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.
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Notes
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.
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Acknowledgements
We would like to thank Dr. Robert J. DeRubeis for his helpful comments on a draft of this paper.
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Ezawa, I.D., Strunk, D.R. Differences in the Delivery of Cognitive Behavioral Therapy for Depression When Therapists Work with Black and White Patients. Cogn Ther Res 46, 104–113 (2022). https://doi.org/10.1007/s10608-021-10254-0
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DOI: https://doi.org/10.1007/s10608-021-10254-0