Cultural identity and race-based stress and trauma shape beliefs about self, others, and the world.

• Beliefs may seem “problematic” when evaluated outside the context of a client’s culture, leading to pathologizing cultural values and norms (e.g., individualistic cultures encourage independence, assertiveness, and individuality whereas collective cultures encourage respect, trust, and social harmony in relationships). A few examples:
  • An Asian client who believes that disagreeing with family is disrespectful may not be struggling with assertiveness, but honoring norms on respect and family harmony
  • A Latinx client’s belief that they should prioritize family over self may reflect collectivist values instead of individualistic values (e.g., familismo often prioritizes loyalty to family members interests above personal interests; Rosselló et al., 2008)
• Approach discussions of race-based stress and trauma with curiosity, humility, and respect for the client’s lived experiences (e.g., Does this feel helpful to talk about?)
• Validate reactions to race-based stress and trauma, as these are sensible responses to actual or perceived threats based on one’s history, identity, and sociocultural context
• Avoid challenging or questioning interpretations (“negative automatic thoughts”) of whether an experience qualified as race-based stress and trauma (e.g., a Black client struggles to attend meetings due to worries about his boss saying something racist to him), as interpretations may be accurate and/or protective reactions to oppression and challenging them can enact invalidate, racism, and harm therapeutic alliance (Graham et al., 2016)

When examining the purpose of beliefs, use terms such as helpful or unhelpful beliefs instead of adaptative/maladaptive or rational/irrational to describe beliefs (Organista & Muñoz, 1996)

Internalized racism refers to stigmatizing and devaluing beliefs about one’s racial/ethnic group

• Internalized racism can lead to beliefs on inferiority, inadequacy, personal blame, powerlessness, and belief in a just world (Steele, 2024)
• These beliefs (e.g., inadequacy) can create rigid rules (e.g., I must work twice as hard to be seen as competent), reinforce unhelpful coping behaviors (e.g., overworking to prove worth to an employer) to control perceived deficits, and contribute to negative quality of life (e.g., burnout) in people of color (Steele, 2024)

Label race-based stress and trauma to create distance from internalized racist beliefs

• Describe the effects of racism on thoughts and beliefs about oneself, others, and the world to shift mindsets and reduce the negative effects of racism (Williams et al., 2020)
• It can be helpful to externalize race-based stress and trauma experiences caused by oppression versus inherent meaning about the person (e.g., “I am powerless”  “I am having the thought I am powerless because of unfair racist events”) 

Validate that all reactions to race-based stress and trauma are understandable (e.g., It makes sense you felt anxious when the store manager followed you around the store).

Instead of challenging thoughts or beliefs associated with racial/ethnic identities (e.g., People treat me as I don’t belong because I am Latinx), focus on helping clients understand that meaning-making from race-based stress and trauma shapes beliefs about oneself, others, and the world:

• To build insights to how racism contributes to their problems, ask clients:
  • (1) why certain thoughts or beliefs may be rooted in racist experiences (e.g., being repeatedly asked “Where are you really from?” may make someone question their belonging in society)
  • (2) how the broader sociocultural context reinforces these thoughts or beliefs (e.g., negative portrayals of Latino/a individuals in the media or harmful immigration policies that contribute to a sense of exclusion or dehumanization)
• Encourage reflection on origins of internalized racism beliefs (Steele, 2024):
  • “Let’s take a look at where some of these painful beliefs may have come from. They might not be beliefs you chose, as they could be messages from personal experiences or societal messages that have stayed with you. When we hear negative messages about our racial and ethnic groups repeatedly, we can start to believe them, even if they’re not true. That can really affect how we see ourselves and how we move through the world.”
    • “Where do you think you first learned these messages?”
    • “How were they reinforced in your past or current experiences?”
    • “What are the stereotypes associated with your racial/ethnic group?”
    • “How do these stereotypes affect the way you see yourself and others?”
• Clarify that clients are not to blame for experiences of race-based stress and trauma
  • Explain that exposure to race-based stress and trauma is not caused by personal flaws or deficiencies but is rooted in interpersonal and systemic racism to reduce harmful internalization of these events (e.g., “It is common for people to blame themselves for race-based stress and trauma. Sometimes people have thoughts like ’I should/could have done something to prevent it’. These experiences are not your fault. They are caused by larger systems of racism, not by something you did or didn’t do, and not because there’s anything wrong with you.”; Carlson et al., 2018)

When introducing common “Thinking Traps”, it is critical to share that “Jumping to Conclusions” or “Thinking the Worst” may be shortcuts for survival (e.g., An Asian client catastrophizes about food insecurity due to environmental racism, increasing urgency to stockpile food and reduce spending to cope with threats). Discuss helpful versus limiting thinking styles:

• “Thinking the Worst has helped you prepare for threats to your family. When has this thinking style made it harder for you? Has it undermined your ability to handle stress?”)

When identifying and challenging beliefs (e.g., using the “Identifying and Evaluating Automatic Appraisals” or “Downward Arrow” tools), it can be helpful to look at how certain beliefs work for or work against clients. Encourage clients to reflect on their beliefs (e.g., You’re in charge of deciding if and when it might help to work on finding more balanced or flexible ways of thinking”):

• “Are there times when this belief actually helps me or keeps me safe?”
• “Are there times when this belief gets in the way or holds me back?”
• “If I relaxed beliefs that limit me in situations that are objectively safe, what may I learn?”

Guide clients in assessing what meaning they formed about themselves due to the race-based stress and trauma (e.g., What did the racist experience mean about you?) and identify alternative thoughts or beliefs that are more helpful by highlighting their personal strengths and the role of the external context of structural racism causing these events (Graham et al., 2016):

• “How would you label your and the person’s stage of racial/ethnic identity development?”
• “How might systemic racism be shaping how you’re being treated?
• “What does the person’s actions mean about them rather than you?”
• “What strengths and values have helped you succeed despite these challenges?”
• “If you could talk to a loved one in your shoes, what would you say?”

Addressing the impact of racism on veterans of color: A race-based stress and trauma intervention. Psychology of violence, 8(6), 748-762.

The mediating role of internalized racism in the relationship between racist experiences and anxiety symptoms in a Black American sample. Cultural Diversity & Ethnic Minority Psychology, 22(3), 369-376.

Cognitive behavioral therapy with Latinos. Cognitive and Behavioral Practice, 3(2), 255-270.

Healing from racial stress/trauma: A race-based stress/trauma and empowerment (RBSTE) group intervention manual. Adapted from “Addressing the impact of racism on veterans of color: A Race-Based Stress & Trauma Intervention,” by M. Carlson, M. Endsley, D. Motley, L. N. Shawahin, M. T. Williams, (2018). Adapted with permission. San Antonio, TX: South Texas Veterans Health Care System.

Individual and group CBT and IPT for Puerto Rican adolescents with depressive symptoms. Cultural Diversity & Ethnic Minority Psychology, 14(3), 234-245.

Racism and African American mental health: Using cognitive behavior therapy to empower healing. Taylor & Francis. 

Reducing microaggressions and promoting interracial connection: The racial harmony workshop. Journal of Contextual Behavioral Science, 16, 153-161.