Cultural Adaptations of Prolonged Exposure Therapy for Treatment and Prevention of Posttraumatic Stress Disorder in African Americans

Abstract

Posttraumatic stress disorder (PTSD) is a highly disabling disorder, afflicting African Americans at disproportionately higher rates than the general population. When receiving treatment, African Americans may feel differently towards a European American clinician due to cultural mistrust. Furthermore, racism and discrimination experienced before or during the traumatic event may compound posttrauma reactions, impacting the severity of symptoms. Failure to adapt treatment approaches to encompass cultural differences and racism-related traumas may decrease treatment success for African American clients. Cognitive behavioral treatment approaches are highly effective, and Prolonged Exposure (PE) in particular has the most empirical support for the treatment of PTSD. This article discusses culturally-informed adaptations of PE that incorporates race-related trauma themes specific to the Black experience. These include adding more sessions at the front end to better establish rapport, asking directly about race-related themes during the assessment process, and deliberately bringing to the forefront race-related experiences and discrimination during treatment when indicated. Guidelines for assessment and the development of appropriate exposures are provided. Case examples are presented demonstrating adaptation of PE for a survivor of race-related trauma and for a woman who developed internalized racism following a sexual assault. Both individuals experienced improvement in their posttrauma reactions using culturally-informed adaptations to PE.

Identifying and Treating Race‐Based Trauma in Counseling

“…IOCs can experience significant stress caused by cultural, individual, and institutional experiences with racism. Chronic racism and discrimination can lead to a wide variety of psychological problems, including denigration of one's sociocultural in‐groups, feelings of helplessness, numbing, paranoid‐like guardedness, medical illnesses, anxiety, fear, and the development of posttraumatic stress disorder (Matthews et al, ; Myers et al, ; Paradies et al, ; Pieterse et al, ; Ponds, ; M. T. Williams et al, ). Garcia and Sharif () stated that, to improve health outcomes among IOCs, those who work with minorities, including all health professionals, must address racism.…”

The Enhancement of Natural Resilience in Trauma Interventions

“…Furthermore, an expanded view of trauma response that involves factors beyond symptom severity will enhance the ability for clinicians to incorporate an individual’s unique sociocultural background into evidence-based, but still symptom-focused, treatments. Pathways to resilient coping are likely to be influenced by cultural factors (e.g., Alim et al, 2008), and tapping into these resources may facilitate better therapeutic outcomes (Williams et al, 2014). Conceptualizing effective PTSD treatments as powerful ways to harness factors that underlie resilience, as well as reduce pathology, may widen the lens through which we view our interventions.…”

Medical mistrust as a key mediator in the association between perceived discrimination and adherence to antiretroviral therapy among HIV-positive Latino men

“…Using CBT with HIV-positive Latinos in the context of the findings of this study would focus on assisting them to cope constructively with discriminatory experiences and also lower their mistrust of the medical system. CBT techniques have been used to address the impact of racism and discrimination on posttraumatic stress disorder (PTSD) among African Americans with subsequent improvement in their PTSD reactions (Williams et al, 2014). These results argue for addressing similar discriminatory experiences among HIV-positive Latinos.…”