Why Do Brief Online Writing Interventions Improve Health? Examining Mediators of Expressive Writing and Self-Affirmation Intervention Efficacy Among Sexual Minority Emerging Adults

A limited number of studies have examined mechanisms undergirding interventions that mitigate mental health problems or health-risk behaviors that disproportionately burden sexual minorities. A recent trial of expressive writing and self-affirmation writing found that these brief interventions had salubrious effects on mental health and health-risk behaviors; the present research examines the putative mechanisms underlying these effects. Sexual minority emerging adults (N = 108) completed a brief online expressive writing, self-affirmation writing, or neutral control writing intervention and, at baseline and 3-month follow-up, completed measures of mental health, health-risk behaviors, stress, and self-regulation. Expressive writing yielded improvements in mental health and these effects were mediated by reductions in perceived stress. Self-affirmation caused improvements in health-risk behaviors, thoughneither stress nor self-regulation mediated these effects. This finding provides preliminary novel evidence regarding a mechanism underlying a widely used psychological intervention with documented mental health benefits for sexual minorities and other populations disproportionately affected by stres

Brief Online Interventions for LGBTQ Young Adult Mental and Behavioral Health: A Randomized Controlled Trial in a High-Stigma, Low-Resource Context

OBJECTIVE: To identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions-expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee. METHOD: In consultation with sexual minority young adults (n = 10) and stakeholders (n = 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (Mage = 23.68, SD = 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up. RESULTS: Compared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d = 0.48) and general psychological distress (d = 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d = 0.62) and drug abuse (d = 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control. CONCLUSION: Brief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Perceiving Object Shape from Specular Highlight Deformation, Boundary Contour Deformation, and Active Haptic Manipulation.

It is well known that motion facilitates the visual perception of solid object shape, particularly when surface texture or other identifiable features (e.g., corners) are present. Conventional models of structure-from-motion require the presence of texture or identifiable object features in order to recover 3-D structure. Is the facilitation in 3-D shape perception similar in magnitude when surface texture is absent? On any given trial in the current experiments, participants were presented with a single randomly-selected solid object (bell pepper or randomly-shaped "glaven") for 12 seconds and were required to indicate which of 12 (for bell peppers) or 8 (for glavens) simultaneously visible objects possessed the same shape. The initial single object's shape was defined either by boundary contours alone (i.e., presented as a silhouette), specular highlights alone, specular highlights combined with boundary contours, or texture. In addition, there was a haptic condition: in this condition, the participants haptically explored with both hands (but could not see) the initial single object for 12 seconds; they then performed the same shape-matching task used in the visual conditions. For both the visual and haptic conditions, motion (rotation in depth or active object manipulation) was present in half of the trials and was not present for the remaining trials. The effect of motion was quantitatively similar for all of the visual and haptic conditions-e.g., the participants' performance in Experiment 1 was 93.5 percent higher in the motion or active haptic manipulation conditions (when compared to the static conditions). The current results demonstrate that deforming specular highlights or boundary contours facilitate 3-D shape perception as much as the motion of objects that possess texture. The current results also indicate that the improvement with motion that occurs for haptics is similar in magnitude to that which occurs for vision

Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial

Background: Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations. Method: We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes. Conclusions: This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals

LGBQ-Affirmative Cognitive-Behavioral Therapy for Young Gay and Bisexual Men's Mental and Sexual Health: A Three-Arm Randomized Controlled Trial

Objective: Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existing interventions. Method: Participants were young human immunodeficiency virus (HIV)-negative SMM (N = 254; ages = 18-35; 67.2% racial/ethnic minority) experiencing a depression, anxiety, and/or stress-/trauma-related disorder and past-90-day HIV transmission risk behavior. After completing HIV testing and counseling, participants were randomized to receive 10-session ESTEEM (n = 100); 10-session community-based lesbian, gay, bisexual, and queer/questioning (LGBQ)-affirmative counseling (n = 102); or only HIV testing and counseling (n = 52). Results: For the primary outcome of any HIV transmission risk behavior at 8 months, ESTEEM was not significantly associated with greater reduction compared to HIV testing and counseling (risk ratio [RR] = 0.89, p = .52). Supportive analyses of the frequency of HIV transmission risk behavior at 8 months showed a nonsignificant difference between ESTEEM compared to HIV testing and counseling (RR = 0.69) and LGBQ-affirmative counseling (RR = 0.62). For secondary outcomes (e.g., depression, anxiety, substance use, suicidality, number of mental health diagnoses) at 8 months, ESTEEM had a larger effect size than the two comparison conditions, but these comparisons did not reach statistical significance when adjusting for the false discovery rate. Observed effect sizes for condition comparisons were smaller than the effect sizes used to power the study. In exploratory analyses, ESTEEM showed promise for reducing comorbidity. Conclusions: Because the control conditions were associated with stronger effects than anticipated, and given the heterogeneous nature of transdiagnostic outcomes, the study possessed insufficient power to statistically detect the consistently small-to-moderate benefit of ESTEEM compared to the two control conditions. What is the public health significance of this article? As long as young sexual minority men (SMM) face minority stress, identity-affirming and effective psychological interventions are needed to address the impact that this stress has on their mental and sexual health. This study found evidence that an lesbian, gay, bisexual, and queer/questioning (LGBQ)-affirmative, minority-stress-focused, transdiagnostic cognitive-behavioral therapy (CBT) intervention called ESTEEM was associated with reductions across numerous mental and sexual health outcomes among young SMM experiencing co-occurring mental and sexual health concerns, though not significantly greater reductions than the two existing interventions to which ESTEEM was compared

Results of Experiment 2.

<p>The participants’ shape-matching accuracies (in terms of percent correct) are plotted as functions of both 1) the stimulus presentation type and 2) the presence or absence of object motion/active haptic manipulation. BC = boundary contours only, SH = specular highlights only, SH+BC = specular highlights with accompanying boundary contours, VT+BC = volumetric texture with accompanying boundary contours, H = haptic manipulation. The error bars indicate ± 1 SE. The dashed line indicates chance performance.</p

A photograph of the naturally-shaped solid objects (replicas of bell peppers, <i>Capsicum annuum</i>) used in Experiment 1.

<p>They are arranged in numerical order (1–12) from top-left to bottom right. These objects (and subsets of them) have been used in multiple previous investigations [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149058#pone.0149058.ref018" target="_blank">18</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149058#pone.0149058.ref026" target="_blank">26</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149058#pone.0149058.ref028" target="_blank">28</a>].</p

Example stimulus displays used in the visual conditions of Experiment 1.

<p>From bottom-left going clockwise are depicted objects defined by 1) specular highlights without occlusion boundary contours, 2) specular highlights with occlusion boundary contours, 3) occlusion boundary contours only (i.e., silhouettes), and 4) volumetric/solid texture, where the surface markings resemble those of marble.</p

Results of Experiment 2.

<p>The participants’ shape-matching accuracies (in terms of percent correct) are plotted as functions of both 1) the stimulus presentation type and 2) stimulus object complexity (the 8 stimulus objects were partitioned into two groups possessing low and high stimulus complexity). BC = boundary contours only, SH = specular highlights only, SH+BC = specular highlights with accompanying boundary contours, VT+BC = volumetric texture with accompanying boundary contours, H = haptic manipulation. The error bars indicate ± 1 SE. The dashed line indicates chance performance.</p