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22-07-2021 | Original Article

Differences in the Delivery of Cognitive Behavioral Therapy for Depression When Therapists Work with Black and White Patients

Auteurs: Iony D. Ezawa, Daniel R. Strunk

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 1/2022

Abstract

Background

Although Cognitive behavioral therapy (CBT) appears to be an effective treatment for depression, studies of CBT have largely been composed of White patients. Whether the benefits or process of change in CBT differ among ethnic/racial minority patients requires further investigation.

Methods

We drew data from three previous studies to examine differences among Black and White patients. Our combined sample consisted of 229 patients with depression who had participated in CBT (23 Black and 206 White patients). Observer ratings of therapist use of cognitive methods, behavioral methods, and alliance were available for early sessions. Depressive symptoms were assessed at each session.

Results

Patient race was not associated with slope of symptom change or the risk of dropout. There were no differences in therapists’ use of behavioral methods or the alliance. However, CBT therapists used cognitive methods less extensively when working with Black as compared to White patients. Patient race did not moderate the relation between cognitive methods and symptom change.

Conclusions

Taken together, these results raise the possibility that standard CBT can be implemented in ways that are culturally responsive, but also call into question whether some of the recommended ways to personalize CBT enhance outcome. We encourage future research investigating CBT for Black patients.

vorige artikel Rumination and Emotional Modulation of the Attentional Blink

volgende artikel Empathic Communication Among Women with High or Low Social Anxiety

Alleen toegankelijk voor geautoriseerde gebruikers

The term “Black” in this study refers to individuals who self-identified with worldwide Black or African ancestry.

A total of 24 patients from the total combined dataset were not included in the current sample. Of these patients, 6% (n = 15) were Asian American, 3% (n = 7) were Hispanic, and 1% (n = 2) were Native American.

There were slight differences in the items used across studies. The portion of the sample drawn from DeRubeis and colleagues’ (2005) study (with process ratings reported in Strunk et al., 2010) used homework items that did not differentiate cognitive and behavioral assignments. In the other two samples, items that made this distinction were used and contributed to cognitive and behavioral methods scores, respectively.

In two of the studies, a more detailed explanation was also provided. Dropout was limited to cases in which patients completed fewer than 10 sessions in Adler et al. (2015). Dropout was defined as either informing one’s therapist of the decision to discontinue treatment or being unable to be reached for four weeks in Schmidt et al. (2019).

The main findings are similar to when the BDI covariate is raw (i.e., not limited to a within-patient score).

We examined session 1 process measure scores as predictors of dropout. The direction and significance of results of this model were the same as the model in which we included only patients for whom all early process ratings were available.

Adler, A. D., Strunk, D. R., & Fazio, R. H. (2015). What changes in cognitive therapy for depression? An examination of cognitive therapy skills and maladaptive beliefs. Behavior Therapy, 46, 96–109. https://doi.org/10.1016/j.beth.2014.09.001CrossRefPubMed

Allison, P. D. (2009). Fixed effects regression models. Sage.CrossRef

Bailey, R. K., Patel, M., Barker, N. C., Ali, S., & Jabeen, S. (2011). Major depressive disorder in the African American population. Journal of the National Medical Association, 103, 548–557. https://doi.org/10.1016/S0027-9684(15)30380-1CrossRefPubMed

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory (2nd ed.). The Psychological Corporation.

Bolger, N., & Laurenceau, J. (2013). Intensive longitudinal methods: An introduction to diary and experience sampling research. Guilford Press.

Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015). Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression. Behaviour Research and Therapy, 70, 32–37. https://doi.org/10.1016/j.brat.2015.05.004CrossRefPubMedPubMedCentral

Bruijniks, S. J., Los, S. A., & Huibers, M. J. (2020). Direct effects of cognitive therapy skill acquisition on cognitive therapy skill use, idiosyncratic dysfunctional beliefs and emotions in distressed individuals: An experimental study. Journal of Behavior Therapy and Experimental Psychiatry, 67, 101460. https://doi.org/10.1016/j.jbtep.2019.02.005CrossRefPubMed

Busch, A. M., Kanter, J. W., Landes, S. J., & Kohlenberg, R. J. (2006). Sudden gains and outcome: A broader temporal analysis of cognitive therapy for depression. Behavior Therapy, 37, 61–68. https://doi.org/10.1016/j.beth.2005.04.002CrossRefPubMed

Cabral, R. R., & Smith, T. B. (2011). Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology, 58, 537–554. https://doi.org/10.1037/a0025266CrossRefPubMed

Chaney, C., & Robertson, R. V. (2013). Racism and police brutality in America. Journal of African American Studies, 17, 480–505. https://doi.org/10.1007/s12111-013-9246-5CrossRef

Cooper, A. A., & Conklin, L. R. (2015). Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials. Clinical Psychology Review, 40, 57–65. https://doi.org/10.1016/j.cpr.2015.05.001CrossRefPubMed

Curran, P. J., & Bauer, D. J. (2011). The disaggregation of within person and between-person effects in longitudinal models of change. Annual Review of Psychology, 62, 583–619. https://doi.org/10.1146/annurev.psych.093008.100356CrossRefPubMedPubMedCentral

Deitch, E. A., Barsky, A., Butz, R. M., Chan, S., Brief, A. P., & Bradley, J. C. (2003). Subtle yet significant: The existence and impact of everyday racial discrimination in the workplace. Human Relations, 56, 1299–1324. https://doi.org/10.1177/00187267035611002CrossRef

DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., & Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409–416. https://doi.org/10.1001/archpsyc.62.4.409CrossRefPubMed

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM–IV axis I disorders, research version, non-patient edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute.

Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy: Theory Research, Practice, Training, 43, 531–548. https://doi.org/10.1037/0033-3204.43.4.531CrossRef

Hays, P. A. (2009). Integrating evidence-based practice, cognitive–behavior therapy, and multicultural therapy: Ten steps for culturally competent practice. Professional Psychology: Research and Practice, 40, 354–360. https://doi.org/10.1037/a0016250CrossRef

Hollon, S. D., Evans, M. D., Auerbach, A., DeRubeis, R. J., Elkin, I., Lowery, A., Piasecki, J. M. (1988). Development of a system for rating therapies for depression: Differentiating cognitive therapy, interpersonal psychotherapy and clinical management pharmacotherapy. Unpublished manuscript.

Hollon, S. D., Stewart, M. O., & Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285–315. https://doi.org/10.1146/annurev.psych.57.102904.190044CrossRefPubMed

Horrell, S. C. V. (2008). Effectiveness of cognitive-behavioral therapy with adult ethnic minority clients: A review. Professional Psychology: Research and Practice, 39, 160–168. https://doi.org/10.1037/0735-7028.39.2.160CrossRef

Huey, S. J., Jr., Tilley, J. L., Jones, E. O., & Smith, C. A. (2014). The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annual Review of Clinical Psychology, 10, 305–338. https://doi.org/10.1146/annurev.psych.60.110707.163651CrossRefPubMed

Kohn, L. P., Oden, T., Muñoz, R. F., Robinson, A., & Leavitt, D. (2002). Brief report: Adapted cognitive behavioral group therapy for depressed low-income African American women. Community Mental Health Journal, 38, 497–504.CrossRef

Lee, R. T., Perez, A. D., Boykin, C. M., & Mendoza-Denton, R. (2019). On the prevalence of racial discrimination in the United States. PLoS ONE, 14, e0210698. https://doi.org/10.1371/journal.pone.0210698CrossRefPubMedPubMedCentral

McGraw, K. O., & Wong, S. P. (1996). Forming inferences about some intraclass correlation coefficients. Psychological Methods, 1, 30–46. https://doi.org/10.1037/1082-989X.1.1.30CrossRef

Miranda, J., Chung, J. Y., Green, B. L., Krupnick, J., Siddique, J., Revicki, D. A., & Belin, T. (2003). Treating depression in predominantly low-income young minority women: A randomized controlled trial. JAMA, 290, 57–65. https://doi.org/10.1001/jama.290.1.57CrossRefPubMed

Owen, J., & Hilsenroth, M. J. (2014). Treatment adherence: The importance of therapist flexibility in relation to therapy outcomes. Journal of Counseling Psychology, 61, 280–288. https://doi.org/10.1037/a0035753CrossRefPubMed

Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70, 41–55. https://doi.org/10.1093/biomet/70.1.41CrossRef

Sahker, E., Pro, G., Sakata, M., & Furukawa, T. A. (2020). Substance use improvement depends on Race/Ethnicity: Outpatient treatment disparities observed in a large US national sample. Drug and Alcohol Dependence, 213, 108087. https://doi.org/10.1016/j.drugalcdep.2020.108087CrossRefPubMed

Schmidt, I. D., Pfeifer, B. J., & Strunk, D. S. (2019). Putting the “cognitive” back in cognitive therapy: Sustained cognitive change as a mediator of in-session insights and depressive symptom improvement. Journal of Consulting and Clinical Psychology, 87, 446–456. https://doi.org/10.1037/ccp0000392CrossRefPubMed

Strunk, D. R., Adler, A. D., & Hollon, S. D. (2017). Cognitive therapy of depression. In R. J. DeRubeis & D. R. Strunk (Eds.), The Oxford handbook of mood disorders (pp. 411–422). Oxford University Press.

Strunk, D. R., Brotman, M. A., & DeRubeis, R. J. (2010). The process of change in cognitive therapy for depression: Predictors of early intersession symptom gains. Behaviour Research and Therapy, 48, 599–606. https://doi.org/10.1016/j.brat.2010.03.011CrossRefPubMedPubMedCentral

Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894–904. https://doi.org/10.1037/0022-006X.67.6.894CrossRefPubMed

Tang, T. Z., DeRubeis, R. J., Beberman, R., & Pham, T. (2005). Cognitive changes, critical sessions, and sudden gains in cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 73, 168–172. https://doi.org/10.1037/0022-006X.73.1.168CrossRefPubMed

Tichenor, V., & Hill, C. E. (1989). A comparison of six measures of working alliance. Psychotherapy: Theory Research, Practice, Training, 26, 195–199. https://doi.org/10.1037/h0085419CrossRef

Ünlü Ince, B., Riper, H., van ‘t Hof, E., & Cuijpers, P. (2014). The effects of psychotherapy on depression among racial-ethnic minority groups: A metaregression analysis. Psychiatric Services, 65, 612–617. https://doi.org/10.1176/appi.ps.201300165CrossRefPubMed

Vasquez, M. J. (2007). Cultural difference and the therapeutic alliance: An evidence-based analysis. American Psychologist, 62, 878–885. https://doi.org/10.1037/0003-066X.62.8.878CrossRef

Wang, L. P., & Maxwell, S. E. (2015). On disaggregating between-person and within person effects with longitudinal data using multilevel models. Psychological Methods, 20, 63–83. https://doi.org/10.1037/met0000030CrossRefPubMed

Ward, E. C., & Brown, R. L. (2015). A culturally adapted depression intervention for African American adults experiencing depression: Oh happy day. American Journal of Orthopsychiatry, 85, 11–22. https://doi.org/10.1037/ort0000027CrossRef

Titel: Differences in the Delivery of Cognitive Behavioral Therapy for Depression When Therapists Work with Black and White Patients
Auteurs: Iony D. Ezawa
Daniel R. Strunk
Publicatiedatum: 22-07-2021
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 1/2022
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-021-10254-0

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Differences in the Delivery of Cognitive Behavioral Therapy for Depression When Therapists Work with Black and White Patients

Abstract

Background

Methods

Results

Conclusions

Andere artikelen Uitgave 1/2022

Higher Order Repetitive Negative Thinking Is More Robustly Related to Depression, Anxiety, and Mania Than Measures of Rumination or Worry

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Effects of Cognitive Restructuring and Defusion for Coping with Difficult Thoughts in a Predominantly White Female College Student Sample

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Abstract

Background

Methods

Results

Conclusions

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Higher Order Repetitive Negative Thinking Is More Robustly Related to Depression, Anxiety, and Mania Than Measures of Rumination or Worry

Empathic Communication Among Women with High or Low Social Anxiety

Effects of Cognitive Restructuring and Defusion for Coping with Difficult Thoughts in a Predominantly White Female College Student Sample

More and Better: Reappraisal Quality Partially Explains the Effect of Reappraisal Use on Changes in Positive and Negative Affect

The Reliability and Validity of Response-Based Measures of Attention Bias

Posttraumatic Stress Disorder and Pain in Veterans: Indirect Association Through Anxiety Sensitivity