| 1.Introduction, Discrimination, Prejudice, and Microaggressions |
Psychoeducation about discrimination and physical and mental health Discussion of client’s relevant identities or characteristics that expose them to minority Stress Discussion of client’s experiences with discrimination and victimization Introduction and discussion of microaggressions and experiences of pride Daily monitoring of discrimination, microaggressions, and monitoring of the following core experiences which are monitored in all future sessions where outside of session assignments include tracking: pride events and mood, substance use, anxiety, and other behaviors deemed significant or related |
| 2. Coping with Discrimination |
Psychoeducation about the cognitive-behavioral model Psychoeducation about matching the type of coping to the type of stressor (solving the problem, managing how the problem is viewed, or managing feelings related to the problem) and how to apply coping Practice different strategies for coping with discrimination and track these outside of session along with core experiences (as described in session 1). |
| 3. Anticipation of Discrimination |
Discussion of the client’s experiences in applying coping strategies to discrimination experiences Further discussion of the connection between events and thoughts, feelings, and behaviors Psychoeducation on hypervigilance and health Discussion of client’s experience of anticipation of discrimination or hypervigilance Psychoeducation about accuracy of safety assessments and decision tree about making safety assessments Outside of session tracking of settings, thoughts that discrimination may occur or safety may be at risk, body sensations they experience, actual experiences of discrimination or threat, ratings of hypervigilance, and core experiences (as in session 1) |
| 4. Coping with Anticipation of Discrimination |
Discussion of client’s tracking of anticipation of discrimination Collaborative empiricism focused on safety assessments Values clarification exercise on anticipation of discrimination with hypothetical scenario related to chronic anticipation of discrimination Introduction of skills for coping with hypervigilance: assess the evidence, identify skills for coping with both credible threats and hypervigilance in the absence of a threat, including both cognitive and relaxation skills Introduce “intentional attention,” a mindfulness exercise that directs the client to practice gaining control of their attention by intentionally focusing it on different internal and external stimuli Outside of session assignment to practice making conscious choices consistent with one’s values in response to hypervigilance and situations in which one makes automatic assessments of danger, to have daily intentional attention practice, and to track core experiences (as in session 1) |
| 5. Concealment or openness about individual characteristics |
Discussion of client’s responses to hypervigilance, assessments of danger, and intentional attention practice Psychoeducation about concealment, openness, and physical health Discussion of client’s experiences of concealing or being open about identity characteristics Outside of session assignment to track situations in which they conceal or are open about their individual characteristics, related thoughts, emotions, behaviors, and core experiences (as in session 1) |
| 6. Skills and Choices Related to Openness or Concealment |
Review of openness and concealment tracking assignment Discussion of intentions and values related to openness and concealment, and changes over time Outside of session assignment is behavioral experiments related to openness about and concealment of individual characteristics, and to track thoughts and feelings related to these behaviors Shame is introduced as a topic related to concealment, openness, and stigma |
| 7. Internalized Stigma |
Thoughts, feelings, and behaviors (and their connections) related to openness and concealment are discussed Psychoeducation about internalized stigma and how it can be related to avoidance, substance use, or sexual behavior Discussion of client’s experiences with internalized stigma and its connections with other behaviors (e.g., substance use, sexual behavior) Outside of session assignment to track internalized stigma and pride, thoughts, feelings, and core experiences (as in session 1), as well as to continue intentional attention practice |
| 8. Coping with Internalized Stigma |
Discussion of the tracking of internalized stigma and the client’s associated thoughts, feelings, and behaviors Skills are offered for coping with internalized stigma (challenging the thoughts through logic or through the eyes of a benevolent other, modifying or replacing thoughts, or observing thoughts, and maximizing prideful thoughts) Outside of session assignment is to document challenges to internalized stigma and track the outcomes of these challenges |
| 9. Integration and Making Meaning |
Discussion of client’s experiences challenging internalized stigma Summary of the intervention content Summary of client’s work in intervention Discussion of the components of the intervention that the participant plans to use Discussion of making meaning of difficulties, and of how individual characteristics have improved the client’s life |
