Racial/Ethnic Identity Moderates Changes in Skill Use and Therapeutic Alliance but Not Anxiety or Depression in the Unified Protocol

Cognitive-behavioral therapy (CBT) patients with minoritized racial/ethnic backgrounds report similar outcomes as White patients but may report weaker alliances and less frequent CBT skill use. Given its transdiagnostic utility, we tested how racial/ethnic background impacted treatment outcomes, the alliance, and therapy skill use in the Unified Protocol (UP). Participants (N = 70, Mage = 33.7, 67% female, 74% White) with emotional disorders completed six sessions of core UP modules. Participants rated their past-week anxiety, depression, and skill use before each session and the strength of the alliance after each session. We tested whether racial/ethnic background moderated the slopes of symptom change, alliance, and skill use. White patients reported marginally steeper reductions in anxiety than patients with minoritized identities, B = .27, p = .08, but similar improvements in depression and overall alliance, ps > .10. However, White patients reported steeper increases in agreement on the tasks of therapy, B = –.31, p = .047, and skill use, B = .36, p = .02. Patients with minoritized identities may achieve similar reductions in anxiety and depression as White patients despite smaller increases in therapy task agreement and skill use. Clinicians working with patients with minoritized identities may prioritize these two constructs.