🧪 Most cognitive-behavior treatments for mood & anxiety, including the Unified Protocol (UP), lead to similar outcomes for people from different racial/ethnic backgrounds. But are the processes of change the same? We (Alex Urs, @shannonsauerzavala.bsky.social, & Tom Adams) investigated. 🧵 - ThreadSky

mattsouthward.bsky.social • 74 days ago

🧪 Most cognitive-behavior treatments for mood & anxiety, including the Unified Protocol (UP), lead to similar outcomes for people from different racial/ethnic backgrounds.

But are the processes of change the same?

We (Alex Urs, @shannonsauerzavala.bsky.social, & Tom Adams) investigated. 🧵

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mudassar444.bsky.social•74 days ago

Exploring the processes of change across diverse backgrounds is such a crucial step

mattsouthward.bsky.social•74 days ago

We looked at this in the first 6 sessions of our UP SMART among 70 adults with anxiety & mood disorders:
- 74% white (n = 52)
- 13% Black (n = 9)
- 4% East Asian (n = 3)
- 3% Latinx (n = 2)
- 3% South Asian (n = 2)
- 3% Arab-American/Middle Eastern (n = 2)

mattsouthward.bsky.social•74 days ago

Because of those percentages, for statistical power we dichotomized our sample into white patients/patients of color, with clear caveats about the limitations regarding generalizability, applicability to different populations, etc.

mattsouthward.bsky.social•74 days ago

Replicating previous work, we did *not* find significant differences in the slopes of change in anxiety 😬 or depression 😔 between white patients & patients of color, although the group differences in anxiety change were nearly significant: B = .27, SE = .15, p = .08. 👀

mattsouthward.bsky.social•74 days ago

Where we *did* find differences were in changes specifically in task agreement (from the working alliance inventory) 🤝 and skillfulness 🛠️, with white patients reporting steeper improvements in both than patients of color across the first 6 sessions.

mattsouthward.bsky.social•74 days ago

Now, racial/ethnic identity did *not* moderate the within-person relations between task agreement/skillfulness and session-to-session symptom change (maybe a power issue, maybe a true null).

mattsouthward.bsky.social•74 days ago

We think these results suggest that people with different racial/ethnic backgrounds use different processes of change in the UP, at least with primarily white therapists.

If we want folks to use skills, we may need to modify how we delivery them to make them more relevant.

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