Fostering Resilience to Race-Based Stress: A Pilot Study

培养对种族压力的适应能力：一项试点研究

• 批准号: 10579114
• 负责人: Ariel J Lang
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10579114
• 关键词: Acute; Address; Aftercare; Atmosphere; Attitude; Black, Indigenous, People of Color; Caring; Chronic; Chronic stress; Clinical; Color; Communities; Data; Discrimination; Evaluation; Exclusion; Fostering; Future; Goals; Health; Health behavior; Human Resources; Human Rights; Individual; Institutional Racism; Intervention; Link; Measurable; Measurement; Mental Health; Military Personnel; Nature; Occupational; Outcome; Participant; Perception; Personal Satisfaction; Physiological; Physiology; Pilot Projects; Population; Post-Traumatic Stress Disorders; Practice Management; Preparation; Process; Provider; Psyche structure; Psychotherapy; Race; Randomized; Randomized Controlled Trials; Reporting; Research; Research Misconduct; Resources; Role; Shoulder; Stress; Techniques; Therapeutic; Time; Training; Trauma; United States; Veterans; Videoconferencing; allostatic load; base; burden of illness; coping; efficacy testing; emotion regulation; emotional distress; empowerment; experience; functional restoration; health care availability; health care service utilization; health disparity; high risk; improved; indexing; innovation; intervention effect; military service; military veteran; mortality; multimodality; novel strategies; participant retention; people of color; perceived discrimination; physical conditioning; programs; provider behavior; psychologic; psychological distress; psychosocial; racial and ethnic; racial discrimination; racism; randomized trial; recruit; resilience; service member; socioeconomic disadvantage; socioeconomic disparity; sound; stress management; stressor; therapy design; trial comparing

Health disparities between White and Black, Indigenous and People of Color (BIPOC) are well documented in the United States; this phenomenon is driven in part by discrimination experiences and is an important contributor to well-being and functioning, including among military service members and Veterans. The chronic stress of racism has both psychological and physiological effects. Discrimination is associated with increased psychological distress, including higher rates of PTSD among Veterans of Color (VOC), poorer health behavior and decreased healthcare utilization. Race-based stress is also linked to increased allostatic load (AL), which is a measurable index of wear-and-tear on the body due to chronic stress exposure that is associated with greater disease burden and mortality. Recognizing the unmet need for interventions to help VOC process and cope with experiences of discrimination, the Race-based Stress/Trauma and Empowerment (RBSTE) intervention (Carlson, Endsley, Motley, Shawahin, & Williams, 2018) was developed. RBSTE is a group-based therapy that combines cultural adaptations of established psychotherapeutic techniques with novel strategies to foster resilience and empowerment for VOC. Initial qualitative data suggests the promise of this approach, but no systematic data are yet available to determine whether or not RBST E is achieving its goals of enhancing coping and restoring well-being. The proposed project is a pilot randomized controlled trial (RCT) with multi-modal longitudinal assessment. Participants will be recruited from VA facilities and the surrounding community. VOC who report race-based stress, with minimal exclusions, will be evaluated at baseline, randomized in groups to one of two therapy conditions and then re-evaluated immediately after treatment. The treatments include RBSTE and a non-specific psychotherapy control, Present Centered Therapy (PCT), designed to control for nonspecific aspects of RBSTE, including support and participation in an all-BIPOC group. The interventions will be delivered in 8 weekly 90-minute group sessions by a trained therapist using videoconferencing. The aims of the project are (1) to assess the feasibility of recruiting VOC for an RCT of this nature; (2) to examine the acceptability and appropriateness of treatment content, the feasibility of participation, and participant’s perceptions of provider behavior and attitudes; and (3) to establish the optimal strategy for quantifying mental and physical health outcomes for future studies. Thus, the project will set the stage for evaluation of RBSTE’s efficacy and ultimately implementation. This critically important program of research will provide guidance as to best practices for the management of race-based stress, with the ultimate goal of eliminating health disparities for Veterans and the community more broadly.

白人与黑人、原住民与有色人种 (BIPOC) 之间的健康差异在《 美国；这种现象部分是由歧视经历造成的，是一个重要的原因 为福祉和功能做出贡献，包括军人和退伍军人。 种族主义压力具有心理和生理影响，与歧视的增加有关。 心理困扰，包括有色人种退伍军人 (VOC) 的 PTSD 发生率较高、健康行为较差 种族压力也与非稳态负荷（AL）增加有关。 是由于与以下因素相关的慢性压力暴露而导致的身体磨损的可测量指数 认识到帮助 VOC 处理和治疗的干预措施的需求尚未得到满足。 应对歧视经历、基于种族的压力/创伤和赋权 (RBSTE) 干预（Carlson、Endsley、Motley、Shawahin 和 Williams，2018）是基于团体的 RBSTE。 将现有心理治疗技术的文化适应与新颖策略相结合的疗法 增强 VOC 的复原力和赋权 初步定性数据表明了这种方法的前景， 但目前还没有系统数据来确定 RBST E 是否实现了其目标 增强应对能力并恢复健康 拟议项目是一项试点随机对照试验（RCT）。 将从 VA 设施及周边地区招募参与者。 报告基于种族的压力的 VOC 社区，将在基线上进行评估， 随机分组接受两种治疗条件之一，然后在治疗后立即重新评估。 治疗方法包括 RBSTE 和非特异性心理治疗控制、当前中心治疗 (PCT)、 旨在控制 RBSTE 的非特定方面，包括支持和参与全 BIPOC 干预措施将由训练有素的治疗师通过每周 8 次、每次 90 分钟的小组课程进行。 该项目的目的是 (1) 评估为此 RCT 招募 VOC 的可行性。 （2）审查处理内容的可接受性、适当性、可行性； 参与，以及参与者对提供者行为和态度的看法；以及 (3) 建立最佳的 因此，该项目将制定量化未来研究的心理和身体健康结果的策略。 评估 RBSTE 的功效并最终实施这一至关重要的计划。 研究将为管理种族压力的最佳实践提供指导，最终结果是 消除退伍军人和更广泛社区的健康差距的目标。