The Racial Trauma Treatment Triad (RTTT): a culturally adapted cognitive-behavioural-physiological framework for Aboriginal Australians

Objective This paper proposes the Racial Trauma Treatment Triad (RTTT), a culturally adapted treatment framework for Aboriginal Australians experiencing racial trauma. It compares the RTTT against five best-practice trauma treatments to identify where standard approaches fail for race-mediated traumaMethod A narrative review evaluated prolonged exposure, trauma-focused cognitive-behavioural therapy, cognitive processing therapy, eye movement desensitisation and reprocessing, and narrative exposure therapy against the pre-trauma, peri-trauma, and post-trauma variables identified for Aboriginal racial trauma. The RTTT is then described, including its session structure, adapted content, and measurement framework.Results All five treatments assume trauma has a definable onset and offset, do not address race-mediated cognitive content (internalised racism, Black identity disruption), fail to target race-specific physiological activation (acculturative stress, racial battle fatigue), and cannot address race-mediated behavioural patterns (collective fawn, system avoidance). The RTTT addresses these gaps by requiring that every session targets at least one goal in each triad domain – thoughts, physical responses, and behaviours – with culturally specific content informed by Black identity formation and the Acculturation Scale for Aboriginal Australians.Conclusions Racial trauma requires a framework that adapts, rather than replaces, the evidence base. The RTTT provides a structured, measurable framework operationalising cultural competence as clinical skill.