Fostering Resilience to Race-Based Stress: A Pilot Study

白人和黑人、土著和有色人种之间的健康差异(BIPOC)在 美国；这一现象在一定程度上是由歧视经历推动的，是一个重要的 为包括军人和退伍军人在内的福祉和职能作出贡献。慢性病患者 种族主义压力既有心理影响，也有生理影响。歧视与更多的 心理困扰，包括退伍军人(VOC)创伤后应激障碍(PTSD)发生率较高，健康行为较差 并降低了医疗保健利用率。基于种族的压力也与增加的不平衡负荷(AL)有关，这 是身体因长期应激暴露而产生的磨损的可测量指标，这与 更大的疾病负担和死亡率。认识到未得到满足的干预需求，以帮助VOC进程和 应对歧视、基于种族的压力/创伤和赋权(RBSTE)的经历 制定了干预措施(Carlson，Endsley，Motley，Shawahin，&Williams，2018)。RBSTE是一种基于组的 将既有心理治疗技术的文化适应与新策略相结合的疗法 培养VOC的复原力和赋权。最初的定性数据表明了这种方法的前景， 但目前还没有系统的数据来确定RBST E是否正在实现其目标 加强应对，恢复幸福感。建议的项目是一项试点随机对照试验(RCT)。 具有多模式纵向评估。参与者将从退伍军人管理局设施和周围地区招募 社区。报告种族压力的VOC将在基线上进行评估，排除的可能性最小， 随机分组到两种治疗条件中的一种，然后在治疗后立即重新评估。这个 治疗包括RBSTE和非特异性心理治疗对照，呈现中心治疗(PCT)， 旨在控制RBSTE的非特定方面，包括支持和参与全BIPOC 一群人。干预措施将由训练有素的治疗师在每周8次90分钟的小组会议中进行，使用 视频会议。该项目的目标是(1)评估招募VOC进行RCT的可行性 (2)为审查处理内容的可接受性和适当性， 参与，以及参与者对提供者行为和态度的感知；以及(3)建立最优 为未来研究量化心理和身体健康结果的战略。因此，该项目将设置 评估RBSTE的有效性并最终实施的阶段。这一至关重要的计划 研究将为管理基于种族的压力的最佳做法提供指导，最终 目标是消除退伍军人和更广泛社区的健康差距。

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.