Using Cognitive Behavioral Therapy to Assist Individuals Facing Oppression

Many individuals in the U.S. experience oppression on the basis of their racial and/or ethnic identity, immigration status, socioeconomic status, disability, sexual orientation, gender identity, gender expression, religious identity, language, etc. (Benner & Wang, 2014; Corbett & Hill, 2012; Maira, 2004; Unks, 1995; M. S. Williams, 2000). Further, many individuals hold multiple marginalized identities that intersect and influence how they experience oppression (Crenshaw, 1991) . With current governmental policies (Goodman, Shaikh, & Rivas, 2018), greater visibility of discrimination on social media and news outlets (Robbins, 2018), and an increase in hate crimes reported since the 2016 U.S. presidential election (FBI, 2016), members of marginalized groups may be experiencing heightened mental symptoms (American Psychological Association, 2017; Belluz, 2017).  While the ultimate prevention and intervention strategies for marginalization and oppression in the U.S. need to be at the structural and systemic levels and delivered via governmental policies and laws, there is also the need to think about and utilize tools that may help individuals to cope within the context of ongoing oppression.

Evidence-based psychological treatments such as cognitive behavioral therapy (CBT) have demonstrated efficacy and effectiveness in decreasing mental health symptoms including depression, anxiety, trauma, and substance use (Celano, NeMoyer, Stagg, & Scott, 2018; Ramos, Erkanli, & Koenig, 2018; Shein‐Szydlo et al., 2016; Weaver & Himle, 2017; Windsor, Jemal, & Alessi, 2015). However, most therapists trained in CBT may have limited experience with delivering CBT well when the antecedent of the mental symptoms are linked to experiences of marginalization and oppression (M. T. Williams, 2013).  In addition, some of the key strategies and core assumptions of how mental health symptoms are sustained may be problematic when the antecedents are experiences of marginalization. Nonetheless, CBT can be beneficial in empowering individuals in coping with marginalization and oppression by keeping the following 5 suggestions in mind.

1. Enhance Awareness Of How Marginalization, Oppression, And Discrimination Impact Thoughts, Feelings, And Behaviors

Experiences of marginalization can negatively impact a person’s feelings (e.g. sadness, anger, feeling jumpy), thoughts (e.g. thinking negative about oneself), and behaviors  (e.g. turning to alcohol or drugs to numb the emotion) (Dale & Merren, 2018).  One of the tools of CBT is assisting a client in learning that there are three components of every emotion experience and that these three components are all connected and influence each other (Barlow et al., 2017).  Enhancing an individual’s awareness of how marginalizing/oppressive experiences impact their internal thoughts, feelings, and behaviors can be beneficial.

2. Enhance Awareness Of Antecedents, Behaviors, And Consequences

Another CBT tool that can assist an individual in reflecting on and coping with marginalized experiences are the ABCs, with A= Antecedents, B=Behaviors, and C= Consequences (Barlow et al., 2017). Antecedents are the situations that precede or trigger your emotions and behavioral reactions. Behaviors are the reactions (inclusive of thoughts, feelings, and behaviors) you may have. Assisting an individual in tracking their ABCs, may provide insight into common antecedents that occur before they have certain thoughts, feelings, behaviors, as well as the resulting personal consequence following certain behaviors. Ultimately, for a client paying attention to their ABCs is about learning to see common antecedents, observing their own thoughts and feelings, and ultimately choosing the desired behavior for them that best aligns with the consequence they desire.

3. Do Not Pathologize Thoughts And Behaviors That May Be Normative In Response To Oppression And Marginalization

Given supporting theories and research (Clark & Beck, 1999), it is common for CBT therapists to be of the mind frame that a client’s unhelpful thoughts (e.g. the world is dangerous) and behaviors are what drives the mental symptoms (e.g. depression, anxiety) and to place effort into helping clients to change these unhelpful thoughts.  One method is to teach clients to ask themselves certain questions (e.g. Is their evidence for this belief or fear?) (Barlow et al., 2017) when they are having an unhelpful thought. The hope is that the client’s responses to these questions will help the client to dismiss the unhelpful thought or change it to something more adaptive. However, when a person’s symptoms and thoughts (e.g. the world is dangerous, people are evil) are in response to marginalization, labeling these thoughts as unhelpful and/or asking certain questions can be further marginalizing, dismissive, and inaccurate (i.e. the world can be dangerous for marginalized groups). Instead, a therapist will need to acknowledge and link these thoughts to the experiences of marginalization.

Further, a therapist can assist a person in expanding their thought in a way that may decrease negative emotions linked to the thought  (e.g. world is dangerous, but my community will continue to fight to survive) as well as pull on an individual’s strengths by asking other questions from CBT (Barlow et al., 2017) such as If ______ happened, could I handle it?,  How would I cope with it?, and In the past how have I coped with it? A therapist may also encourage empowering thoughts (Dale, Pierre-Louis, Bogart, O’Cleirigh, & Safren, 2018) that have been  noted in research among marginalized groups such as “I have the power within me” [oppression attempts to disempower individuals but they are inherently powerful] and “I am not to blame” [person or institution that perpetrated the oppression is at fault].

4. Review And Enhance The Use Of Distress Tolerance Tools

Distress tolerance tools such as self-soothing and distraction activities are taught in a particular type of CBT, Dialectical Behavioral Therapy (Linehan, 2014), and may be helpful to clients coping with marginalization as they try to bring down their distress and cope with difficult situations. Self-soothing activities include those that utilize vision (e.g. looking at the trees), hearing (listening to music), touch (e.g. taking a bath), smell (e.g. smelling a fragrance), and/or taste (e.g. have a favorite treat). Distracting activities are those done to temporarily shift one’s cognitive and emotional focus onto something else such as playing a game, helping a friend or family with a task, watching a funny movie, counting to 100, and singing the words to a song.

5. Elicit From The Client And Discuss Culturally Congruent Coping

Elicit from the client and encourage behaviors that may be beneficial and culturally congruent as they cope with marginalization. These may include seeking support from similar peers, engaging in activities that celebrate and enhance pride in one’s marginalized identities, and exploring avenues for activism and advocacy.

6. Strongly Encourage Engagement In Regular Self-care Activities Elicited From The Client

CBT therapist should also actively encourage self-care/enjoyable activities irrespective of what symptoms are being targeted/treated in therapy (Dale & Safren, 2018). If we use the analogy of a cellphone, experiences of marginalization and oppression drains a person’s battery, and engaging in activities to care for oneself and experience joy, may help to replenish and recharge one’s battery. In encouraging self-care the therapist should elicit enjoyable activities directly from the client and be mindful not to suggest activities that may not be feasible or accessible for the client.