Cultural adaptations of prolonged exposure therapy for treatment and prevention of posttraumatic stress disorder in african americans.
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.
Department of Psychological and Brain Sciences, Center for Mental Health Disparities, University of Louisville, Louisville, KY 40292, USA.
Monnica T
MT
Williams
Department of Visual Studies, University of Pennsylvania, Philadelphia, PA 19104, USA.
Emily
E
Malcoun
Department of Psychological and Brain Sciences, Center for Mental Health Disparities, University of Louisville, Louisville, KY 40292, USA.
Broderick A
BA
Sawyer
Department of Psychological and Brain Sciences, Center for Mental Health Disparities, University of Louisville, Louisville, KY 40292, USA.
Darlene M
DM
Davis
Department of Psychological and Brain Sciences, Center for Mental Health Disparities, University of Louisville, Louisville, KY 40292, USA.
Leyla Bahojb
LB
Nouri
Department of Psychological and Brain Sciences, Center for Mental Health Disparities, University of Louisville, Louisville, KY 40292, USA.
Simone Leavell
SL
Bruce
African Americans; posttraumatic stress disorder; prolonged exposure; racism; therapeutic alliance; trauma