A review of the inclusion of ethnoracial groups in empirically supported posttraumatic stress disorder treatment research (Psychological Trauma: Theory, Research, Practice, and Policy)

A review of the inclusion of ethnoracial groups in empirically supported posttraumatic stress disorder treatment research

This study assessed ethnoracial representation in United States-based randomized controlled trials (RCTs) for three evidence-based treatments for posttraumatic stress disorder (PTSD)—Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye-Movement Desensitization and Reprocessing (EMDR).

Article Abstract

“Objective: Empirically supported treatments (ESTs) have been criticized for lack of ethnoracial representation, which may limit the generalizability of findings for non-White patients. This study assessed ethnoracial representation in United States-based randomized controlled trials (RCTs) for three evidence-based treatments for posttraumatic stress disorder (PTSD)—Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye-Movement Desensitization and Reprocessing (EMDR).

Method: Representation was measured by explicit inclusion of people of color in published PTSD RCTs. Follow-up emails were sent to corresponding authors if full demographic information was not included in the reviewed manuscripts. Information concerning participant remuneration was collected for descriptive purposes.

Results: All three treatment modalities reported White participants as the majority in their sample. PE and CPT trials reported similar levels of ethnoracial diversity, while EMDR efficacy studies reported the least ethnoracial diversity. Across the reviewed studies, with few exceptions, we found low numbers of non-White participants in the majority of reviewed studies, which was compounded by poor or unclear methods of reporting ethnoracial information.

Conclusions: This study demonstrates that the ESTs for PTSD are not adequately representative of the majority of non-White participants. Future RCTs should place a stronger emphasis on broad ethnoracial diversity in study participants to improve generalizability of findings.

Impact Statement: This study highlights a concerning lack of ethnoracial representation in PTSD clinical trials for commonly used, evidence-based PTSD treatments. This lack of ethnoracial representation impairs our ability to detect cross-cultural differences in treatment response and offer culturally sensitive, evidence-based PTSD treatment. We encourage researchers to explicitly include larger numbers of non-White participants in PTSD clinical trials and to conduct analyses to detect ethnoracial differences in both symptom presentation and treatment response. “

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Grau, P. P., Kusch, M. M., Williams, M. T., Loyo, K. T., Zhang, X., Warner, R. C., & Wetterneck, C. T. (2022). A review of the inclusion of ethnoracial groups in empirically supported posttraumatic stress disorder treatment research. Psychological Trauma: Theory, Research, Practice, and Policy, 14(1), 55-65. https://doi.org/10.1037/tra0001108

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A review of the inclusion of ethnoracial groups in empirically supported posttraumatic stress disorder treatment research (Psychological Trauma: Theory, Research, Practice, and Policy)