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

项目摘要 父母的支持是性和性别少数青年（SGMY）心理健康的最强预测因子。 健康然而，超过一半的父母对SGMY的披露表示拒绝。甚至相对接受 父母可能会感到不适，而SGMY经常报告父母未满足的需求， 成年几乎没有干预措施可以帮助父母支持他们的SGMY孩子，并且没有一个在一个 随机试验，有效减少父母排斥和增加对SGMY的支持。这 该提案将开发和测试两种旨在解决这一差距的基于理论的干预措施的有效性。 这些干预措施分别解决了两种机制，表明父母拒绝SGMY - 父母对他们的SGMY未解决的负面情绪和对他们的SGMY缺乏同情心。第一 干预-表达性写作（EW）-通过帮助人们理解压力来减少负面情绪 事件在我们改编的电子战中，我们将要求不接受的父母写下他们的压力影响， 孩子的SGM身份在三个20分钟的课程中对他们有影响。第二种干预-基于依恋 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的父母中建立同情心。然而，依恋型家庭的父母关注的任务 治疗目前需要与受过训练的治疗师进行2-3次治疗，这阻碍了广泛的使用。我们将创造一个 这种疗法的基于书写的版本与EW并行（即，3个20分钟的写作课程）。这种适应 将要求父母以书面形式参与基于依恋的家庭治疗的核心组成部分（即，写作 关于一个人对孩子的影响，一个人自己的依恋需求，以及孩子的需求）。三个目标，我们 将制定和测试这两个简短的干预措施，为不接受父母的初步疗效， 美国东南部-一个地区最高的反SGM耻辱和最高的SGMY心理健康需求在美国。 目标1将使社区利益相关者，不接受父母，和SGMY在东南部通知 编写提示和在线平台的外观。目标2将测试EW的初步效果， ABW。我们将129名不接受的父母随机分为EW、ABW或对照组。家长将报告小学 结果（即，拒绝和支持行为），目标介体（即，负面情绪，同理心），以及 次要结果（例如，基线、干预后和3个月时的父母和青少年抑郁/焦虑） 随访我们亦会研究可否让家长替子女登记，以便我们研究 干预措施对SGMY本身的影响。目标3将确定干预措施的可接受性和实施情况 在美国东南部的家长支持组织的协调员。结果 到 心理 将确定有助于 父母的拒绝和发展可扩展的方法，以减少这些机制，以缩小实质性的 影响SGMY的健康差距。如果有效，这些干预措施可以通过在线方式扩大规模， 平台能够绕过障碍，在高耻辱的地区SGMY的父母支持。

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.