PART A: A compassion-focused approach to understand threats faced by Black British Caribbean youth: A Conceptual Review

Introduction: Black British Caribbean youth are particularly vulnerable to emotional dysregulation due to inherited stress sensitivity and repeated exposure to racial threats, leading to heightened threat responses. Their emotional distress is often misinterpreted as disruptive behaviour, prompting punitive responses from authority figures like teachers and police, which can worsen their threat responses. Compassion Focused Therapy offers a framework to reframe this behaviour as distress rather than disruption, promoting compassionate responses. This review aims to challenge racialised stereotypes of Black British Caribbean youth and encourage a more compassionate understanding of their distress, shaped by both historical and current racism.

Compassion Focused Conceptualisation: Black British Caribbean youth routinely face threats in various social contexts, including school, parent-child relationships, and police encounters. Using Compassion Focused Therapy's three-emotion system, this review demonstrates that frequent threat exposure may lead to an oversensitive threat system, a drive system that may be over- or under-stimulated, and an underactive soothe system, collectively contributing to strained emotional regulation.

Clinical Implications: Clinical implications focus on reducing Black British Caribbean youth’s exposure to threats and enhancing access to their soothing system. Suggested changes include adjustments within schools, mental health services, and at national policy and funding levels.

Research Implications: More co-produced research is needed to address the lack of empirical studies on the effectiveness of Compassion Focused Therapy for Black British Caribbean youth and to explore their exposure to threats across a wider range of social contexts. This research emphasises the need for systemic changes to address the broader impact of racism on Black British Caribbean youth.

Part B: Black British people’s experiences of therapy for post-traumatic stress disorder: An Interpretative Phenomenological Analysis

Background: In England, Black people are more likely than white people to experience post-traumatic stress symptoms, possibly due to intergenerational and lifetime trauma that increases the risk of developing PTSD and intensifies its symptoms. PTSD adversely affects physical and psychological health and quality of life. Trauma-focused cognitive behavioural therapy (TF-CBT) is the National Institute for Health and Care Excellence recommended treatment for PTSD in England. However, there is currently no research exploring Black British people's experiences of therapy for PTSD.

Objective: This study set out to explore how Black British people understand their experiences of therapy for PTSD and consider if these experiences indicate a need for better cultural adaptation to improve access to more effective treatment. 

Methodology: An interpretive phenomenological analysis was conducted to analyse semi-structured interviews with five participants to explore their experiences of self-reported therapy for PTSD. Participants were UK-born, identified as Black or Black mixed, and were of Caribbean or Nigerian heritage, aged between twenty-nine to thirty-seven. All participants reported engaging with TF-CBT.

Results: Three group experiential themes emerged from the analysis and included: 1) ‘historical and contemporary pressures’; 2) ‘changed sense of self following trauma’ and 3) ‘factors affecting safety and containment, with suggestions for improvement.

Conclusions: Participants' therapy experiences were shaped by historical and cultural contexts, highlighting the impact of racism and cultural beliefs. Intergenerational trauma and racism likely heightened threat sensitivity, increasing the risk and intensity of PTSD symptoms. Effective therapy relied on safety and containment, important facilitators were when participants perceived their therapist as non-judgmental and culturally aware, though safety could be compromised by racial similarity or difference with the therapist. Their suggestions for improving PTSD therapy, combined with clinical implications, could guide cultural adaptations of TF-CBT for Black British individuals with PTSD.