title: Delivering cognitive processing therapy in a community health setting: The influence of Latino culture and community violence on posttraumatic cognitions.
abstract: Despite the applicability of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) to addressing sequelae of a range of traumatic events, few studies have evaluated whether the treatment itself is applicable across diverse populations. The present study examined differences and similarities among non-Latino, Latino Spanish-speaking, and Latino English-speaking clients in rigid beliefs-or "stuck points"-associated with PTSD symptoms in a sample of community mental health clients. We utilized the procedures of content analysis to analyze stuck point logs and impact statements of 29 participants enrolled in a larger implementation trial for CPT. Findings indicated that the content of stuck points was similar across Latino and non-Latino clients, although fewer total stuck points were identified for Latino clients compared to non-Latino clients. Given that identification of stuck points is central to implementing CPT, difficulty identifying stuck points could pose significant challenges for implementing CPT among Latino clients and warrants further examination. Thematic analysis of impact statements revealed the importance of family, religion, and the urban context (e.g., poverty, violence exposure) in understanding how clients organize beliefs and emotions associated with trauma. Clinical recommendations for implementing CPT in community settings and the identification of stuck points are provided.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital.
authors.forename: Luana
authors.initials: L
authors.lastname: Marques
authors.affiliation: University of Massachusetts Boston.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Eustis
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital.
authors.forename: Louise
authors.initials: L
authors.lastname: Dixon
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Valentine
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital.
authors.forename: Christina P C
authors.initials: CPC
authors.lastname: Borba
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital.
authors.forename: Naomi
authors.initials: N
authors.lastname: Simon
authors.affiliation: Department of Psychiatry & Behavioral Sciences, University of Washington.
authors.forename: Debra
authors.initials: D
authors.lastname: Kaysen
authors.affiliation: Women's Health Sciences Division, National Center for PTSD.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wiltsey-Stirman
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003151:Community Health Centers; D003469:Culture; D005190:Family / Q000523:psychology; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012067:Religion; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D014754:Violence / Q000523:psychology*