Cognitive Behavioral Therapy for Coping with Discrimination

Overseen By Terry Marsh, MPH

Age: 18+

Sex: Male

Trial Phase: Academic

Sponsor: RAND

Disqualifiers: Cisgender women, Transgender women, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 11

370 Participants Needed

Trial Summary

What is the purpose of this trial?

This study consists of a randomized controlled trial of a multi-session cognitive behavior therapy (CBT) group intervention that addresses coping with discrimination and medical mistrust among Black sexual minority men (SMM). Primary intervention objectives include increasing health care engagement and receipt of evidence-based preventive care, as well as better coping and reduced anticipated and internalized stigma, and medical mistrust among intervention participants.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Cognitive Behavioral Therapy Coping Intervention for coping with discrimination?

Research shows that cognitive behavioral therapy (CBT) can effectively change coping styles and reduce psychological symptoms, as seen in studies where CBT methods like relaxation and problem-solving training led to significant symptom reduction. Additionally, CBT has been adapted successfully for various groups, such as low-income African American women, indicating its flexibility and potential effectiveness in diverse contexts. ^{1 2 3 4 5}

Is Cognitive Behavioral Therapy (CBT) safe for humans?

Cognitive Behavioral Therapy (CBT) is generally considered safe for humans, as it is a well-established treatment used for various conditions, including anxiety and depression, and has been shown to be acceptable and effective in different settings. ^{6 7 8 9 10}

How is the CBT Coping Intervention treatment different from other treatments for coping with discrimination?

The CBT Coping Intervention is unique because it not only helps individuals manage personal distress from discrimination but also encourages understanding and addressing the root causes of discrimination, which are often systemic. This approach combines personal coping skills with a broader awareness of social injustice, making it distinct from treatments that focus solely on individual coping strategies. ^{11 12 13 14 15}

Research Team

Laura Bogart, PhD

Principal Investigator

RAND

Eligibility Criteria

This trial is for Black sexual minority men over 18, who have had sex with other men in the past two years and will be in Los Angeles County for the next year. Participants must speak English and have been biologically male at birth. Transgender individuals and cisgender women cannot join.

Inclusion Criteria

Anticipate being in Los Angeles County and available for the next 12 months to attend study visits

Able to interact and communicate in written and spoken English

You identify yourself as a Black or African American person.

Exclusion Criteria

I am a transgender woman.

Unwilling/Unable to provide informed consent

I am a transgender man.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive an 8-session cognitive behavior therapy (CBT) group intervention addressing coping with discrimination and medical mistrust

8 weeks

8 group sessions

Follow-up

Participants are monitored for healthcare engagement and receipt of preventive care through surveys at 4-, 8-, and 12-months post-baseline

12 months

3 follow-up surveys

Treatment Details

Interventions

• CBT Coping Intervention

Trial Overview The study tests a cognitive behavior therapy (CBT) group intervention aimed at helping participants cope with discrimination, reduce medical mistrust, increase engagement in healthcare, and receive preventive care more consistently.

Participant Groups

Group I: Intervention Experimental Treatment 1 Intervention

The intervention is an 8-session cognitive behavior therapy (CBT) group intervention that addresses coping with discrimination and medical mistrust among Black sexual minority men (SMM).

Group II: No-treatment control Active Control 1 Intervention

Participants who are assigned to the control group will not receive the intervention.

Who Is Running the Clinical Trial?

RAND

Lead Sponsor

Trials

145

Recruited

617,000+

University of Massachusetts, Boston

Collaborator

Trials

42

Recruited

17,800+

APLA Health

Collaborator

Trials

2

Recruited

670+

University of Southern California

Collaborator

Trials

956

Recruited

1,609,000+

Findings from Research

Cognitive behavior therapy, specifically relaxation techniques and problem-solving training, significantly improved coping styles and reduced psychological and physical symptoms in a study of 20 subjects over a 4-week treatment period.

The benefits of these therapies were maintained even after a 14-month follow-up, while the control group showed no significant changes, highlighting the long-term efficacy of these coping strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The cause-effect relationship between coping and psychological/physical symptoms]. Nakano, K.[2019]

A meta-analysis of 12 studies involving 1,291 patients found that matching patients' coping styles with the appropriate psychotherapy focus can significantly improve treatment outcomes, with a medium effect size of 0.55.

Specifically, externalizing patients benefit more from symptom-focused treatments, while internalizing patients respond better to insight-focused therapies, highlighting the importance of considering individual coping styles in therapy selection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping style. Beutler, LE., Harwood, TM., Kimpara, S., et al.[2011]

The study focused on adapting a cognitive-behavioral therapy intervention to be culturally sensitive for treating depression in low-income African American women, highlighting the importance of cultural relevance in mental health treatments.

Women in the culturally adapted group showed a greater reduction in their depression scores (measured by BDI) compared to those in the non-adapted group, suggesting that culturally tailored interventions can be more effective for specific populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapted cognitive behavioral group therapy for depressed low-income African American women. Kohn, LP., Oden, T., Muñoz, RF., et al.[2022]

Group cognitive behavioural therapy (CBT) has been shown to effectively address significant and long-term psychosocial problems in cancer patients, including those with advanced disease.

The article emphasizes the importance of time-limited interventions and provides guidance for health workers on how to implement group CBT techniques to support emotionally distressed cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group cognitive behavioural therapy: an intervention for cancer patients. Bottomley, A.[2019]

Coping is a circular process involving perception of change, cognitive processing, and active coping strategies, with active behaviors being more beneficial for patient well-being than passive ones.

Structured coping-based interventions, which include establishing a therapeutic relationship and problem analysis, have been shown to significantly enhance the healing process across various medical fields.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping-based intervention strategies. Heim, E.[2019]

Coping effectiveness training (CET) and supportive group therapy (SGT) both led to reductions in anxiety and depression symptoms in a study of 40 participants with acute spinal cord injuries, but CET achieved these results in fewer sessions.

Despite improvements during treatment, symptoms of depression increased for both groups after hospital discharge, highlighting the need for ongoing support and innovative interventions post-rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial. Duchnick, JJ., Letsch, EA., Curtiss, G.[2015]

A study involving 688 undergraduates found that cognitive behavioral therapy (CBT) that incorporates safety behaviors is significantly more acceptable to participants than traditional CBT that discourages such behaviors.

Cognitively based CBT was preferred over extinction-based CBT, and factors like previous treatment and higher anxiety levels were linked to lower acceptability ratings, highlighting the importance of tailoring CBT approaches to enhance their acceptance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Further Support for the Acceptability-Enhancing Roles of Safety Behavior and a Cognitive Rationale in Cognitive Behavioral Therapy for Anxiety Disorders. Levy, HC., Senn, JM., Radomsky, AS.[2020]

Cognitive-behavioral therapy (CBT) is based on scientific experimentation rather than just theories, making it a unique and evidence-based approach to treatment.

Recent research at the University of Minnesota has integrated new neuroscientific findings with CBT, potentially enhancing its effectiveness and understanding in therapeutic practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use of cognitive-behavioral therapy in the University of Minnesota's outpatient psychiatry clinic. Kushner, MG.[2018]

The Coping Effectiveness Training (CET) program significantly reduced levels of depression and anxiety in participants with spinal cord injuries, with improvements noted immediately after the intervention and sustained at six weeks follow-up.

While the CET intervention did not lead to significant changes in coping strategies, participants found the group interactions to be particularly beneficial, suggesting that social support plays a key role in psychological adjustment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping effectiveness training for people with spinal cord injury: preliminary results of a controlled trial. King, C., Kennedy, P.[2022]

Individuals on or recently receiving disability benefits showed high engagement and treatment satisfaction with internet-delivered cognitive behavioral therapy (ICBT), with significant improvements in depression, anxiety, and disability for insurance company employees after treatment.

However, while insurance company plan members also experienced improvements, their gains were not maintained at 3 months, and their effect sizes were smaller compared to those from a publicly funded ICBT clinic, indicating that higher levels of pretreatment disability may impact long-term effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Clients Referred and Funded by Insurance Companies Compared With Those Who Are Publicly Funded: Longitudinal Observational Study. Hadjistavropoulos, HD., Peynenburg, V., Mehta, S., et al.[2020]

The Coping With Discrimination Scale (CDS) was developed and validated through four studies involving a total of 929 participants, identifying five key coping factors related to discrimination, with strong internal consistency reliability (0.72 to 0.90).

The CDS demonstrated incremental validity by explaining additional variance in important psychological outcomes like depression and self-esteem beyond what general coping strategies could account for, indicating its effectiveness in assessing coping mechanisms specific to discrimination.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and validation of a Coping with Discrimination Scale: factor structure, reliability, and validity. Wei, M., Alvarez, AN., Ku, TY., et al.[2022]

The study identified a variety of coping responses to racism, highlighting both adaptive and maladaptive strategies, which go beyond the typical negative emotional responses like anger and anxiety.

The findings suggest that understanding these coping mechanisms from a biopsychosocial perspective can help health practitioners provide more holistic care for individuals affected by cultural stress, potentially improving both mental and physical health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Black's Coping Responses to Racial Stress. Griffin, EK., Armstead, C.[2022]

In a study of 743 emerging adults aged 18-29, experiencing racial discrimination was linked to increased dissociative symptoms, suggesting that such discrimination can be perceived as a form of psychological trauma.

Utilizing active coping strategies in response to racial discrimination was associated with lower levels of dissociative symptoms, indicating that how individuals cope can significantly influence their mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Racial discrimination as race-based trauma, coping strategies, and dissociative symptoms among emerging adults. Polanco-Roman, L., Danies, A., Anglin, DM.[2020]

Marginalized individuals often face ongoing discrimination, which creates chronic stress, highlighting the need for therapeutic approaches that address both personal distress and systemic issues.

The authors advocate for integrating social capital into mental health treatment, emphasizing that therapy should not only focus on individual coping skills but also on understanding and combating the root causes of discrimination and social injustice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Getting to the Root of the Problem: Supporting Clients With Lived-Experiences of Systemic Discrimination. Bartlett, A., Faber, S., Williams, M., et al.[2022]

In a study of 164 African Americans with osteoarthritis, those who experienced personal discrimination showed higher depressive symptoms, particularly in the control group, indicating a link between discrimination and mental health.

Participants who received pain coping skills training (PCST) did not show the same increase in depressive symptoms related to discrimination, suggesting that PCST may help mitigate the negative mental health effects of perceived discrimination.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Discrimination Experiences and Depressive Symptoms among African Americans with Osteoarthritis Enrolled in a Pain Coping Skills Training Randomized Controlled Trial. Griesemer, I., Hausmann, LR., Arbeeva, L., et al.[2023]

References

1. Japan pubmed.ncbi.nlm.nih.gov

[The cause-effect relationship between coping and psychological/physical symptoms]. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Coping style. [2011]

3. United States pubmed.ncbi.nlm.nih.gov

Adapted cognitive behavioral group therapy for depressed low-income African American women. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Group cognitive behavioural therapy: an intervention for cancer patients. [2019]

5. Ireland pubmed.ncbi.nlm.nih.gov

Coping-based intervention strategies. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial. [2015]

7. United States pubmed.ncbi.nlm.nih.gov

Further Support for the Acceptability-Enhancing Roles of Safety Behavior and a Cognitive Rationale in Cognitive Behavioral Therapy for Anxiety Disorders. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

The use of cognitive-behavioral therapy in the University of Minnesota's outpatient psychiatry clinic. [2018]

9. England pubmed.ncbi.nlm.nih.gov

Coping effectiveness training for people with spinal cord injury: preliminary results of a controlled trial. [2022]

10. Canada pubmed.ncbi.nlm.nih.gov

An Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Clients Referred and Funded by Insurance Companies Compared With Those Who Are Publicly Funded: Longitudinal Observational Study. [2020]

11. United States pubmed.ncbi.nlm.nih.gov

Development and validation of a Coping with Discrimination Scale: factor structure, reliability, and validity. [2022]

12. Switzerland pubmed.ncbi.nlm.nih.gov

Black's Coping Responses to Racial Stress. [2022]

13. United States pubmed.ncbi.nlm.nih.gov

Racial discrimination as race-based trauma, coping strategies, and dissociative symptoms among emerging adults. [2020]

14. United States pubmed.ncbi.nlm.nih.gov

Getting to the Root of the Problem: Supporting Clients With Lived-Experiences of Systemic Discrimination. [2022]

15. United States pubmed.ncbi.nlm.nih.gov

Discrimination Experiences and Depressive Symptoms among African Americans with Osteoarthritis Enrolled in a Pain Coping Skills Training Randomized Controlled Trial. [2023]