Explore the client’s cultural background by asking questions to understand whether specific cultural values, norms, or beliefs resonate with their lived experiences to minimize overgeneralization or imposing cultural explanations (e.g., you might ask a Puerto Rican woman whether traditional cultural norms around gender roles, such as men being viewed as having more authority than women, have influenced her relationships or experiences; Graham et al., 2013)

Collaboratively develop emotion exposures that honor the client’s values and agency (e.g., a Puerto Rican woman who has cultural beliefs around male authority may not want to be assertive in dating situations with men. However, she may want to be empowered by speaking up more in academic settings, such as participating in a class led by a male professor; Graham et al., 2013)

Acknowledge the possibility of race-based stress and trauma occurring in emotion exposures 

Encourage and prepare clients to cope with the effects of race-based stress and trauma in life:

• Community Connection: Social events or spaces associated with racial and ethnic identities (e.g., churches, community events or centers, affinity groups) can increase a sense of belonging and identity empowerment to buffer against race-based stress and trauma (Holder et al. 2015, Noh & Kaspar, 2003; Quaye et al. 2019).
• Self-Compassion: Compassion-focused practices and groups (e.g., mindfulness, yoga meditation, journaling) can reduce distress, shame, and internalized racism (Banks et al., 2021; Hwang & Chan, 2019; Liu et al. 2020). Self-compassion can also include self-care practices (Holder et al. 2015, Quaye et al. 2019): (1) unplugging or disconnecting from people and places that made them feel fatigued (e.g., social media, news, and non-Hispanic White people), (2) finding or connecting with physical or virtual community (e.g., family, friends, other people of color, and/or White allies), (3) attending to one’s body (e.g., physical movement practices, breathing exercises), (4) engaging in therapy with providers who have cultural humility and sensitivity around the impact of race-based stress and trauma, and (5) exploring family narratives, heritage/traditions/lineage, and ancestral struggles. 
• Expressive Writing: Private writing about emotional experiences may reduce emotional distress from stressful or traumatic experiences (e.g., racism), especially for communities where open emotional expression is discouraged (Hirai et al. 2012; Tavakoli et al., 2009).
• Activism: Involvement in activism focused on meaningfully causes can be a way to express emotions (e.g., anger at injustice) in collective spaces and increase a sense of control and self-esteem (Carlson et al., 2018). Activism can range on a spectrum based on time commitment, resources, and skills: donating, writing a post, volunteering, contacting political leaders, starting a petition, protesting, etc. Acknowledge that activism can be protective for some people of color but may also increase distress if not balanced with self-care practices due to activism burnout or exposure to stressful experiences (Heard-Garris et al. 2021).

• Work with the client to choose emotion exposures on their hierarchy that build confidence and ability to tolerate uncomfortable emotions, as well as explore predictions about what might happen and their ability to cope
• Clarify what the patient hopes to learn or practice through the exposure (e.g., reduce shame and build pride in one’s racial and ethnic identity by attending a community event)

• Emphasize the client’s personal choice to choose emotion exposures aligned with their goals, as some clients of color may feel pressured to do exposures that are “prescribed” by authority figures: “This is your choice to decide on exposures that expand your world and coping abilities. We’ll work on exposures that feel aligned with your values, not what others think you should do.”
• Choose emotion exposures that are objectively safe (i.e., asking clients to evaluate safety) and values-consistent (i.e., identifying meaningful qualities that a client wants to behave or act upon on an ongoing basis) for clients of color. Ask clients:
  • Safety: Would others in your community view this emotion exposure as emotionally or physically threatening, dangerous, and/or invalidating based on your identity?
  • Values: Is this emotion exposure connected to a value you want to live by (e.g., respect, compassion, connection or community, family, cultural pride, advocacy)?
• Identify alternative actions to uncomfortable emotions that support safety and agency 
  • Shame: An Asian client chooses to wear cultural attire (e.g., a kurta) to a social event after years of avoiding it due to fears of being seen as “too different.” This action reflects a step toward embracing cultural pride and gently challenging internalized shame by affirming their heritage in a way that feels right for them.
  • Guilt: A Latinx client decides to stay in therapy to support themselves and be more effective in their family relationships despite messaging that “seeking help means airing the family’s dirty laundry.” This choice reflects care for their own mental well-being and a courageous step toward breaking intergenerational patterns of emotional silence while still honoring the importance of family.
  • Sadness: A Black client returns to church services after taking space to grieve in response to ongoing racial violence impacting Black communities of faith. This action reflects a desire for healing, collective support, and connection to traditions that have long offered resilience and strength.
  • Fear/Anxiety: An Asian client begins to speak more openly in classroom discussions at a predominantly White university after staying silent out of fear of saying the “wrong thing” and being devalued as a minority. This aligns with their value of self-expression and personal growth and represents an intentional effort to use their voice in settings where they have not always felt fully seen or heard.

• Frame emotion exposures as building resilience and self-efficacy in real-world settings that may include race-based stress and trauma rather than minimizing, denying, or ignoring race-based stress and trauma 
• Guide patients in preparing for the possibility of identity-related aggressions
  • Explore how to cope with distress if these occur by creating a plan that supports personal safety and boundaries (e.g., “Even though my teacher mispronounced my name again, I corrected them because respecting my identity matters to me.”)
  • Reinforce engaging in values-aligned and self-protective strategies, such as self-validation to affirm their own experience of a racist situation rather than second-guessing its validity, setting limits and walking away to preserve emotional resources and let go of the burden to educate others, educating others only if it aligns with their values, emotional capacity, and the other person is receptive, etc.
  • Encourage ongoing coping strategies to reduce the negative effects of racism such as community connection, self-compassion, expressive writing, and activism.

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

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An investigation of the efficacy of online expressive writing for trauma-related psychological distress in Hispanic individuals. Behavior Therapy, 43(4), 812–824.

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