PMID- 36299539
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230918
IS  - 1664-0640 (Print)
IS  - 1664-0640 (Electronic)
IS  - 1664-0640 (Linking)
VI  - 13
DP  - 2022
TI  - MDMA-assisted psychotherapy; Inclusion of transgender and gender diverse people 
      in the frontiers of PTSD treatment trials.
PG  - 932605
LID - 10.3389/fpsyt.2022.932605 [doi]
LID - 932605
AB  - INTRODUCTION: Transgender and gender diverse (TGD) people experience stigma, 
      discrimination, trauma, and post-traumatic stress disorder (PTSD) at higher rates 
      compared to the general population; however, TGD people have been 
      underrepresented in PTSD research. Clinical trials of 
      3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy demonstrate 
      promising safety and efficacy for the treatment of PTSD. Issues related to 
      equitable access, power imbalances in the therapeutic relationship, and 
      vulnerable states of consciousness occasioned by MDMA are magnified when working 
      with people affected by structural vulnerabilities and health disparities, and 
      community engagement in research planning and implementation is essential. To 
      inform the inclusion and safety of TGD people in future MDMA-assisted 
      psychotherapy research, the aims of the current study were to: characterize TGD 
      experiences with trauma-related mental health care, assess openness of TGD people 
      to participate in experimental PTSD research, and to gather specific feedback on 
      protocol design for conducting MDMA-assisted psychotherapy with TGD people. 
      MATERIALS AND METHODS: We conducted three virtual focus group discussions (FGDs) 
      with 5-6 participants each (N = 17). Eligible TGD participants had a history of 
      receiving trauma-related mental health care. Each FGD was facilitated by two 
      licensed clinicians who identified as TGD. Qualitative data analysis was 
      conducted via an iterative process of identification of recurrent patterns and 
      themes. RESULTS: We have identified several key issues TGD people face when 
      seeking and engaging in trauma-related mental health care, including barriers to 
      receiving adequate gender-affirming and trauma-informed mental health care and 
      frustration with providers lacking cultural humility. Suggested amendments to 
      MDMA-assisted psychotherapy protocols include: routine collection of 
      trans-inclusive gender identity data, implementing an explicit gender-affirming 
      treatment approach, ensuring a culturally safe setting, and diversifying 
      co-therapy dyads. DISCUSSION: The inclusion of TGD voices in early conversations 
      about emerging experimental PTSD interventions promotes equitable access, in the 
      context of health and healthcare disparities, and helps researchers understand 
      the needs of the community and tailor research to meet those needs. Through an 
      ongoing conversation with the TGD community, we aim to incorporate a 
      gender-affirming approach into existing research protocols and inform future 
      applications of MDMA-assisted psychotherapy in addressing the effects of minority 
      stress and boosting resilience.
CI  - Copyright (c) 2022 Stauffer, Brown, Adams, Cassity and Sevelius.
FAU - Stauffer, Christopher S
AU  - Stauffer CS
AD  - Social Neuroscience and Psychotherapy Lab, Oregon Health and Science Institute, 
      Department of Psychiatry, Portland, OR, United States.
AD  - Portland VA Health Care System, Department of Mental Health, Portland, OR, United 
      States.
FAU - Brown, Melanie R
AU  - Brown MR
AD  - School of Public Health, Oregon Health and Science University-Portland State 
      University, Portland, OR, United States.
FAU - Adams, Dee
AU  - Adams D
AD  - Center for Public Health and Human Rights, Department of Epidemiology, John 
      Hopkins University, Baltimore, MD, United States.
FAU - Cassity, Marca
AU  - Cassity M
AD  - Social Neuroscience and Psychotherapy Lab, Oregon Health and Science Institute, 
      Department of Psychiatry, Portland, OR, United States.
AD  - Portland VA Health Care System, Department of Mental Health, Portland, OR, United 
      States.
FAU - Sevelius, Jae
AU  - Sevelius J
AD  - Center of Excellence for Transgender Health, Department of Medicine, University 
      of California, San Francisco, San Francisco, CA, United States.
LA  - eng
GR  - IK2 CX001495/CX/CSRD VA/United States
GR  - K24 DA051328/DA/NIDA NIH HHS/United States
PT  - Journal Article
DEP - 20221010
PL  - Switzerland
TA  - Front Psychiatry
JT  - Frontiers in psychiatry
JID - 101545006
PMC - PMC9589439
OTO - NOTNLM
OT  - 4-methylenedioxymethamphetamine (MeSH)
OT  - N-methyl-3
OT  - focus groups (MeSH)
OT  - gender identity (MeSH)
OT  - hallucinogens (MeSH)
OT  - health equity (MeSH)
OT  - post-traumatic stress disorder (MeSH)
OT  - psychotherapy (MeSH)
OT  - transgender persons (MeSH)
COIS- Author CS is a paid clinical supervisor and trainer for MDMA-assisted 
      psychotherapy with the MAPS Public Benefit Corporation. The remaining authors 
      declare that the research was conducted in the absence of any commercial or 
      financial relationships that could be construed as a potential conflict of 
      interest. The handling editor JM declared a shared affiliation with the author JS 
      at the time of review.
EDAT- 2022/10/28 06:00
MHDA- 2022/10/28 06:01
PMCR- 2022/10/10
CRDT- 2022/10/27 02:26
PHST- 2022/04/30 00:00 [received]
PHST- 2022/09/20 00:00 [accepted]
PHST- 2022/10/27 02:26 [entrez]
PHST- 2022/10/28 06:00 [pubmed]
PHST- 2022/10/28 06:01 [medline]
PHST- 2022/10/10 00:00 [pmc-release]
AID - 10.3389/fpsyt.2022.932605 [doi]
PST - epublish
SO  - Front Psychiatry. 2022 Oct 10;13:932605. doi: 10.3389/fpsyt.2022.932605. 
      eCollection 2022.