Minority Participation in Randomized Controlled Trials for Prolonged Exposure Therapy: A Systematic Review of the Literature

Benuto, Lorraine T.; Bennett, Natalie; Casas, Jena

doi:10.1002/jts.22539

Cited by 25 publications

(34 citation statements)

References 61 publications

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“… 6 – 8 Although several efficacious treatments exist for PTSD (eg, prolonged exposure 9 and cognitive processing therapy 10 ) existing treatment studies largely do not address the role of race or ethnicity. 11 Furthermore, evidence shows that treatment dropout rates are high among POC. 12 , 13 Thus, the development of treatments for racial trauma is sorely lacking.…”

Section: Introductionmentioning

confidence: 99%

Increases in Psychological Flexibility Mediate Relationship Between Acute Psychedelic Effects and Decreases in Racial Trauma Symptoms Among People of Color

Davis

Xin

Sepeda³

et al. 2021

Chronic Stress

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Background Previous research showed acute psychedelic effects were associated with decreases in racial trauma (RT) symptoms among black, indigenous, and people of color (BIPOC). Among samples comprised primarily of white participants, positive outcomes of psychedelic experiences have been mediated by increases in psychological flexibility. Therefore, we examined whether changes in psychological flexibility from before to after a psychedelic experience mediated the relationship between acute psychedelic effects and changes in RT symptoms among BIPOC. Methods This cross-sectional online survey study included 313 BIPOC (mean age = 33.1; SD = 11.2; female = 57%). A multiple linear regression analysis was used to examine the association between acute psychedelic effects and decreases in RT symptoms in a nonclinical setting; a path analysis was used to explore whether changes in psychological flexibility mediated this relationship. Results Acute insight and challenging effects were significantly ( p < .001) associated with decreases in RT symptoms following a psychedelic experience. Increases in psychological flexibility partially mediated relationships between greater intensity of psychological insight and less intensity of challenging experiences and decreases in RT symptoms ( ps<.001). Conclusion This research suggests psychedelics confer potential benefits in decreasing RT symptoms among BIPOC and psychological flexibility may be an important mediator of these effects. Future research should test this hypothesis in a longitudinal clinical trial among BIPOC.

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Section: Introductionmentioning

confidence: 99%

Increases in Psychological Flexibility Mediate Relationship Between Acute Psychedelic Effects and Decreases in Racial Trauma Symptoms Among People of Color

Davis

Xin

Sepeda³

et al. 2021

Chronic Stress

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“…Despite these efforts, literature reviews of ethnoracial minority representation in clinical trials for obsessive compulsive disorder (OCD; Williams et al, 2010), panic disorder (Mendoza et al, 2012), depression (Polo et al, 2019), posttraumatic stress disorder (PTSD; Grau et al, 2021), and Prolonged Exposure (PE) therapy for PTSD (Benuto et al, 2020) reveal that ethnoracial minority groups are largely underrepresented in the RCTs that comprise the evidence base for these treatments. Fewer than half of the RCTs for OCD, panic disorder, and depression even reported the ethnoracial characteristics of the samples (Mendoza et al, 2012; Polo et al, 2019; Williams et al, 2010), though there is evidence that reporting practices in clinical trials for depression have improved over time (Polo et al, 2019).…”

mentioning

confidence: 99%

The inclusion of ethnoracial, sexual, and gender minority groups in randomized controlled trials of dialectical behavior therapy: A systematic review of the literature.

Harned¹,

Coyle²,

Garcia³

2022

Clinical Psychology: Science and Practice

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This systematic review evaluated the sample reporting practices and inclusion rates for ethnoracial, sexual, and gender minority groups in randomized controlled trials (RCTs) of Dialectical Behavior Therapy (DBT; 18 RCTs, N = 1,175). Participants' race (94.4%) and ethnicity (72.2%) were frequently reported, but not their sexual orientation (11.1%) or gender identity (5.6%). Inclusion rates were 39.2% for ethnoracial minority groups (16 RCTs, n = 1,018) and 27.3% for sexual minority groups (9 RCTs, n = 428). The gender minority inclusion rate could not be determined. Compared with the U.S. population, all ethnoracial minority groups were well-represented and all sexual minority groups were overrepresented. No studies examined if treatment outcomes differed for minority groups. The evidence base for DBT appears to adequately represent ethnoracial and sexual minority groups, and improvements are needed in sample reporting and data analytic practices. Public Health Significance StatementDialectical Behavior Therapy (DBT) is an evidence-based psychotherapy for borderline personality disorder as well as suicidal and self-injurious behaviors. This systematic review indicates that the evidence base for DBT appears to include a representative number of ethnoracial and sexual minority participants, which supports the use of DBT with these minority groups in clinical practice.

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“…Additionally, Marquez (2019) found that level of adherence to Latinx culture was a significant predictor of treatment acceptability for therapy. The results from these studies highlight the intricate interplay of cultural values with attitudes and beliefs about treatment and suggest that adherence to cultural factors might predict treatment acceptability, particularly considering that exposure-based treatments were developed in a non-Latinx context, and most studies have not included an adequate representation of Latinx participants (Benuto et al, 2020).…”

Section: Treatment Acceptabilitymentioning

confidence: 99%

Acceptability of exposure-based treatments for PTSD among Latinxs: A mixed-methods study.

Benuto¹,

Casas²,

Chavez-Najera³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Latinx individuals are the largest and fastest growing ethnic group in the United States and are substantially impacted by trauma. Despite the potential benefit that Latinx individuals could experience from existing evidence-based treatments, they demonstrate low service-utilization rates. The current study examined treatment acceptability of exposure-based treatment for PTSD, using mixed methodology. Because exposure-based PTSD treatments were developed through a Western cultural lens, we hypothesized that (a) Latinx individuals would have low rates of treatment acceptability, (b) acculturation would positively predict treatment acceptability, and (c) enculturation would negatively predict treatment acceptability. Method: Participants were 95 Latinx individuals. All participants were provided with a vignette depicting a fictional character who underwent exposure therapy for PTSD. A subset of participants completed a semistructured interview assessing their views on exposure-based treatments for PTSD (n = 25), and a subset of participants completed a questionnaire examining treatment acceptability of exposure-based therapy for PTSD (n = 70). Results: Results from the qualitative data revealed that Latinx individuals identified both favorable and negative elements of exposure-based interventions for PTSD. Additionally, we noted that participants had a belief system regarding how they perceived exposure-based treatments to work. Results from the quantitative data indicate that our participants generally found exposure-based therapy to be acceptable and that enculturation (but not acculturation) predicted treatment acceptability. Conclusions: Because attitudes toward treatment contribute to outcomes, we concluded that the aggravating elements, mitigating factors, and perceived mechanism of change together contribute to Latinx acceptability of exposure-based treatment for PTSD. Clinical Impact StatementThis study suggests that Latinx individuals generally find exposure-based treatments for PTSD acceptable and that the mechanism of change resonates with their cultural values. Additionally, adherence to Latinx cultural values predicted treatment acceptability. Taken together, these results suggest that Latinx cultural values might not interfere with exposure-based treatments of PTSD and might even promote treatment engagement.

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Minority Participation in Randomized Controlled Trials for Prolonged Exposure Therapy: A Systematic Review of the Literature

Cited by 25 publications

References 61 publications

Increases in Psychological Flexibility Mediate Relationship Between Acute Psychedelic Effects and Decreases in Racial Trauma Symptoms Among People of Color

Increases in Psychological Flexibility Mediate Relationship Between Acute Psychedelic Effects and Decreases in Racial Trauma Symptoms Among People of Color

The inclusion of ethnoracial, sexual, and gender minority groups in randomized controlled trials of dialectical behavior therapy: A systematic review of the literature.

Acceptability of exposure-based treatments for PTSD among Latinxs: A mixed-methods study.

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