MDMA-assisted psychotherapy; Inclusion of transgender and gender diverse people in the frontiers of PTSD treatment trials.
MDMA-assisted psychotherapy; Inclusion of transgender and gender diverse people in the frontiers of PTSD treatment trials.
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DOI：
10.3389/fpsyt.2022.932605
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发表时间：
2022
影响因子：
4.7
通讯作者：
Sevelius, Jae
中科院分区：
文献类型：
--
作者：
Stauffer, Christopher S.;Brown, Melanie R.;Adams, Dee;Cassity, Marca;Sevelius, Jae
关键词：
跨性别和性别多元（TGD）人群相较于普通人群，遭受耻辱、歧视、创伤以及创伤后应激障碍（PTSD）的比例更高；然而，在PTSD研究中，TGD人群的代表性不足。3,4 - 亚甲基二氧甲基苯丙胺（MDMA）辅助心理治疗的临床试验表明，其在治疗PTSD方面具有良好的安全性和有效性。在与受结构性弱势和健康差异影响的人群合作时，与公平获取相关的问题、治疗关系中的权力失衡以及MDMA引发的意识脆弱状态会被放大，并且社区参与研究规划和实施至关重要。为了给TGD人群参与未来MDMA辅助心理治疗研究提供相关信息并确保其安全性，本研究的目的是：描述TGD人群在与创伤相关的心理健康护理方面的经历，评估TGD人群参与PTSD实验研究的意愿，并收集针对TGD人群进行MDMA辅助心理治疗的方案设计的具体反馈。
我们进行了三次虚拟焦点小组讨论（FGD），每次有5 - 6名参与者（共17人）。符合条件的TGD参与者有接受过与创伤相关的心理健康护理的经历。每次焦点小组讨论由两名自我认同为TGD的有执业资格的临床医生引导。通过对反复出现的模式和主题进行识别的迭代过程进行定性数据分析。
我们已经确定了TGD人群在寻求和参与与创伤相关的心理健康护理时面临的几个关键问题，包括获得充分的性别肯定和考虑创伤因素的心理健康护理的障碍，以及对缺乏文化谦逊的服务提供者的失望。对MDMA辅助心理治疗方案提出的修改建议包括：常规收集包含跨性别者的性别认同数据，实施明确的性别肯定治疗方法，确保文化安全的环境，以及使联合治疗组合多样化。
在关于新兴的PTSD实验性干预措施的早期讨论中纳入TGD人群的声音，在健康和医疗保健差异的背景下促进了公平获取，并帮助研究人员了解社区的需求，调整研究以满足这些需求。通过与TGD社区持续的对话，我们旨在将性别肯定方法纳入现有的研究方案，并为MDMA辅助心理治疗在解决少数群体压力影响和增强复原力方面的未来应用提供信息。
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. 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. 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. 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.
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