Race-Based Stress Trauma and Empowerment (RBSTE)

Fostering Resilience to Race-Based Stress: A Pilot Study

The existence of racially/ethnically based health disparities is well established, both within the civilian community and among Service Members and Veterans. Experiences of discrimination are acute and chronic stressors that substantially contribute to greater emotional distress, poorer health behavior, lower healthcare utilization and increased allostatic load, all of which undermine well-being, functioning and Whole Health. An innovative clinical program, the Race-Based Stress/Trauma and Empowerment (RBSTE) group, was developed to help Veterans of Color to build coping resources and empowerment. Although qualitative data suggest the promise of this intervention, systematic evaluation is lacking. The proposed feasibility project will lay the groundwork for a future randomized controlled trial to evaluate RBSTE as compared to a control group in terms of Whole Health, functioning and mental/physical wellness. The project thus begins a program of research to address the health implications of systemic racism.

Study Overview

• Status: Completed
• Conditions: Racism; Life Stress
• Intervention / Treatment: Behavioral: RBSTE; Behavioral: PCT

Detailed Description

Health disparities between White and Black, Indigenous and People of Color (BIPOC) are well documented in the United States; this phenomenon is driven in part by discrimination experiences and is an important contributor to well-being and functioning, including among military service members and Veterans. The chronic stress of racism has both psychological and physiological effects. Discrimination is associated with increased psychological distress, including higher rates of PTSD among Veterans of Color (VOC), poorer health behavior and decreased healthcare utilization. Race-based stress is also linked to increased allostatic load (AL), which is a measurable index of wear-and-tear on the body due to chronic stress exposure that is associated with greater disease burden and mortality. Recognizing the unmet need for interventions to help VOC process and cope with experiences of discrimination, the Race-based Stress/Trauma and Empowerment (RBSTE) intervention (Carlson, Endsley, Motley, Shawahin, & Williams, 2018) was developed. RBSTE is a group-based approach that combines cultural adaptations of established psychotherapeutic techniques with novel strategies to foster resilience and empowerment for VOC. Initial qualitative data suggests the promise of this approach, but no systematic data are yet available to determine whether or not RBSTE is achieving its goals of enhancing coping and restoring well-being. The proposed project is a pilot randomized controlled trial (RCT) with multi-modal longitudinal assessment. Participants will be recruited from VA facilities and the surrounding community. VOC who report race-based stress, with minimal exclusions, will be evaluated at baseline, randomized in groups to one of two wellness interventions and then re-evaluated immediately after treatment. The interventions include RBSTE and Present Centered Therapy (PCT), designed to control for nonspecific aspects of RBSTE, including support and participation in an all-BIPOC group. The interventions will be delivered in 8 weekly 90-minute group sessions by a trained mental health professional using videoconferencing. The aims of the project are (1) to assess the feasibility of recruiting VOC for an RCT of this nature; (2) to examine the acceptability and appropriateness of intervention content, the feasibility of participation, and participant's perceptions of provider behavior and attitudes; and (3) to establish the optimal strategy for quantifying mental and physical health outcomes for future studies. Thus, the project will set the stage for evaluation of RBSTE's efficacy and ultimately implementation. This critically important program of research will provide guidance as to best practices for the management of race-based stress, with the ultimate goal of eliminating health disparities for Veterans and the community more broadly.

• Study Type: Interventional
• Enrollment (Actual): 37
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • San Diego, California, United States, 92161-0002
      • VA San Diego Healthcare System, San Diego, CA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• self-identified as a BIPOC
• Veteran
• able to consent to study activities
• endorsing one or more perceived discrimination experiences on the Everyday Discrimination Form (short version) or the Major Experiences of Discrimination Scale (abbreviated version) "a few times a year" or more frequently and endorsing stress on a validated single-item measure

Exclusion Criteria:

• serious mental illness, alcohol/substance use disorders, or cognitive impairment that may interfere with the ability to benefit from group

  • (e.g., severe depression, psychotic illness, mania, dementia, untreated alcohol/substance dependence)
• serious suicidality or homicidality (e.g., ideation with plan/intent) that is likely to require urgent/emergent intervention within the study period

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: RBSTE; 8-week health promotion group focused on supporting coping with racism and empowerment	Behavioral: RBSTE; 8-week health promotion group focused on supporting coping with racism and empowerment
Active Comparator: PCT; 8-week health promotion group focused on providing support and facilitating problem solving	Behavioral: PCT; 8-week health promotion group focused on providing support and facilitating problem solving; Other Names: Present Centered Therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability of Intervention Measure (AIM)	Perceived acceptability of the interventions by participants AIM range 4-20 with greater scores indicating better acceptability	week 8
Intervention Appropriateness Measure (IAM)	Perceived appropriateness of the interventions by participants IAM range 4-20 with greater scores indicating better appropriateness	week 8
Feasibility of Intervention Measure (FIM)	Perceived feasibility of the interventions by participants FIM range 4-20 with greater scores indicating better feasibility	week 8
Enrollment Rate	Percentage of individuals enrolled out of total contacted	week 0
Initiation Rate	Percentage of subjects who initiate any intervention among all enrolled subjects	week 1
Per Protocol Completion	Percentage of subjects who complete 5 or 6 sessions of intervention among those who start the intervention	week 8
Intent-to-treat Completion	Percentage of subjects who complete 5 or 6 sessions of intervention among all randomized subjects	week 8

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brief Personal Health Inventory (B-PHI): Physical Health	self-appraisal of physical well being range 1-5 with higher scores indicating better health	change from week 1 to week 8
Brief Personal Health Inventory (B-PHI): Mental Health	self-appraisal of mental well being range 1-5 with higher scores indicating better mental health	change from week 1 to week 8
Brief Personal Health Inventory (B-PHI): Daily Living	self-appraisal of daily living range 1-5 with higher scores indicating better daily living	change from week 1 to week 8

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Ariel J. Lang, PhD, VA San Diego Healthcare System, San Diego, CA

Publications and helpful links

General Publications

• Wang C, Malaktaris A, McLean CL, Kelsven S, Chu GM, Ross KS, Endsley M Jr, Minassian A, Liu L, Hong S, Lang AJ. Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention. Contemp Clin Trials. 2023 Apr;127:107118. doi: 10.1016/j.cct.2023.107118. Epub 2023 Feb 14.

Study record dates

Study Major Dates

• Study Start (Actual): January 2, 2023
• Primary Completion (Actual): September 30, 2024
• Study Completion (Actual): December 31, 2024

Study Registration Dates

• First Submitted: June 13, 2022
• First Submitted That Met QC Criteria: June 13, 2022
• First Posted (Actual): June 16, 2022

Study Record Updates

• Last Update Posted (Actual): December 29, 2025
• Last Update Submitted That Met QC Criteria: December 8, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Health promotion; Randomized controlled trial; Life stress; Racism
• Additional Relevant MeSH Terms: Behavioral Symptoms; Behavior; Social Behavior; Prejudice; Social Discrimination; Stress, Psychological; Racism
• Other Study ID Numbers: D4070-P; 1I21RX004070-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No