Peer coach support in internet-based cognitive behavioral therapy for college students with social anxiety disorder: efficacy and acceptability

Social anxiety disorder is common among emerging adults and is associated with serious functional impairment. Cognitive-behavioral therapy (CBT) is an effective intervention for social anxiety. An online version may increase access but low completion rates limit utility. This study investigated a self-guided, internet based CBT (ICBT) with peer coach support. Participants were 35 undergraduate students randomized for immediate treatment (IT) or wait-list control (WL) in a randomized controlled trial design. IT participants completed a six-week ICBT program on their own and met briefly with a minimally trained undergraduate student as a “coach” between each lesson. IT participants had a greater decline in social anxiety relative to WL participants. High treatment retention and satisfaction ratings demonstrate the acceptability of this online intervention with peer coach support. The higher than expected enrollment from international students suggests ICBT may serve hard-to-reach college populations. This model of care could augment traditional mental health services to expand the availability of care

A Systematic Review of Recommendations for Behavioral Health Services for Transgender and Gender Diverse Adults: The Three-Legged Stool of Evidence-Based Practice is Unbalanced

There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD communities. More research, including clinical trials adapting established interventions, is needed to inform state-of-the-art TGD-affirmative behavioral health care

Psychometric Evaluation of the Transgender Congruence Scale

Introduction Despite increased attention to transgender and gender diverse (TGD) issues in psychological literature during the past decade, gaps remain for psychometric validation of TGD-specific measures. Kozee et al. (Psychology of Women Quarterly 36(2):179–196, 2012) addressed such gaps by creating the Transgender Congruence Scale (TCS), measuring gender acceptance and feelings of gender congruence between internal and external attributes across a broad range of gender identities. The current study extended Kozee and colleagues’ work by further examining the psychometric properties of the TCS. Methods Between October and November of 2017, 210 transmasculine, transfeminine, and gender diverse adults between ages 19 and 73 completed online surveys containing demographic, gender identity-specific, and well-being measures including the TCS. Results Results of confirmatory factor analysis replicated the original two-factor model (Appearance Congruence and Gender Identity Acceptance), with the elimination of two poorly loading items, resulting in a 10-item reduced model (TCS-10). Higher scores on TCS-10 were associated with positive scores on gender-related well-being, congruence, and pride, positive affect, and life satisfaction, as well as lower scores on gender-related dysphoria, non-affirmation, internalized transphobia, and marginalization. There were modest but significant associations between Gender Identity Congruence and both depression and negative affect. Conclusions Despite limitations of sample size and diversity of identities, the study reaffirmed the utility of the TCS as an overall construct of gender identity congruence with a 10-item reduced structure related to other established TGD constructs. Policy Implications Though socio-political climate is the ultimate domain for alleviating TGD stigma and discrimination, factors such as gender congruence are essential areas of focus to foster resiliency

Transgender and Gender Diverse Clients’ Experiences in Therapy: Responses to Sociopolitical Events and Helpful and Unhelpful Experiences

We examined transgender and gender-diverse (TGD) people’s reports of their therapy experiences over the course of a year. We explored how participants’ therapists integrated discussions about current events, as well as their more general perspectives on helpful and unhelpful experiences. A total of 107 participants provided data on these questions at least once over 12 months of surveys (M age = 33.79; 70.1% White), reflecting on their current therapy experiences. Through thematic analysis of qualitative data, the following themes were constructed regarding discussing sociopolitical events: (a) facilitating coping via bearing witness to clients’ internal experiences and implementing other therapeutic interventions; (b) moving beyond the individual by integrating identity, systems, or contexts; (c) feeling disconnected and misunderstood. We grouped participants’ helpful experiences into the following themes: (1) availability, connection, and therapeutic approaches facilitate positive experiences; (2) the necessity of knowledge, education, and affirmation of TGD identities; (3) helpful therapy means seeing the world in which clients live. We grouped participants’ unhelpful experiences into the following themes: (1) logistical issues can interfere with therapy; (2) lack of depth and disconnection results in subpar therapy; (3) insufficient understandings of TGD identities results in potentially harmful practices. These findings deepen understandings of how to integrate discussions about current events into therapy and provide competent and affirming care to TGD clients

Is Our Research Inclusive? Experiences in Psychological Research for Participants Identifying as Transgender and Gender Diverse

Research practices have historically excluded transgender and gender diverse communities by unnecessarily excluding them from research or have not been inclusive of these identities by using demographic questions that do not ask about gender identity outside of the male/female binary. There are several guidelines and recommendations for conducting affirming and ethical research with TGD populations (e.g., (Adams et al., 2017; Staples et al., 2018; Vincent, 2018). However, no empirical research exists on applying ethical standards for social and psychological research for TGD communities (Adams et al., 2017). The present study sought to pilot and test these recommendations by adapting research materials and procedures to be inclusive and affirming of TGD identities. Participants were randomized to either view materials and procedures adapted to be affirming or materials and procedures that were not adapted and more typically seen in research studies. Results show that participants rated the adapted materials and procedures as more affirming, would be more likely to continue in a study using these materials and procedures, and would be more likely to recommend another TGD person to the study. The present study also sought to examine if constructs such as critical consciousness and experiences of gender marginalization stressors moderated the relationship between condition and ratings. Results show that with the exception of internalized transphobia there is no significant relationship between these constructs. These results suggest there are tangible changes that can be made to research practices that are more inclusive and affirming of TGD identities. Limitations of this study was recruitment difficulties and a lack of demographic diversity

Systems of cissexism and the daily production of stress for transgender and gender diverse people

Background: Transgender and gender diverse (TGD) people encounter a range of minority stressors (e.g., harassment, victimization, misgendering) that impact many areas of life. Much of the empirical literature on gender minority stress has utilized frameworks that were developed with a focus on sexual orientation and were often limited to cisgender sexual minorities (lesbian, gay, bisexual, and other non-heterosexual individuals), leaving questions about how well existing models fit the experiences of TGD people. Aims: To expand understandings of gender minority stress, we conducted a daily diary study where participants detailed the types of stressors they encountered on a daily basis for 56 days. Methods: There were 181 TGD participants recruited into the study (M age = 25.6 years; SD = 5.6), with 167 retained in the daily surveys from which these analyses were conducted. Results: The written responses revealed a variety of stressors, some of which are novel to the literature. Many participants reported instances of non-affirmation, such as misgendering, as well as vicarious stress when learning of oppressive experiences impacting other TGD people and seeing negative media portrayals of the lives of TGD individuals. Participants also reported bodily vigilance when being on alert for how others were perceiving their gender. Other stressors included rejection, political oppression, physical violence, uneasiness from others, and the enforcement of gender binarism. Discussion: These findings highlight gaps in the existing understandings of marginalization for TGD people that must be addressed to ensure that frameworks include and center the experiences of gender minorities