Brian A. Feinstein

Substance Use in Lesbian, Gay, and Bisexual Populations: An Update on Empirical Research and Implications for Treatment

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies and more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation vs. abstinence), targets for intervention, and specific treatment modalities.

Efficacy of Telehealth Treatments for Posttraumatic Stress-Related Symptoms: A Meta-Analysis

This meta-analysis summarizes the findings of outcome research on the degree to which telehealth treatments reduce posttraumatic stress disorder (PTSD)-related symptoms. In a search of the literature, 13 studies were identified for inclusion in the meta-analysis and were coded for relevant variables. A total of 725 participants were included. Results indicate that telehealth treatments are associated with significant pre- to postreduction in PTSD symptoms (d = 0.99, 95% confidence interval [CI]: 0.87–1.11, p < .001), and result in superior treatment effects relative to a wait-list comparison condition (d = 1.01, 95% CI: 0.76–1.26, p < .001). However, no significant findings were obtained for telehealth intervention relative to a supportive counseling telehealth comparison condition (d = 0.11, 95% CI: − 0.38 to 0.60, p = .67), and telehealth intervention produced an inferior outcome relative to a face-to-face intervention (d = − 0.68, 95% CI: − 0.39 to − 0.98, p < .001). Findings for depression symptom severity outcome were generally consistent with those for PTSD outcome. Telehealth interventions produced a significant within-group effect size (d = 0.98, 95% CI: 0.86 to 1.10, p < .001) and superior effect relative to wait-list comparison condition (d = 0.80, 95% CI: 0.56–1.05, p < .001). Relative to face-to-face interventions, telehealth treatments produced comparable depression outcome effects (d = 0.13, 95% CI: − 0.55 to 0.28, p = .53). Taken together, these findings support the use of telehealth treatments for individuals with PTSD-related symptoms.

Written exposure as an intervention for PTSD: A randomized clinical trial with motor vehicle accident survivors

The present study examined the efficacy of a brief, written exposure therapy (WET) for posttraumatic stress disorder (PTSD). Participants were 46 adults with a current primary diagnosis of motor vehicle accident-related PTSD. Participants were randomly assigned to either WET or a waitlist (WL) condition. Independent assessments took place at baseline and 6-, 18-, and 30-weeks post baseline (WL condition not assessed at 30 weeks). Participants assigned to WET showed significant reductions in PTSD symptom severity at 6- and 18-week post-baseline, relative to WL participants, with large between-group effect sizes. In addition, significantly fewer WET participants met diagnostic criteria for PTSD at both the 6- and 18-week post-baseline assessments, relative to WL participants. Treatment gains were maintained for the WET participants at the 30-week post baseline assessment. Notably, only 9% of participants dropped out of WET and the WET participants reported a high degree of satisfaction with the treatment. These findings suggest that a brief, written exposure treatment may efficaciously treat PTSD. Future research should examine whether WET is efficacious with other PTSD samples, as well as compare the efficacy of WET with that of evidence-based treatments for PTSD.

Rumination Mediates the Association Between Cyber-Victimization and Depressive Symptoms

The current study examined the 3-week prospective associations between cyber-victimization and both depressive symptoms and rumination. In addition, a mediation model was tested, wherein rumination mediated the association between cyber-victimization and depressive symptoms. Participants (N = 565 college-age young adults) completed online surveys at two time points 3 weeks apart. Results indicated that cyber-victimization was associated with increases in both depressive symptoms and rumination over time. Furthermore, results of the path analysis indicated that cyber-victimization was associated with increases in rumination over time, which were then associated with greater depressive symptoms, providing support for the proposed mediation effect for women, but not men. Findings extend previous correlational findings by demonstrating that cyber-victimization is associated with increases in symptomatology over time. Findings also suggest that the negative consequences of cyber-victimization extend beyond mental health problems to maladaptive emotion regulation. In fact, rumination may be a mechanism through which cyber-victimization influences mental health problems, at least for women. Mental health professionals are encouraged to assess cyber-victimization as part of standard victimization assessments and to consider targeting maladaptive emotion regulation in addition to mental health problems in clients who have experienced cyber-victimization.

The durability of beneficial health effects associated with expressive writing.

Abstract This study examined the durability of benefits associated with expressive writing. Sixty-eight college undergraduates completed measures of physical and psychological health at the beginning of their first year and were then randomized to either an expressive writing or a control writing condition. Changes in physical health, psychological health (i.e., depression, stress, and anxiety), and academic performance were assessed two, four, and six months later. Findings indicated that participants assigned to the expressive writing condition reported less depression symptom severity at the two-month follow-up assessment relative to participants assigned to the control condition. However, these symptom reductions were not observed at any of the subsequent follow-up assessments. No significant changes were reported for physical health complaints, stress symptoms, anxiety symptoms, or academic performance. These findings suggest that, among first-year college students, expressive writing may provide some short-term relief for certain symptoms.

Bisexuality, Minority Stress, and Health

Purpose of ReviewBisexual individuals are at increased risk for negative health outcomes compared to heterosexual individuals and often compared to gay/lesbian individuals as well. The goal of this article is to summarize the current evidence-base on bisexual health disparities, to describe factors that influence them, and to review interventions designed to improve the health of bisexual individuals.Recent FindingsBased on our review of the literature, we conclude that there is strong evidence that bisexual individuals are at increased risk for mental health and substance use problems. These disparities are evident across dimensions of bisexuality (identity, attraction, and behavior), but there are important nuances to these findings. There is also evidence that bisexual men are at increased risk for sexually transmitted infections (STIs) compared to heterosexual men and that bisexual women are at increased risk for STIs compared to both lesbians and heterosexual women. Although there are numerous causes of these disparities, a leading contributor is stress related to stigma and discrimination. Most of the interventions that have been developed for bisexual individuals are HIV prevention programs for behaviorally bisexual men of color. Despite less attention to mental health and substance use interventions for bisexual individuals, recent developments show promise in their potential application to this population.SummaryBisexual individuals are at increased risk for mental health, substance use, and sexual health problems, and this is due, in part, to stigma and discrimination. Future research should continue to examine how different dimensions of bisexuality relate to health disparities and factors that influence them. There is also an urgent need to develop, test, and disseminate interventions to improve the health of bisexual individuals..

Pre-Exposure Prophylaxis (PrEP) Use and Condomless Anal Sex: Evidence of Risk Compensation in a Cohort of Young Men Who Have Sex with Men

Background: Young men who have sex with men (YMSM) are disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition. It remains unclear if PrEP use increases rates of condomless sex (ie, risk compensation), which may increase risk of infection if PrEP adherence is not optimal. This study aimed to examine whether PrEP use and PrEP adherence were associated with change in sexual risk behaviors in a large longitudinal cohort of YMSM reporting on multiple sexual partnerships over time. Method: Data were obtained from the first 3 visits of an ongoing cohort study of YMSM in Chicago (analytic N = 953; 14.1% HIV-positive at baseline). Participants reported up to 4 sexual partnerships at each visit, including sexual behavior, PrEP use, and PrEP adherence within partnerships. Results: YMSM reported higher rates of receptive condomless anal sex (CAS) in partnerships during which they were on PrEP compared with those when they were not on PrEP. This association was consistent across both HIV-negative and HIV-positive participants reporting on partnerships with both perceived HIV-negative/unknown and HIV-positive partners. The rate of receptive CAS was higher in PrEP nonadherent partnerships compared with non-PrEP partnerships. The rate of receptive CAS was also higher in PrEP nonadherent than adherent partnerships, but this was not statistically significant. Conclusions: These analyses provide compelling data suggesting that YMSM are engaging in risk compensation when on PrEP. If rates of receptive CAS are highest among YMSM who are PrEP nonadherent, PrEP as a prevention strategy could fail to curb HIV incidence among YMSM.

Self-concept and self-stigma in lesbians and gay men

This study examined the associations among three aspects of self-concept (self-esteem, self-concept clarity and sexual identity confusion), self-stigma and depressive symptoms. Two hundred and eighty eight participants (163 lesbians and 125 gay men) completed an anonymous, online survey. Results indicated that individuals with lower self-esteem, lower self-concept clarity and higher sexual identity confusion reported higher self-stigma. Furthermore, the negative association between self-concept clarity and self-stigma was significant for individuals with lower self-esteem, but not those with higher self-esteem. Finally, the positive association between self-stigma and depressive symptoms was significant for individuals with lower self-esteem, but not those with higher self-esteem, and it was stronger for those with lower sexual identity confusion. The current findings highlight the importance of self-concept in the internalisation of sexual stigma and its sequelae.

Minority stress, sexual identity uncertainty, and partner gender decision making among nonmonosexual individuals.

Despite decades of research on sexual identity development and minority stress, sexual identity uncertainty has received relatively little attention. Sexual identity uncertainty refers to the extent to which an individual is uncertain about which sexual identity label best captures their pattern of attractions and behavior. Although theory suggests that sexual identity uncertainty is a consequence of negative experiences related to one’s sexual identity, this has not been empirically tested. The current study examined factors that influence sexual identity uncertainty as well as its potential consequences for relationship decision making in a sample of nonmonosexual individuals (individuals attracted to more than one gender; N = 397). For nonmonosexual individuals who reported low sexual identity disclosure, more frequent experiences of monosexism were associated with greater internalized monosexism, which in turn, was associated with greater sexual identity uncertainty. Additionally, among nonmonosexual individuals who reported that others frequently made assumptions about their sexual orientation, higher sexual identity uncertainty was associated with more partner gender management. Specifically, these individuals reported that their relationship decisions were more influenced by concern about being seen in relationships with one gender over another and desire to be seen in relationships with one gender over another. In summary, findings are consistent with a theoretical model of how sexual identity uncertainty develops among nonmonosexual individuals (Weinberg, Williams, & Pryor, 1994). Results also suggest that sexual identity uncertainty can influence the decisions that nonmonosexual individuals make about relationships. Implications and directions for future research are discussed.

Development and Initial Validation of the Sexual Minority Women Rejection Sensitivity Scale

The goals of the current studies were to develop a measure of sexual orientation rejection sensitivity (RS) for sexual minority women (SMW) and to examine its preliminary reliability and validity. In Study 1a, data from 150 SMW were used to develop scenarios for the SMW Rejection Sensitivity Scale (SMW-RSS). In Study 1b, data from a second sample of 128 SMW were used to streamline the SMW-RSS and test its factor structure. In Study 2, data from a third sample of 300 SMW were used to test the convergent and discriminant validity of the SMW-RSS. The SMW-RSS demonstrated strong convergent validity, correlating with the indices of minority stress (discrimination, sexual identity acceptance concerns, difficulty developing a positive sexual identity, internalized negativity, and concealment motivation) and internalizing psychopathology (anxiety and depression symptoms). The measure also demonstrated strong discriminant validity, predicting psychosocial outcomes above and beyond existing measures of RS. Findings demonstrate the utility of the SMW-RSS to assess concerns and expectations of sexual orientation rejection among women and underscore the importance of examining the unique concerns about rejection that SMW experience. Additional online materials for this article are available to PWQ subscribers on PWQ’s website at http://pwq.sagepub.com/supplemental