat to one’s life. Carter (2007) subsequently compiled a comprehensive overview of the psychological impact of racism and events that can result in race-based stress and trauma. Racial trauma appears to be relatively common among treatment-seeking people of color. Hemmings and Evans (2018) conducted a survey of counselors and found that the majority of professionals had encountered race-based trauma in their clinical work (71%), but few had received training in the assessment or treatment of those afflicted.
Background
Expressive writing about a traumatic event is promising in treating posttraumatic stress disorder (PTSD) symptoms in adult trauma survivors. To date, the comparative efficacy and acceptability of this approach is uncertain. Therefore, we aimed to examine the comparative efficacy and acceptability of expressive writing treatments.
Methods
We included 44 RCTs with 7724 participants contributing 54 direct comparisons between expressive writing (EW), enhanced writing (i.e. including additional therapist contact or individualized writing assignments; EW+), PTSD psychotherapies (PT), neutral writing (NW), and waiting-list control (WL).
Results
EW, EW+, PT, and NW were statistically significantly more efficacious than WL at the longest available follow-up, with SMDs (95% CI) of −0.78 (−1.10 to −0.46) for PT, −0.81 (−1.02 to −0.61) for EW+ , −0.43 (−0.65 to −0.21) for EW, and −0.37 (−0.61 to −0.14) for NW. We found small to moderate differences between the active treatments. At baseline mean PTSD severity was significantly lower in EW+ compared with WL. We found considerable heterogeneity and inconsistency and we found elevated risk of bias in at least one of the bias dimensions in all studies. When EW+-WL comparisons were excluded from the analyses EW+ was no longer superior compared with EW.
Conclusions
The summarized evidence confirms that writing treatments may contribute to improving PTSD symptoms in medium to long-term. Methodological issues in the available evidence hamper definite conclusions regarding the comparative efficacy and acceptability of writing treatments. Adequately sized comparative randomized controlled trials preferably including all four active treatment approaches, reporting long-term data, and including researchers with balanced preferences are needed.
Current research suggests that ketamine-assisted psychotherapy has benefit for the treatment of mental disorders. We report on the results of ketamine-assisted intensive outpatient psychotherapeutic treatment of a client with treatment-resistant, posttraumatic stress disorder (PTSD) as a result of experiences of racism and childhood sexual abuse. The client's presenting symptoms included hypervigilance, social avoidance, feelings of hopelessness, and intense recollections. These symptoms impacted all areas of daily functioning. Psychoeducation was provided on how untreated intergenerational trauma, compounded by additional traumatic experiences, potentiated the client's experience of PTSD and subsequent maladaptive coping mechanisms. Ketamine was administered four times over a 13-day span as an off-label, adjunct to psychotherapy. Therapeutic interventions and orientations utilized were mindfulness-based cognitive therapy (MBCT) and functional analytic psychotherapy (FAP). New skills were obtained in helping the client respond effectively to negative self-talk, catastrophic thinking, and feelings of helplessness. Treatment led to a significant reduction in symptoms after completion of the program, with gains maintained 4 months post-treatment. This case study demonstrates the effective use of ketamine as an adjunct to psychotherapy in treatment-resistant PTSD.
Mindfulness and Shinrin-yoku (SY) translated as forest bathing, is potentially effective to alleviate mental health issues related to the COVID-19 pandemic and beyond. The purpose of this article is to provide a translational and pragmatic approach to understanding mindfulness in the context of SY and psychological wellbeing through a rapid review of the literature. The background of mindfulness and SY practice are discussed and the emotional, neuroendocrine, and neurobiological responses are examined. Next, a rapid review of the literature examined six studies, published between 2010 and 2020 to determine what is known regarding the relationship between SY, mindfulness, and psychological wellbeing. The studies included 21–360 participants with a mean age of 20–55 years. The results demonstrated a significant positive correlation between nature, mindfulness, and measures of psychological wellbeing. During uncertain events, including COVID-19, weaving mindfulness with SY may be specifically important to at-risk groups, those experiencing depression, loneliness, and social isolation, and at-risk populations such as college students, veterans, and professionals with high levels of stress. The goal of this review is to provide a thorough background and support of this cost-effective modality to promote overall psychological wellbeing as a preventative measure to those at risk or experiencing psychological illnesses.
Racial battle fatigue is the exhaustion that People of Color feel from repeated exposure to racism, as well as its negative impact on their emotional, physiological, and psychological health and wellbeing. Although People of Color have engaged in resistance and resilience in the midst of racism, it still takes a toll on their bodies. In this article, we focus specifically on Black student affairs educators, given the racial battle fatigue they navigate working in a helping profession where they are often expected to prioritize students’ needs above their own. Using a narrative methodological approach, we centered the stories of 35 Black student affairs educators across various institutions to identify the strategies they used to practice self-care in the midst of racial battle fatigue, including unplugging from the people and places that caused them harm, building community with other Black educators, caring for their bodies, finding safe spaces, and using counseling. We offer implications for practice for Black student affairs educators and those working to support them in navigating racial battle fatigue.
This article offers women of colour in social work a black feminist self-care practice based on three principles from Audre Lorde’s work. The colonial situation of social work inevitably marginalises black feminist thinking and methods. In the context of chronic racist denigration, generic social work models of recovery, reparation and resilience equate to complicity with intersectional racism. Social work values and ethics alone are not enough. A material shift in power relations is required. Black feminist self-care practice responds to the physical, material and emotional impacts of silence, exhaustion and vilification of feeling that women of colour encounter in their living. In a call for women of colour in social work to gather together for mutual sharing of experience, this article affirms the power of collective dialogues as the primary strategy of black feminist self-care practice.
This article is the first to provide empirical support for the concept of microaffirmation in psychology and education. The theory of microaffirmation stems from the idea that it is important and useful to focus on positive experiences in the hopes that they might be promoted or replicated. Using Consensual Qualitative Research methodology, we examined the microaffirmation experiences of graduate students who were culturally diverse in terms of race/ethnicity, sexual orientation, socioeconomic status, international status, and other identities. We identified four domains related to microaffirmation: the construct of microaffirmation itself, the experience of the recipient of microaffirmation, the qualities of people who microaffirm, and outcomes of microaffirmative behavior. We discuss ways in which psychologists, educators, and advocates can work effectively with culturally diverse students in higher education settings to support their academic adjustment. We provide suggestions for future research and implications for theory and practice.
This article presents a CBT approach to internalized racial oppression among African American clients. Cognitive conceptualization and treatment planning using CBT are illustrated through a case study, followed by a discussion on the generalizability of a proposed cognitive model of internalized racism to other marginalized populations. The article concludes with a discussion of further implications for practice, including those for social justice advocacy.
African American youth are more likely than their peers from other racial and ethnic groups to experience interpersonal traumas and traumatic racist and discriminatory encounters. Unfortunately, evidence-based trauma treatments have been less effective among these youth likely due to these treatments not being culturally tailored to address both interpersonal and racial trauma. In this article, we utilize the racial encounter coping appraisal and socialization theory to propose suggestions for adapting trauma-focused cognitive behavioral therapy—an evidence-based trauma treatment for children and adolescents—to include racial socialization or the process of transmitting culture, attitudes, and values to help youth overcome stressors associated with ethnic minority status. We conclude by discussing implications for the research and clinical community to best promote healing from both interpersonal and racial trauma for African American youth.
Following the outbreak of COVID-19, reports of discrimination and violence against Asians and Asian Americans and Pacific Islanders (AAPIs) have increased substantially. The present article offers a timely conceptualization of how public and societal fears related to COVID-19 may contribute to unique mental health disparities and the presence of race-based trauma among AAPIs residing in the United States. The relationships between media, increasing rates of xenophobia and sinophobia, and racial discrimination are provided. Next, the deleterious effects of race-based discrimination on the emotional and physical well-being of people of color and Indigenous groups (POCI) and AAPIs are described. Finally, the article identifies the clinical implications of counseling AAPI clients, encourages a decolonization of current trauma-focused interventions, and presents specific strategies to heal race-based trauma in AAPI client populations.
Research has demonstrated a connection between microaggressions and decreased mental health across racial and ethnic groups. Microaggressions on college campuses can have a negative impact on students of color, which has led to a push for more microaggression-focused diversity trainings on college campuses. However, no training thus far has demonstrated efficacy in reducing participants’ propensity to commit microaggressions. We reported an intervention, the Racial Harmony Workshop (RHW), to reduce racial biases and microaggressions and promote interracial connection among college students. The RHW was designed to increase connectedness across racial groups, using principles and techniques from Functional Analytic Psychotherapy (FAP) and Acceptance and Commitment Therapy (ACT). The study was conducted with Black and White undergraduate students (N = 44) randomly assigned to an active control group or the RHW. Participants were given pre-test, post-test, and follow-up batteries to assess inter-group feelings and racial attitudes. Results indicated positive benefits for both Black and White participants, including increased mood and positive feelings towards Black people for the White students, as well as increased ethnic identity for the Black students. White students in both conditions showed a decreased likelihood of committing microaggressions, and those in the RHW condition also showed a decreased likelihood of having microaggressive thoughts and increased gains over time. Overall, the results suggest there are several benefits to the RHW, and further research is warranted to build upon these findings.
The negative impacts of racism, including experiences of racial trauma, are well documented (e.g., Bryant-Davis & Ocampo, 2006; Carter, 2007). Because of the deleterious effects of racial trauma on Black people, interventions that facilitate the resistance and prevention of anti-Black racism are needed. Critical consciousness is one such intervention, as it is often seen as a prerequisite of resistance and liberation (Prilleltensky, 2003, 2008). To understand how individuals advance from being aware of anti-Black racism to engaging in actions to prevent and resist racial trauma, nonconfidential interviews with 12 Black Lives Matter activists were conducted. Using constructivist grounded theory (Charmaz, 2014) under critical-ideological and Black feminist-womanist lenses, a model of Critical Consciousness of Anti-Black Racism (CCABR) was co-constructed. The 3 processes involved in developing CCABR include: witnessing anti-Black racism, processing anti-Black racism, and acting critically against anti-Black racism. This model, including each of the categories and subcategories, are detailed herein and supported with quotations. The findings and discussion provide context-rich and practical approaches to help Black people, and counseling psychologists who serve them, prevent and resist racial trauma.
Objective
This study aimed to examine the personal (i.e., self-compassion) and social (i.e., social connectedness) resources that can buffer individuals’ psychological distress in the face of difficulty based on previous literature on self-compassion and social connectedness.
Method
We used a cross-sectional online survey to examine whether there was a three-way interaction of racial discrimination, three self-compassion components (i.e., self-kindness, mindfulness, and common humanity), and social connectedness on depression among Asian American college students. Participants were 205 Asian Americans from a West Coast public university.
Results
Results supported the moderation hypothesis with social connectedness and self-kindness as moderators. Specifically, at higher social connectedness and higher self-kindness, the association between racial discrimination and depression was not significant. Conversely, at higher social connectedness and lower self-kindness, the association between racial discrimination and depression was significantly positive. Furthermore, at lower social connectedness and higher self-kindness, the association between racial discrimination and depression was significantly positive. However, at lower social connectedness and lower self-kindness, the association between racial discrimination and depression was not significant. The same results applied to the second (i.e., social connectedness and mindfulness as moderators), but not the third (i.e., social connectedness and common humanity as moderators) moderation hypothesis.
Conclusion
Both personal (i.e., self-compassion) and social (i.e., social connectedness) factors work together to buffer the impact of racial discrimination on depression among Asian American college students.
Erroneous beliefs are difficult to correct. Worse, popular correction strategies, such as the myth-versus-fact article format, may backfire because they subtly reinforce the myths through repetition and further increase the spread and acceptance of misinformation. Here we identify five key criteria people employ as they evaluate the truth of a statement: They assess general acceptance by others, gauge the amount of supporting evidence, determine its compatibility with their beliefs, assess the general coherence of the statement, and judge the credibility of the source of the information. In assessing these five criteria, people can actively seek additional information (an effortful analytic strategy) or attend to the subjective experience of easy mental processing—what psychologists call fluent processing—and simply draw conclusions on the basis of what feels right (a less effortful intuitive strategy). Throughout this truth-evaluation effort, fluent processing can facilitate acceptance of the statement: When thoughts flow smoothly, people nod along. Unfortunately, many correction strategies inadvertently make the false information more easily acceptable by, for example, repeating it or illustrating it with anecdotes and pictures. This, ironically, increases the likelihood that the false information the communicator wanted to debunk will be believed later. A more promising correction strategy is to focus on making the true information as easy to process as possible. We review recent research and offer recommendations for more effective presentation and correction strategies.
Twenty-six Black collegians were exposed to a vicarious racial harassment stimulus (VRHS) then randomized into a Black Lives Matter Meditation for Healing Racial Trauma condition or a silence control condition. Heart rate (HR) was recorded throughout the experiment. Semi-structured interviews were then conducted to elicit participants’ appraisal of the VRHS and meditation. Using a Qual:Quan mixed methods experimental design, this pilot study qualitatively categorized how participants (1) described their reactions to the VRHS and (2) appraised the meditation. Participants described three types of race-based stress reactions and reported mostly positive appraisal of the meditation, although some indicated that it would not be a preferred coping strategy. To triangulate the quantitative findings, we found a significant increase in HR during VRHS. The meditation group displayed statistically significant reductions in HR from stimulus to the end of meditation; however, there were no statistically significant differences between the control and meditation groups. Results have implications for understanding and facilitating race-based stress recovery.
With the increased desire to engage in antiracist clinical research, there is a need for shared nomenclature on racism and related constructs to help move the science forward. This article breaks down the factors that contributed to the development and maintenance of racism (including racial microaggressions), provides examples of the many forms of racism, and describes the impact of racism for all. Specifically, in the United States, racism is based on race, a social construct that has been used to categorize people on the basis of shared physical and social features with the assumption of a racial hierarchy presumed to delineate inherent differences between groups. Racism is a system of beliefs, practices, and policies that operate to advantage those at the top of the racial hierarchy. Individual factors that contribute to racism include racial prejudices and racial discrimination. Racism can be manifested in multiple forms (e.g., cultural, scientific, social) and is both explicit and implicit. Because of the negative impact of racism on health, understanding racism informs effective approaches for eliminating racial health disparities, including a focus on the social determinants of health. Providing shared nomenclature on racism and related terminology will strengthen clinical research and practice and contribute to building a cumulative science.
Recent police brutality has reminded people in the United States of America that racism and discrimination toward Black Americans is still prevalent. Evidence supports the claim that many Black Americans experience racial trauma due to the relatively common occurrence of discriminatory racial encounters in their life. Racial traumas are events of danger related to real or secondary experiences of racial discrimination that may cause psychological, emotional, or physical injury. The goal of this article is to identify the ethical complexities for psychologists in addressing racial trauma among Black Americans. First, the article describes examples of racial traumas for Black Americans and their impact on overall mental health. Second, there is an in-depth analysis of ethical issues for psychologists relevant to racial trauma in areas such as competency, discrimination and harassment, bias, assessment, training programs, and harm. Finally, recommendations for psychologists are provided to address racial trauma among Black American clients, students, supervisees, and colleagues.
Black communities face multiple stressors including racism, discrimination, and navigating systems of oppression, all of which affect their mental health and wellbeing. In recent years, the practice of self-care has gained popularity as a strategy to cope with stress and to improve overall health. However, the current discourse often focuses on individual self-care behaviors and excludes systemic and community level factors that encourage, sustain, or inhibit self-care practices. This paper contextualizes a conceptual model of self-care with intersectionality theory and the psychology of liberation framework, in relation to the lived experiences of Black communities. The paper aims to underscore the necessity of self and community care as a tool for social justice, preservation, and resistance against oppressive systems that threaten the mental health and wellness of this community.
Glomerular filtration rate (GFR) is a key index of renal function. The classic method for assessing GFR is the clearance of inulin. Several current methods using isotopic (125I-iothalamate, 51Cr-EDTA, or 99Tc-DTPA) or nonisotopic (iohexol or iothalamate) markers are available. Clinically, GFR is estimated (eGFR) from serum creatinine or cystatin C levels. Estimated GFR based on creatinine and/or cystatin are less accurate than measured GFR. The creatinine-based equations calculate higher eGFR values (suggesting better kidney function) for black individuals. This upward adjustment for all black individuals is embedded in eGFR calculations on the belief of higher serum creatinine concentrations among black individuals than among white individuals. Thus "race-corrected" eGFR has become a widely accepted and scientifically valid procedure. However, race is not a genetic or biological category. Rather, race is a social construction defined by region-specific cultural and historical ideas. Furthermore, there is no accepted scientific method for classifying people as black or white individuals. Studies typically rely on self-identification of race. However, any person in the United States with any known black ancestry is considered to be a black individual. This is known as the "one-drop rule," meaning that a single drop of "black blood" makes anyone a black individual. It does not matter if an individual has 50%, 25%, 5%, or 0.5% African ancestry. The limited accuracy and reliability of this approach would not be allowed for any other scientific variable. Admixture and migration have produced such broad variations that race categories should not be used as experimental variables.
Introduction
Biological race, the fallacy that racial health disparities reflect differences in human biology, exerts undue influence on medicine. Interventions that teach against this myth are largely absent from required medical curricula. Here, we describe and present student and facilitator evaluations of an educational intervention, organised around Dorothy Roberts' book Fatal Invention: How Science, Politics, and Big Business Re-Create Race in the Twenty-First Century that included a discussion of preselected chapters from Fatal Invention, case studies illustrating strategies to prevent the misuse of race in medicine and a question-and-answer session with Dorothy Roberts.
Methods
Online feedback surveys were distributed to students and facilitators to capture their general perceptions of the session, how well it satisfied its objectives and the pre-session training materials provided to facilitators. Quantitative measures were analysed using descriptive statistics, and qualitative responses were evaluated using thematic analysis.
Results
Student and facilitator surveys garnered response rates of 59.8% (61/102) and 75% (30/40), respectively, and most expressed satisfaction with the session. Students felt more prepared to address the misuse of race in clinical contexts than in pre-clinical contexts (90.16% vs. 77.05%) and among peers than among superiors (95.08% vs. 72.13%) (p < 0.05). Some students (31.15%) felt that their small group facilitators were unprepared to address microaggressions.
Discussion
Our survey responses suggest that this intervention was effective in teaching against biological racism and equipped students with tools to address the misuse of race, particularly in clinical contexts. Future iterations should highlight strategies to confront biological racism in pre-clinical contexts and among superiors.
The use of multicultural principles to enhance cognitive behavioral therapy (CBT) for individuals of marginalized backgrounds has received increased attention in light of the heightened national awareness of systemic oppression and racialized violence directed towards Black, Indigenous, and People of Color. However, there has been less of a focus on applying such principles to consultation for skill development. If ethical guidelines are expected to influence the behavior of clinicians in session, guidance is needed to indicate how and where and when clinicians should receive training in implementing culturally responsive CBT. Individual reading and reflection are necessary but are not sufficient in acquiring new clinical skills. Consultation is recommended and strongly suggested when clinicians are working with new populations or delivering a new treatment, or even using a new modality. Consultation can also be useful when adopting a new approach or stance to therapy. For practicing clinicians who have not developed these skills, additional consultation can and should be used to address this gap. Moving forward, integration of cultural responsiveness into standard consultation will ensure that these skills are seen as a core competency, rather than an optional additional skill that may be (or not be) elected. This paper presents core experiences that may be integral to a CBT consultation model that aims to enhance providers’ ability to provide CBT in a way that is culturally responsive to their clients. These recommendations attend to both content and process within CBT consultation and reflect guiding assumptions for helping clinicians to develop the ability to practice CBT in a culturally responsive manner, including (a) normalizing discussions of cultural identity and oppression, (b) an emphasis on cultural self-awareness, (c) emphasizing culturally informed CBT case conceptualization, and (d) skill development in applying cultural elements to CBT interventions.
This chapter describes empirically informed best practices for the assessment and diagnostic process with clients of color, including the intake process and culturally informed diagnostic considerations. The multicultural counseling competencies comprise a widely used model for training that consists of three developmental areas: attitudes and beliefs (awareness of one's assumptions, values, and biases); knowledge (understanding the world views and values of diverse clients); and skills (developing relevant and appropriate assessment, diagnostic, prevention, and intervention strategies and techniques). The chapter focuses on these skills as they relate to assessment and diagnosis and how this can contribute to the development of effective therapeutic relationships and mental health treatment retention. Clinicians should introduce issues of marginalization early in the assessment process, and they should assess for the experience, frequency, and perceived impact of experiences of race-based discrimination and marginalization based on the clients' intersecting identities. Clinicians must also be aware of the role of stereotype threat in maintaining disparities in seeking and engaging in mental health treatment. Clinicians should determine the impact of mental health stigma for clients of color to aid in case conceptualization. Sources of this stigma are widespread, including media and societal messages as well as cultural and familial influence.
Mindfulness-based interventions (MBIs; e.g., MBSR, MBCT, ACT) have been widely used and disseminated for treatment of myriad physical and psychological problems. However, most MBIs have primarily been used with middle-or upper-class White populations, with some instances where they have been adapted for use with diverse populations (e.g., Burnett-Ziegler et al., 2016; Roth & Robbins, 2004). However, even when adapted, most MBIs have not explicitly addressed unique factors faced by the target population, such as racial discrimination, unemployment, lack of financial means, and other stressors. We developed and used an iterative approach to refine a MBI group based on MBSR and MBCT, for a racially and ethnically diverse population in the Bronx, considered by the U.S. census to be the most diverse in the country. Based on a trauma-informed care and centering people of color approach, we developed a longer than usual (16 weeks) mindfulness-based group, where core skills were broken down into smaller chunks to facilitate easier incorporation into daily life. We also used a longer duration and 1-hour weekly meeting time keeping in mind needs of the individuals, who often had limited time to participate due to work limitations and other comorbid physical conditions. While acknowledging that the individuals this group was catering to had experienced multiple traumatic events, we sought to also highlight and further develop the resilience and courage people in the Bronx community bring to the table. We review two clinically rich case vignettes, and also discuss recommendations for working with racially and economically marginalized people, and include a call to action for health care providers and organizations to engage in activism.
Objective
Despite evidence that chronic stress, racism, and discrimination impact the well-being and the risk for cardiovascular disease (CVD) in Black women, there are few evidence-based interventions that improve well-being and reduce the risk for CVD in women of minority groups. The purpose of this pilot study was to evaluate the psychobehavioral and anti-inflammatory benefit of a race-based stress reduction program “Resilience, Stress, and Ethnicity (RiSE) for Black women at risk for CVD. Methods: Black women were recruited from the Chicagoland community and randomized to either the 8-week RiSE intervention (n = 40) or control group (n = 34). Participants were assessed for coping strategies, psychological distress, and blood levels of TNF-alpha and high sensitivity C-reactive protein (hsCRP) at baseline and at 4 and 8 weeks after baseline. Results: Participation in RiSE was associated with a more rapid decline in the use of avoidance coping (b = -0.3585, SE = 0.1705, p < .01). Reductions over time in TNF-alpha (b = -0.0163, SE = .0087, p = .08) and hsCRP (b= -0.4064, SE = 0.2270, p = .08) approached statistical significance. Conclusions: Findings provide preliminary evidence in Black women at risk for CVD that RiSE contributes to decreases in avoidance coping. Although preliminary, these results suggest RiSE to be an effective intervention to promote improved coping associated with racism and discrimination in minorities.
There is a dearth of psychological intervention research to guide clinicians in supporting individuals who are impacted by systemic racism. Internalized racial oppression, adopting the negative beliefs about one’s group, is one pathway through which racism affects mental health. Techniques from Acceptance Commitment Therapy have been found to decrease internalized self-stigma and to mitigate negative mental health symptoms. The current pilot study examined the feasibility of a group-based intervention for Black women targeting internalized racial oppression. We found pre-post decreases in internalized racial oppression and shame, and psychological distress.
Exploring radical self-care practices as liberatory political resistance exposes the paradox that freedom from suffering is not free or an entitlement, instead it is a daily practice. This is a particularly important political claim for the three radical self-care practices surveyed in this article: Queen Mother Maasht Amm Amen’s The Divine Power of Joy events live-streamed and held in-person in the United States; Nalokai, Omisade, and Julia’s The Lemonade Series: Self-Care and Renewal Retreat in Treasure Beach, Jamaica; and Oyabunmi’s The Self Love Holiday Retreat in Dominicale, Costa Rica. Each practice was envisioned, organized, and led by Black women linked to African or Pan-African spiritual traditions between 2018 and 2020. Drawing on participant observation, interviews, and digital print media, what emerged from these events are theories and practices influenced by a worldview reflective of a collective spiritual and political response to the afterlives of punitive public policies including Johnson’s “War on Poverty’’ and Nixon’s “War on Drugs’’ which have contributed to the othering and subjugation of Black bodies, Black experiences, and Black politics enforced through violent punishment. The execution of these punitive public policies consequently provides an enduring context for alternative forms of radical and liberatory political resistance. Intersectionality, as a liberatory practice for Black women, proved to be a useful methodology for analyzing and making sense of how the COVID-19 crisis exposed racial, health, and economic disparities, the global mass resistance to anti-Black racism, criminalization resulting in police murders of unarmed Black and Brown people, and the rise of radical self-care events. The three radical self-care practices created by Black women are examples of new legacies being forged through ongoing and evolving strategic activities and techniques that produce what I call transformative radical self-determination.
From Safe to Brave is a performance piece developed from the stories of fifty-seven voices from the Temple University community, including students, faculty, administrators, and nearby residents. The project involved six Interactive Community Conversations. The project drew on numerous arts-based methodologies, including poetic ethnography and body-map storytelling in order to interrogate the dynamics of power, privilege, racism, prejudice, institutional racism, violence, and activism as portrayed in a representation of people's lived experience.
This chapter addresses white readers in particular and acknowledges the guilt and shame that they may experience when engaging in difficult dialogues about race and racism. It analyses the concept of white allyship and, in particular, emphasises the need to understand white allyship as an ongoing process of redoing whiteness rather than a fixed identification. The chapter also delineates the concept of abolishing whiteness and applies it to leadership and organisations as a strategy to dismantle white supremacy. It explores how becoming a ‘race traitor’ comes with considerable risks, where white allies are often met with hostility from their white peers, and how they may overcome these challenges.
This article proposes photovoice as an innovative approach to group work with Black (K-12) youth in school settings. More specifically, this article focuses on how school counselors can use photovoice as a tool to address the race-related struggles (e.g., racial prejudice and discrimination) that Black students experience both inside and outside of school. Photovoice empowers students to take photos capturing issues of shared concern in and around their school and use as the basis of critical dialogue and collective action plans. The key features and stages of this approach are outlined. Implication for practice and future research are discussed.
Racial trauma, an ongoing consequence of historical trauma, has deleterious effects on the well-being of Africana communities. The psychological literature primarily reflects individual processes in the relationship between racial trauma and healing. Going beyond individualistic approaches, we present a community healing framework informed by multidisciplinary scholarship: Community Healing and Resistance Through Storytelling ( C-HeARTS). Three major components of the framework are delineated: (a) justice as both a condition of and an outcome of community healing; (b) culturally syntonic processes (i.e., storytelling and resistance) that direct the renarrating of trauma and act as conduits for transformation; and (c) psychological dimensions (i.e., connectedness, collective memory, and critical consciousness) that promote justice-informed outcomes. In the C-HeARTS framework, community is advanced as an agent of change while centering justice and the important role of cultural practices to facilitate community healing.
This book is intended to provide clinicians and trainees with a better understanding of racial microaggressions as they relate to therapy. This book provides thorough information on the research surrounding microaggressions as well as practical skills to use in session with clients. Microaggressions can be hard to spot and hard to understand. This book provides needed tools to identify microagressive behavior. It also outlines the research on how microaggressions can be damaging to people of color, causes of microaggressions, how to prevent them from happening, and how to help clients suffering as a result of experiencing them. Furthermore, it provides support for therapists of color on how to navigate microaggressions within their professional sphere. The book also describes validated measures and clinical interviews that may be used to better understand microaggressions and other cultural concepts relevant to clients. This book is a road map readers can use to begin their journey toward culturally competence to avoid microaggressive behavior in their profession and in their life in general. Case examples, therapeutic interactions, and discussion scenarios supplement the information provided. Finally, it outlines controversies regarding microaggressions and future directions related to this concept.
The impact of racial experiences on Whites has been underresearched and has rarely been considered traumatic. To understand these experiences, it is important to consider variation in one's orientation to their racial group (i.e., racial identity) and the type of racial encounter. Using a White adult sample and hierarchical cluster analysis, the authors found that reactions to race‐based encounters were associated with varying levels of psychological distress and well‐being and racial identity statuses. Clinical implications are discussed.
El impacto de las experiencias raciales en personas blancas no ha sido suficientemente investigado y en raras ocasiones ha sido considerado traumático. Para comprender estas experiencias, es importante considerar la variación en la orientación de cada individuo hacia su grupo racial (es decir, la identidad racial) y el tipo de encuentro racial. Usando una muestra de personas adultas blancas y un análisis jerárquico de clústeres, los autores hallaron que las reacciones a los encuentros raciales estaban asociadas a niveles variables de malestar psicológico, así como de estados de bienestar e identidad racial.
Objective:
Growing evidence demonstrates that perceived discrimination and racism are significant contributing factors to psychological distress, low-grade chronic inflammation, and cardiovascular health disparities among minorities, particularly among Black women. Despite this evidence, there are no evidence-based complementary therapy interventions available to ameliorate chronic stress associated with racism and discrimination. The purpose of this study was to examine the feasibility and effectiveness of a novel, 8-week, group-based stress reduction program, Resilience, Stress and Ethnicity (RiSE), designed to help Black women at risk for cardiovascular disease (CVD) develop effective coping skills for dealing with chronic stress uniquely associated with being a minority.
Methods:
We conducted two semi-structured focus groups with Black women (N = 22) following their participation in the 8-week RiSE program. We analyzed the data using constant comparative qualitative methods.
Results:
Attrition rate was low (13%) with all participants attending at least 6 of the 8 classes. Participants reported high levels of satisfaction with the program and the majority (81%) reported practicing the skills that they learned in real-life stressful situations. In describing the participants' response to the program, four key categories emerged from the data: (1) Increasing awareness of stressors associated with perceived discrimination and racism; (2) Coping with race-based stressors; (3) Coping with other sources of stress; and (4) Increasing sense of empowerment and emotion regulation.
Conclusions:
Findings suggest that RiSE is feasible and effective in helping Black women at risk for CVD cope with chronic stress associated with being a minority. Given evidence that perceived discrimination and racism are underlying factors in many inflammatory-based chronic diseases, this research may have broader implications for reducing health disparities across a wide-spectrum of chronic illnesses in which women minorities are disproportionately affected.