Home > Public Resources > Trauma Blog > 2022 - September Trauma and Diversity: Ableism in Psychological Trauma Clinical Research Amanda J. Khan, PhD September 29, 2022 Over 70% of the population will experience a traumatic event in their lifetime (e.g., Benjet et al. 2016). This includes people with disabilities, who are disproportionately excluded from clinical treatment research that may help alleviate psychological trauma sequelae. This group comprises individuals with a wide range of difficulties in various domains of functioning that affect one or more major life activities. Approximately one billion people worldwide live with some form of disability (WHO, 2021). According to a large population survey, an estimated 20,269,500 people have an ambulatory disability, 11,118,100 have a hearing disability, and 7,016,600 have a visual disability (Erickson & von Schrader, 2022). Despite these statistics, scant studies have examined the efficacy of trauma-focused treatment amongst disabled populations (Post & van Leeuwen, 2012; Rogers & Read, 2007). The majority of trauma-focused treatment studies to date have focused on veterans with traumatic brain injury (TBI) and PTSD (e.g., see review, Monsour, Ebedes, & Borlongan, 2022). Yet, the rates of mental health disorders amongst people with physical disabilities are disparately high in contrast to physically healthy individuals (e.g., see review, Mintz et al., 2022). For example, one study found women who experienced sexual assault and were visually impaired had higher PTSD prevalence rates compared to the general population (Bonsaken, Brunes, & Heir, 2022). Overall, there also has been a larger focus on studies of people with acquired (TBI) versus congenital disorders (e.g., cerebral palsy). Considerations of equity and justice require that historically marginalized groups, including people with physical and/or sensory disabilities, receive fair access to interventions that might benefit them. The inclusion of people with disabilities in clinical research is considered challenging for many reasons including interference with the ability to provide informed consent. Many treatment studies further exclude those with underlying health conditions, making it less likely that people with disabilities will be able to participate. These barriers are not unique to the field of psychological trauma treatment research, but also apply to health research more generally (Schwartz & Unni, 2021; Spong & Bianchi, 2018). Further, disability communities have long endured considerable injustices and discrimination on the part of health care providers and researchers. For example, prior to the U.S. disability rights movement in the 1970s, it was common for children and adults with disabilities to be institutionalized in state-run facilities with poor standards of health, safety, and quality of life (Rothman & Rothman, 2005). Therefore, the inclusion of otherwise-qualified research participants with physical and sensory disabilities should not merely be considered eligible, but also actively recruited into psychological trauma treatment studies as a matter of justice. This argument extends also to those whose physical or sensory disabilities might pose substantial clinical or logistical obstacles during trauma-focused therapies or for whom there may be additional considerations of potential adverse events. Accommodations should be considered across all phases of research from design, recruitment, intake, through to the final follow-up assessment. Importantly, investigator biases towards people with disabilities need addressing. There are two popular models of disability: The medical model posits disability is a pathology worthy of treatment or cure, whereas the social model of disability posits that disability is the result of an interaction between an impairment and inaccessible environments that limits opportunities for those living with their impairment (Shakespeare, Iezzoni, & Groce, 2009). In a recent large national survey, 82% of physicians reported believing that people with disabilities have a lower quality of life than those without disabilities (Iezzoni et al., 2021). This perspective contrasts with how many disabled patients report having a similar or higher quality of life than non-disabled patients (Albrecht & Devlieger, 1999). Researchers conducting clinical trials for the treatment of psychological trauma should be aware of this and other forms of structural ableism in health care, which is the discriminatory manifestation of lowered expectations towards people with disabilities on the part of health care providers. If people with physical and/or sensory disabilities are to be included in trauma-focused treatment trials, it may be helpful to note any history of medical discrimination as part of the intake before starting the intervention. Being aware of such discrimination can alert the therapist to features of the research setting or context that could be activating for a participant and use this as an opportunity to provide collaborative strengths-based corrective experiences. Finally, the field of PTSD treatment research would also benefit from training investigators in the history of disability rights and the medical and social models of disability. It is imperative the field of trauma intervention research begin to better promote access to PTSD and other trauma-focused treatments for disability communities. About the Author Dr. Amanda Khan is a licensed clinical psychologist and researcher working in private practice in California and at Sage Integrative Health, a Bay Area holistic psychedelic clinic. She specializes in the assessment and treatment of PTSD, depression, and anxiety and provides depth and somatic-oriented trauma work, ketamine-assisted psychotherapy, and post-psychedelic integration. Dr. Khan has completed MDMA-Assisted Therapy training with MAPS and serves as a psilocybin therapist on the UCSD phantom limb pain clinical trial. Dr. Khan currently serves as chair for the ISTSS Moral Injury SIG and contributing editor for the Trauma and Diversity column of StressPoints. She volunteers her time mentoring minority trainees, has led numerous diversity-related efforts across several institutions, and gives regular invited talks, presentations, and workshops. References Albrecht, G. L., & Devlieger, P. J. (1999). The disability paradox: High quality of life against all odds. Soc Sci Med, 48, 977–988. Bonsaksen, T., Brunes, A., Heir, T. (2022). Post-traumatic stress disorder in people with visual impairment compared with the general population. Int J Environ Res Public Health, 19(2), 619. Erickson, W., & von Schrader S. (2022) Disability Statistics from the American Community Survey (ACS). Cornell University Disability Statistics. Available from: www.disabilitystatistics.org Iezzoni, L. I., Rao, S. R., Ressalam, J., Bolcic-Jankovic, D., Agaronnik, N. D., Donelan, K., Lagu, T., & Campbell, E. G. (2021). 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