African-American women may benefit as much as their Caucasian counterparts in treatment of Post-Traumatic Stress Disorder (PTSD), despite being more likely to drop out of treatment prematurely. PTSD is a mental health disorder and, specifically, an anxiety disorder, that arises from trauma. Symptoms of distress must also arise in three domains: re-experiencing the trauma (e.g., flashbacks, nightmares); avoidance (numbing, not wanting to talk about the event and avoiding its reminders); and hyperarousal (increased startle response, irritability, sleeplessness). Sexual abuse as a child and sexual assault as an adult are types of trauma that may lead to PTSD in adult women.
Kristen Lester, the lead author of the study published in the Journal of Consulting and Clinical Psychology and a researcher at the National Center for PTSD, used two randomized, controlled studies of cognitive-behavioral therapy for the treatment of women with sexual assault and sexual abuse histories. These two studies were collapsed in order to gain a sufficient sample size to compare women of differing ethnic backgrounds. Ultimately, there were only enough Caucasians and African-American women in the sample to compare (rather than also examining people from other ethnic backgrounds).
Lester and her colleagues were not unsurprised to see that the dropout rate was higher for African-Americans as this is a finding of other studies. However, they were surprised to find that African-American women, even when taking into account those who had dropped out of treatment, were able, as a group, to reduce their PTSD to levels similar to the Caucasian women, who were more likely to stay in the protocol. A closer examination of the data showed that the differences between the two groups was primarily due to the greater improvement in symptoms of African-American who dropped out compared to Caucasian women who failed to complete treatment.
A tentative explanation for what seems like contradictory findings is that African-American women may have been more motivated to seek treatment, given the stigma associated with seeking help for psychological symptoms among the African-American community. Therefore, they may have been able to benefit more quickly given their high motivation level. A related but alternative explanation is that African-American women had a high expectancy for treatment being beneficial if they were to get to the point of actually seeking services. This is in line with the premise of solution-focused therapy, a strengths-based counseling model, in which “pretreatment change” is considered a factor to exploit. The idea is that the very act of committing to an appointment to seek help often makes people feel better. Asking about “what has already changed between the time you made the appointment and now” builds momentum on the change that has already occurred.
The researchers of the study were unable to test if “therapist matching,” seeing if therapists and clients being matched on ethnicity contributed to African-American retention, because there were so few African-American therapists.
Lester, K., Artz, C., Resick, P., & Young-Xu, Y. (2010). Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment. Journal of Consulting and Clinical Psychology, 78, 480-489.