Cultural Competence Within Behavioral Medicine: Culturally Competent CBT with Diverse Medical Populations

Health disparities negatively impact the physical and mental health outcomes of diverse groups. Though more attention has been given to address this issue in the past decade, within behavioral medicine there continue to be limited resources available to address disparities. Cultural competence is a core component necessary for the provision of appropriate care, and a potential tool that can guide the development of clinical care and research. Within behavioral medicine, cultural competence involves knowledge and tools that can be utilized to provide effective care at the intersection of physical and mental health across diverse populations. In this chapter, we begin by discussing the need for cultural competence within behavioral medicine in the context of specific ethno-cultural groups and health disparities. Next we provide evidence base for cultural competence in cognitive behavioral interventions addressing diverse groups with medical conditions, linking these to tools to enhance Cognitive Behavioral Therapy (CBT). We then define cultural competence and provide a framework for addressing cultural competence, including examples of frequently used tools. Finally we provide a case illustration highlighting the application of cultural competence to CBT for the treatment of depression in a Latina woman living with HIV

Optimizing adherence to preexposure and postexposure prophylaxis: the need for an integrated biobehavioral approach

Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) has been shown to be effective in preventing transmission of human immunodeficiency virus (HIV). A dose-response relationship between adherence and HIV transmission is illustrated in the current PrEP literature, and adherence interventions for PrEP may be useful, although currently few effective programs have been developed and tested. There is a paucity of randomized controlled trials testing PEP adherence interventions, and further research is needed. We conclude by proposing the importance of tailoring adherence counseling to address psychosocial factors and mental health stressors that may negatively affect adherence

Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories.

High rates of depression and posttraumatic stress disorder (PTSD) contribute to sexual risk, particularly in men who have sex with men (MSM) who have experienced childhood sexual abuse. The comorbidity between depression and PTSD and mechanisms by which they contribute to sexual risk in MSM remain unclear. This study sought to demonstrate the feasibility and utility of a network approach to (a) characterize symptom interconnections between depression and PTSD in MSM, (b) identify specific symptoms related to sexual risk behavior, and (c) compare symptom networks across groups at different levels of risk. Cross-sectional baseline data were collected from 296 HIV-negative urban MSM as part of a multisite randomized intervention trial. Symptoms of depression and PTSD were self-reported along with sexual risk behavior. Analyses were performed in R using regularized partial correlation network modeling. Network analyses revealed complex associations between depression and PTSD symptoms and in relation to sexual risk behavior. While symptoms clustered within their respective disorders, depression and PTSD were connected at key symptom nodes (e.g., sleep, concentration). Specific symptoms (e.g., avoiding thoughts and feelings) were linked to sexual risk behavior. Network comparisons across risk groups suggested avoidant processes could be more readily activated in higher-risk individuals, whereas hyperarousal symptoms may be more salient and protective for lower-risk individuals. This study is one of the earliest network analyses of depression and PTSD, and first to extend this inquiry to health behavior. Symptom-level investigations may clarify mechanisms underlying psychological comorbidity and behavioral risk in MSM and refine targets for intervention/prevention. (PsycINFO Database Recor