Development and Initial Trial of Brief Interventions to Help Parents of Stigmatized Youth Reduce Distress and Strengthen Attachment

制定和初步试验简短干预措施，帮助受侮辱青少年的父母减轻痛苦并加强依恋

• 批准号: 10741051
• 负责人: LEA R DOUGHERTY
• 金额: $ 46.37万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-07 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10741051
• 关键词: Address; Adult; Affect; Age; Anxiety; Behavior; Binding; Buffers; Bypass; Child; Climacteric; Communities; Conflict (Psychology); Data; Development; Disclosure; Distress; Education; Emotions; Empathy; Enrollment; Face; Family; Family psychotherapy; Future; Geographic Locations; Health; Individual; Instinct; Intervention; Intervention Studies; Interview; Mediator; Mental Health; Parent-Child Relations; Parents; Persons; Population; Psyche structure; Randomized; Reaction; Recording of previous events; Reporting; Research; Running; Science; Services; Sexual and Gender Minority Youth; Social Processes; Source; Southeastern United States; Stigmatization; Stress; Stressful Event; Support Groups; Surveys; Testing; Time; Training; United States National Institutes of Health; Writing; Youth; arm; behavioral health; brief intervention; child depression; community engagement; effectiveness/implementation trial; efficacy testing; experience; expressive writing; feasibility testing; follow-up; gender minority youth; health disparity; high risk population; implementation facilitators; improved; interest; online intervention; post intervention; prevent; primary outcome; psychologic; randomized trial; recruit; scale up; secondary outcome; sexual minority; social expectations; social stigma; stressor; theories; young adult

PROJECT SUMMARY Parental support represents the strongest predictor of sexual and gender minority youth's (SGMY) mental health. However, over half of parents react to their SGMY's disclosure with rejection. Even relatively accepting parents can experience discomfort, while SGMY often report lingering unmet needs from their parents into adulthood. Few interventions exist to help parents support their SGMY child and none has been tested in a randomized trial with efficacy for decreasing parental rejection and increasing support of their SGMY. This proposal will develop and test the efficacy of two theory-based interventions that aim to address this gap. These interventions respectively address two mechanisms shown to underlie parental rejection of SGMY – parents' unresolved negative emotions toward their SGMY and lack of empathy toward their SGMY. The first intervention – expressive writing (EW) – reduces negative emotions by helping people make sense of stressful events. In our adapted EW, we will ask non-accepting parents to write about the stressful impact that their child's SGM identity has on them across three 20-min sessions. The second intervention – attachment-based writing (ABW) – will be based on the only known intervention (called attachment-based family therapy) that builds empathy among parents of SGMY. However, the parent-focused tasks of attachment-based family therapy currently require 2-3 sessions with a trained therapist, preventing broad access. We will thus create a writing-based version of this therapy in a parallel format to EW (i.e., 3 20-min writing sessions). This adaptation will ask parents to engage with the core components of attachment-based family therapy in writing (i.e., writing about one's impact on their child, one's own attachment needs, and their child's needs). Across three aims, we will develop and test the preliminary efficacy of these two brief interventions for non-accepting parents in the Southeast US – a region with the highest anti-SGM stigma and highest SGMY mental health needs in the US. Aim 1 will engage community stakeholders, non-accepting parents, and SGMY in the Southeast to inform the writing prompts and look-and-feel of the online platform. Aim 2 will test the preliminary efficacy of EW and ABW. We will randomize 129 non-accepting parents to EW, ABW, or control. Parents will report primary outcomes (i.e., rejecting and supporting behaviors), target mediators (i.e., negative emotions, empathy), and secondary outcomes (e.g., parent and youth depression/anxiety) at baseline, post-intervention, and 3-month follow-up. We will also explore the feasibility of asking parents to enroll their child so that we can study the interventions' impact on SGMY themselves. Aim 3 will determine intervention acceptability and implementation facilitators in parent support organizations in the Southeast US. Results to mental will identify mechanisms contributing parental rejection and develop scalable approaches to reduce these mechanisms to shrink the substantial health disparities affecting SGMY. If efficacious, these interventions can be scaled up through online platforms capable of bypassing barriers to parental support of SGMY across high-stigma regions.

项目总结 父母支持是性和性别少数民族青年(SGMY)心理的最强预测者 健康。然而，超过一半的父母对他们的SGMY披露的反应是拒绝。即使是相对可接受的 父母可能会感到不适，而SGMY经常报告说，父母的需求挥之不去 成人期。目前很少有干预措施帮助父母支持他们的SGMY孩子，也没有一项干预措施在 减少父母排斥和增加对他们SGMY支持的有效性的随机试验。这 该提案将开发和测试两种以理论为基础的干预措施的有效性，旨在解决这一差距。 这些干预措施分别解决了父母拒绝SGMY的两种机制： 父母对他们的SGMY的负面情绪尚未解决，对他们的SGMY缺乏同理心。第一 干预-表达写作(EW)-通过帮助人们理解压力来减少负面情绪 事件。在我们改编的EW中，我们将要求不接受的父母写下他们的压力影响 在三个20分钟的会话中，孩子的SGM身份在他们身上。第二种干预--依恋 写作(ABW)-将基于唯一已知的干预(称为基于依恋的家庭治疗)， 在SGMY的父母中建立同理心。然而，依恋家庭的父母关注任务 目前，治疗需要与训练有素的治疗师进行2-3次会议，从而防止广泛使用。因此，我们将创建一个 以写作为基础的这种疗法的版本，形式与EW平行(即3次20分钟的写作课程)。这一适应 将要求父母以书面形式(即书面形式)参与基于依恋的家庭治疗的核心组成部分 关于一个人对孩子的影响、自己的依恋需求和孩子的需求)。在三个目标中，我们 将开发和测试这两个针对不接受教育的父母的初步干预效果 美国东南部-美国反SGM污名最高的地区，SGMY精神健康需求最高的地区。 AIM 1将与社区利益相关者、不接受教育的家长和东南部的SGMY接触，以告知 在线平台的写作提示和外观。目标2将测试电子战的初步效果和 阿布。我们将随机将129名不接受治疗的父母分为EW、ABW或对照组。家长将报告初选 结果(即拒绝和支持行为)、目标中介(即负面情绪、同理心)以及 基线、干预后和3个月的次要结果(例如，父母和青少年的抑郁/焦虑) 后续行动。我们亦会探讨要求家长为子女登记的可行性，以便我们可以研究 干预措施对SGMY本身的影响。目标3将决定干预措施的可接受性和实施情况 美国东南部家长支持组织的协助者。结果 至 精神上的 将确定有助于 父母拒绝并开发可扩展的方法来减少这些机制，以缩小实质性 影响SGMY的健康差距。如果有效，这些干预措施可以通过在线扩大规模 能够在高耻辱地区绕过父母支持SGMY的障碍的平台。