The Impact of Cumulative Minority Stress on Cognitive Behavioral Treatment With Gender Minority Individuals: Case Study and Clinical Recommendations

For sexual minority individuals (i.e., lesbian, gay, and bisexual [LGB] persons), minority stress includes experiences of discrimination, expectations of rejection, internalized negativity, and concealment of identity. Sexual minority stress has been linked to various negative mental health outcomes (e.g., depression, anxiety), and levels of psychiatric comorbidity are high among LGB people. However, little is known about the extension of minority stress models to gender minority individuals (i.e., transgender and gender nonconforming persons) and its impact on mental health in this particular group. Further, the influence of gender minority stress on the delivery and outcome of traditional cognitive behavioral therapy (CBT) approaches is unclear. A case study of CBT for chronic depression with a young, transgender individual is presented. This case study highlights potential barriers that may arise with gender minority clients when implementing evidence-based clinical interventions in the context of an individual’s minority stress history. Implications for cognitive-behavioral treatments with gender minority individuals and recommendations for clinicians and researchers are discussed.     

Revision and extension of a multidimensional measure of sexual minority identity: the Lesbian, Gay, and Bisexual Identity Scale

Two studies were conducted to investigate a revised and extended version of the Lesbian and Gay Identity Scale (Mohr & Fassinger, 2000): the 27-item Lesbian, Gay, and Bisexual Identity Scale (LGBIS). This revision features more inclusive and less stigmatizing language than the previous version and includes 2 new subscales assessing identity affirmation and centrality. In Study 1, an exploratory factor analysis (n = 297) and a confirmatory factor analysis (n = 357) supported an 8-factor solution assessing acceptance concerns, concealment motivation, identity uncertainty, internalized homonegativity, difficulty with the identity development process, identity superiority, identity affirmation, and identity centrality. Predicted associations with measures of identity-related constructs and psychosocial functioning provided preliminary validity evidence for LGBIS scores in a college student population. Study 2 (N = 51) provided evidence of the test-retest and internal consistency reliability of LGBIS scores. These studies suggest that the LGBIS may offer researchers an efficient means of assessing multiple dimensions of sexual orientation minority identity.     

Psychological and behavioral correlates of the SATAQ-3 with males

The current study used confirmatory factor analysis (CFA) to investigate the factor structure of a revised version of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) with a sample of undergraduate males. In addition to completing the SATAQ-3, participants completed various measures pertaining to body image, behavioral, and psychological constructs to examine concurrent and discriminant validity. CFA results indicated that the four factors of the SATAQ-3, Information, Pressures, Internalization-General, and Internalization-Athlete, represented the data well and better than an alternative 3-factor structure that combined the two Internalization subscales. All four factors demonstrated excellent concurrent and discriminant validity. Findings from this study support use of a slightly modified version of the SATAQ-3 with males. The present results also support the continued investigation of media influences as multidimensional constructs important to male body image.     

Taiwanese speech–language therapists’ awareness and experiences of service provision to transgender clients

Background: One of the most influential factors that affect the quality of life of transgender individuals is whether they can be perceived by others to “pass” in their felt gender. Voice and communication style are two important identifying dimensions of gender and many transgender individuals wish to acquire a voice that matches their gender. Evidence shows that few transgender individuals access voice therapy, and that this is caused by their concerns about stigmatization or negative past experiences within healthcare services. In order to address the negative experiences faced by transgender populations we need a better understanding of healthcare services’ current levels of knowledge and LGBT awareness. Some studies of Speech–Language Therapists’ (SLTs’) experience and confidence working with transgender individuals have recently been undertaken in the United States (US). However, little research has been carried out in Asia.

Aims: To investigate Taiwanese SLTs’ knowledge, attitudes and experiences of providing transgender individuals with relevant therapy.

Method: A cross-sectional self-administered web-based survey hosted on the Qualtrics platform was delivered to 140 Taiwanese SLTs.

Results: Taiwanese SLTs were, (i) more familiar with the terminology used to address “lesbian, gay, and bisexual groups” than with “transgender” terminology, (ii) generally positive in their attitudes toward transgender individuals, and (iii) comfortable about providing clinical services to transgender clients. However, the majority of participants did not feel that they were sufficiently skilled in working with transgender individuals, even though most believed that providing them with voice and communication services fell within the SLT scope of practice.

Conclusion: It is important for clinicians to both be skilled in transgender voice and communication therapy and to be culturally competent when providing services to transgender individuals. This study recommends that cultural competence relating to gender and sexual minority groups should be addressed in SLTs’ university education as well as in their continuing educational programs.     

Test of the cross-cultural generalizability of a model of sexual harassment

Sexual harassment research has been primarily limited to examination of the phenomena in U.S. organizations; attempts to explore the generalizability of constructs and theoretical models across cultures are rare. This study examined (a) the measurement equivalence of survey scales in U.S. and Turkish samples using mean and covariance structure analysis and (b) the generalizability of the L. F. Fitzgerald, F. Drasgow, C. L. Hulin, M. J. Gelfand, and V. J. Magley (1997) model of sexual harassment to the Turkish context using structural equations modeling. Analyses used questionnaire data from 336 Turkish women and 455 women from the United States. The results indicate that, in general, the survey scales demonstrate measurement equivalence and the pattern of relationships in the Fitzgerald et al. model generalizes to the Turkish culture. These results support the usefulness of the model for explaining sexual harassment experiences in a variety of organizational and cultural contexts.     

Measuring motivations for intercollegiate athlete alcohol use: a confirmatory factor analysis of the drinking motives measure

This study examined the psychometric properties of the Drinking Motives Measure (DMM) on a sample of 227 collegiate athletes. Confirmatory factor analyses indicated that the 4-factor structure of the DMM provided a better fit than either 2- or 1-factor models, but the overall fit of the 4-factor model was moderate at best. A revised 3-factor model consistent with prior research (M. L. Cooper, M. Russell, J. B. Skinner, & M. Windle, 1992) provided the best fit. Hierarchical multiple regression analyses indicated that the 3 DMM factors included in the revised model accounted for 17%-21% of the unique variance on alcohol consumption variables. Results provide preliminary evidence supporting the internal consistency, construct validity, and convergent validity of the revised 3-factor DMM with collegiate athletes.     

The Association of Multiple Identities with Self‐Directed Violence and Depression among Transgender Individuals

Transgender individuals have a high prevalence of self‐directed violence; however, there is scant literature focusing on their unique experiences. The differences in self‐harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation were examined among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorsed self‐directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non‐Hispanic White individuals.     

Menopause Symptoms and Attitudes of African American Women: Closing the Knowledge Gap and Expanding Opportunities for Counseling

Menopause, a normal midlife transition for women, remains poorly understood, especially for minority women. A total of 226 African American midlife women completed the Menopause Symptoms List (J. M. Perz, 1997); Menopause Attitude Scale (C. Bowles, 1986); Attitudes Toward Menopause checklist (B. L. Neugarten, V. Wood, R. J. Kraines, & B. Loomes, 1963); and instruments to elicit information about health status, stressful life events, social support, and demographics. The results reveal strengths as well as areas of concern for African American women in responding to normative midlife changes. Implications for counselors are explored.     

Minority stress and health: Implications for lesbian,gay, bisexual,transgender, and questioning (LGBTQ) young people

Historically, the pathologization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) orientations shaped research and professional practice, while the impact of stigma was not considered. Within a minority stress conceptualization however, stigma-related prejudice and discrimination experienced by LGBTQ people constitute chronically stressful events that can lead to negative health outcomes. Minority stress has been linked to psychological distress among gay men and lesbians and may contribute to elevated rates of distress frequently observed among LGBTQ youth. This study explored the impact of minority stress on psychological distress among LGBTQ youth in Ireland. Measures assessing three components of minority stress (sexual identity distress, stigma consciousness, and heterosexist experiences) were administered online to LGBTQ youth aged 16–24 years (N = 301). Each minority stressor had a significant independent association with distress. Stepwise regression analyses identified the linear combination of minority stressors as significantly predictive of distress [F(3,201) = 30.80, p ≤ 0.001]. Results suggest that the oppressive social environment created through sexual/transgender identity-related stigma negatively impacts on the well-being of LGBTQ youth. These findings have implications for health professionals and policy makers interested in the concerns of LGBTQ youth experiencing difficulties related to minority status and will facilitate the development and tailoring of interventions aimed at reaching those most at risk.     

Developing the Cyber Victimization Experiences and Cyberbullying Behaviors Scales

The reported prevalence rates of cyber victimization experiences and cyberbullying behaviors vary. Part of this variation is likely due to the diverse definitions and operationalizations of the constructs adopted in previous research and the lack of psychometrically robust measures. Through 2 studies, the authors developed (Study 1) and evaluated (Study 2) the cyber victimization experiences and cyberbullying behaviors scales. Participants in Study 1 were 393 (122 boys, 171 girls) and in Study 2 were 345 (153 boys, 192 girls) 11–15-year-olds who completed measures of cyber victimization experiences, cyberbullying behaviors, face-to-face victimization experiences, face-to-face bullying behaviors, and social desirability. The 3-factor cyber victimization experiences scale comprised threat, shared images, and personal attack. The 3-factor cyberbullying behaviors scale comprised sharing images, gossip, and personal attack. Both scales demonstrated acceptable internal consistency and convergent validity.     

What are the relationship experiences of in which one member identifies as transgender? A systematic review and meta-ethnography

Transgender individuals and their partners may face unique challenges that other couples do not. These unique challenges merit investigation, understanding and consideration by systemic practitioners in order to provide a culturally attuned service for transgender clients. A systematic review of the literature into the experiences of couples in which one member is transgender identified 22 qualitative papers. A translation and synthesis of constructs from these papers utilising a meta-ethnographic approach generated a number of third order constructs organised into nine overarching themes. These themes included experiences of stigma and discrimination, issues of power, privilege, visibility and identity, and experiences of dissonance and dysphoria that required adjustments and negotiations on the personal and relationship levels. Implications for practice and avenues for future research are discussed.     

Experiences with stigmatization among transgender individuals after transition: A qualitative study in the Netherlands

Abstract

Background: Transgender individuals belong to one of the most stigmatized groups in society. Although the social stigma of transgender individuals has been examined many times, post transition stigma experiences among transgender individuals have received limited research attention. The aim of this study was to examine experiences with stigmatization among Dutch transgender individuals after their transition.

Method: Ten trans women (age: M?=?58.50, SD?=?9.49) and 10 trans men (age: M?=?42.90, SD?=?13.62) participated in face-to-face semistructured interviews. Grounded theory was used to conceptualize and analyze the data. We examined the positive and negative reactions that transgender individuals experienced in the period after their transition. Furthermore, we explored differences between experiences of trans men and trans women. Finally, we examined differences between cisgender men and women regarding their reactions toward transgender individuals.

Results: Participants reported improved psychological well-being since transition. However, they still experienced different forms of stigmatization. Trans women appeared to experience stronger social stigma than trans men. Trans women also experienced lower social status after their transition. They mainly experienced negative responses from cisgender men. Participants emphasized the importance of social and peer support.

Conclusion: The current study findings demonstrate the presence of stigmatization after transition and argue for psychological aftercare. Social and peer support appeared to be important for coping with stigmatization, and improving the social network of transgender individuals is beneficial. Health providers and researchers are recommended to promote the development of constructive coping skills for transgender individuals with interventions especially targeting trans women.     

Interpersonal problems,personality pathology,and social adjustment after cognitive therapy for depression

The authors examined the level and structure of the Inventory of Interpersonal Problems-Circumplex version (IIP-C; L. M. Horowitz, L. E. Alden, J. S. Wiggins, & A. L. Pincus, 2000) before and after 20 sessions of acute-phase cognitive therapy for depression (N = 118), as well as associations with the Schedule for Nonadaptive and Adaptive Personality (L. A. Clark, 1993b) and the Social Adjustment Scale--Self-Report version (M. M. Weissman & S. Bothwell, 1976). Interpersonal problems had a 3-factor structure (Interpersonal Distress, Love, and Dominance), with the latter 2 factors approximating a circumplex, both before and after therapy. Interpersonal Distress decreased and social adjustment increased with therapy, but the Love and Dominance dimensions were relatively stable, similar to personality constructs. Social adjustment related negatively to Interpersonal Distress but not to Love or Dominance. Personality pathology related broadly to Interpersonal Distress and discriminantly to Love and Dominance. These findings support the reliability and validity of the IIP-C and are discussed in the context of personality theory and measurement.     

An Argument for Separate Analyses of Attitudes Toward Lesbian, Gay, Bisexual Men, Bisexual Women, MtF and FtM Transgender Individuals

While past research has certainly investigated a variety of correlates of U.S. attitudes toward lesbians, gays, bisexual men, bisexual women, male-to-female (MtF) and female-to-male (FtM) transgender (LGBT) individuals, there are no U.S. quantitative studies that could be located that examined attitudes toward each of these groups separately. This is especially important because efforts to combat prejudices are likely to be most successful if they are based in research that explores how attitudes are both similar and different across specified targets of prejudice. Toward that goal, this essay underscores the significance of examining U.S. attitudes toward LGBT individuals as separate constructs. Both the gender and sexual orientation of the target of prejudice and the gender and sexual orientation of the respondent are highlighted as important constructs that should be considered when investigating U.S. attitudes toward LGBT individuals. First, I review previous U.S. studies that have examined attitudes toward LGBT individuals. Second, I offer arguments for how the intersections of gender and sexual orientation may affect attitudes toward LGBT individuals. Third, I discuss future considerations in studies of attitudes toward LGBT individuals in the context of multiple intersectionalities. I suggest that U.S. initiatives to reduce sexual stigma, gender nonconformity stigma, and transgender stigma should be grounded in research that highlights prejudicial attitudes as they vary by the target of prejudice and the respondents’ characteristics.     

The development of the Awe Experience Scale (AWE-S): A multifactorial measure for a complex emotion

ABSTRACT

Awe is a complex emotion composed of an appraisal of vastness and a need for accommodation. The purpose of this study was to develop a robust state measure of awe, the Awe Experience Scale (AWE-S), based on the extant experimental literature. In study 1, participants (N = 501) wrote about an intense moment of awe that they had experienced and then completed a survey about their experience. Exploratory factor analysis revealed a 6-factor structure, including: altered time perception (F1); self-diminishment (F2); connectedness (F3); perceived vastness (F4); physical sensations (F5); need for accommodation (F6). Internal consistency was strong for each factor (α ≥ .80). Study 2 confirmed the 6-factor structure (N = 636) using fit indices (CFI = .905; RMSEA = .054). Each factor of the AWE-S is significantly correlated with the awe items of the modified Differential Emotions Scale (mDES) and Dispositional Positive Emotion Scale (D-PES). Triggers, valence, and themes associated with awe experiences are reported.     

The multidimensional nature of ageism: construct validity and group differences

The authors investigated the factor structure and construct validity of the Fraboni Scale of Ageism and the age and gender differences in ageism scores. Confirmatory factor analyses supported the multidimensional nature of FSA scores and generally corroborated the initial factor structure reported by M. Fraboni, with some notable exceptions. Essentially, the present findings were aligned with theoretical models of ageism that emphasize both cognitive facets and affective facets. That is, on the basis of their factor analytic findings, the authors redefined Fraboni's original factors of Antilocution, Avoidance, and Discrimination as Stereotypes, Separation, and Affective Attitudes, respectively, because of the clustering of items within factors. The revised 3-factor structure accounted for 36.4% of the variance in FSA scores. FSA factor scores significantly related to other scores from other measures of age-related attitudes, with higher correlations among factors that were similar in terms of their cognitive nature versus their affective nature. Finally, younger individuals and men had significantly higher ageism scores on the FSA than older individuals and women. The authors discussed the importance of adequately assessing ageism, with particular emphasis devoted to the understanding of age bias.     

Call to Action: Recommendations for Justice-Based Treatment of Obsessive-Compulsive Disorder With Sexual Orientation and Gender Themes

Gender and sexual minorities are subjected to minority stress in the form of discrimination and violence that leads to vigilance; identity concealment and discomfort; and internalized homophobia, biphobia, and transphobia. These experiences are related to increased susceptibility to mental health concerns in this population. Historically, the behavioral treatment of sexual orientation (SO) and gender-themed obsessive-compulsive disorder (OCD) has inadvertently reinforced anti-lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) stigma and contributed to minority stress in clients, treatment providers, and society at large. We present updated recommendations for treatment of SO- and gender-themed OCD through a more equitable, justice-based lens, primarily through eliminating exposures that contribute to minority stress and replacing them with psychoeducation about LGBTQ+ identities, and exposures to neutral and positive stimuli, uncertainty, and core fears. We also present recommendations for equitable research on SO- and gender-themed OCD.