Black youth from racist communities less likely to benefit from psychotherapy
A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that young Black people living in communities with high (vs. low) anti-Black racism are less likely to benefit from psychotherapy (“talk therapy”; such as therapy cognitive-behavioral).
Racism is a system that labels and categorizes racial groups, viewing specific groups as inferior and providing them with fewer opportunities and resources. Racism exists at different levels: internal (eg, low self-esteem due to the internalization of racial stereotypes), interpersonal (eg, being called a racist slur), and structural (eg, attitudes and laws/policies that impede the well-being of people of color, such as redlining policies). Previous studies have found that anti-Black racism at all three levels is linked to poorer mental health in black people, although few have examined whether racism affects intervention effectiveness (i.e. i.e. how beneficial an intervention, such as psychotherapy or medication, is).
This meta-analytic study – led by Dr. Maggi Price, assistant professor at the Boston College School of Social Work – is the first to assess whether structural racism is associated with the effectiveness of mental health treatments. Specifically, the research team used publicly available data on anti-Black racist attitudes to create a measure of structural racism at the state level and analyzed randomized controlled trial data from studies of psychotherapy with predominantly black youth (36 RCTs representing N = 2182 youth).
Dr. Price and his team found that psychotherapies in states with higher (vs lower) levels of anti-black racism were less effective.
While summarizing the main finding of the study, Dr Price said: “The extent to which racism or other harmful attitudes are endorsed in any given community – such as a neighborhood or state – varies across the country. Our study found that the level of racism in one’s community affects how successful one is in dealing with mental health.”
Dr. Price and colleagues conducted a similar study on structural sexism and found that girls living in places with more (vs less) sexism also had worse treatment outcomes. Asked about the implications of these studies for mental health care providers, Dr Price said that since “identity and stigma are at the heart of an individual’s well-being – and apparently help to explain in which extent one responds to mental health treatment – practitioners should fight against stigma in treatment.”
Providers should also embed advocacy into their practice by recognizing and working to reduce sexism and racism in their patients’ environments. Some examples might include advocating for changes in school policies to eliminate racist disciplinary practices or incorporating implicit bias training to help teachers be more aware of their biases.
Dr. Maggi Price, Assistant Professor, Boston College School of Social Work
Dr. Price concluded with a call to improve provider training and education: “Many training programs do not prepare providers to adequately address stigma and identity with patients. We need to improve training in culturally appropriate care, including how to address racism, sexism, and other treatment stigmas. This is essential and will help us better serve our patients. »
Price, MA, et al. (2022) Meta-analysis: Are psychotherapies less effective for black youth in communities with higher levels of anti-black racism?. Journal of the American Academy of Child and Adolescent Psychiatry. doi.org/10.1016/j.jaac.2021.07.808.