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      Somatic Experiencing ® Informed Therapeutic Group for the Care and Treatment of Biopsychosocial Effects upon a Gender Diverse Identity

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          Abstract

          Background

          Somatic Experiencing ® (SE™) is a resiliency-based treatment for autonomic nervous systems dysregulation syndromes, such as posttraumatic stress disorder, anxiety, depression, and physical syndromes like chronic pain, migraines, and fibromyalgia. “Transgender/gender non-conforming/gender variant” describes people whose gender identity/expression is different, at least part of the time, from the sex assigned at birth. Research indicates transgender individuals have a higher incidence of depression, anxiety, victimization, and discrimination. SE™ tools may support transgender/gender non-conforming individuals to increase resilience in the face of discrimination and social injustice.

          Methods

          This study is a pretest posttest within group ( N = 7) pilot study assessing the impact of a 10 session SE™ based group treatment on depression (PHQ-9), anxiety (GAD-7), somatic symptoms (PHQ-15), quality of life (QoL) (WHOQoL-BREF), and coping with discrimination (CDS) for a cohort of seven individuals identifying as transgender/gender non-conforming. Materials were created in collaboration with members of the LGBTQIA community. Care was taken to be inclusive of gender non-conforming identities and culturally responsive in design.

          Results

          Participants described their gender identities as: non-binary, female to male, male to female, and gender fluid. Participants had significant increase in psychological QoL (psychological well-being) (WHOQoL-BREF) p = 0.004, SD = 2.31, with a modest effect size of d = 0.71. Some likely impacts of historical effect discussed. No other clinical or QoL outcomes were statistically significant. However, one outlier was identified in the dataset. When this outlier was excluded there was a trend toward significant reduction in depression symptoms (PhQ-9) p = 0.097, SD = 3.31 and a modest effect size of d = 0.68; somatic symptoms (PhQ-15) p = 0.093, SD = 3.52 and a modest effect size of d = 0.72.

          Conclusion

          These data indicate that a brief 10 session intervention of SE™ could have a meaningful impact on symptoms of depression, somatization, and QoL for gender non-conforming individuals. Further research is warranted.

          Limitations

          First, this study has a small sample size limiting statistical power and generalizability. Second is a history effect. Less than 1 week prior to final data collection, there was a significant hate-motivated act in Florida targeting the LGBTQIA community.

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          Most cited references31

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          Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

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            Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons.

            The psychiatric impact of interpersonal abuse associated with an atypical presentation of gender was examined across the life course of 571 male-to-female (MTF) transgender persons from the New York City Metropolitan Area. Gender-related abuse (psychological and physical), suicidality, and Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) major depression were retrospectively measured across five stages of the life course using the Life Chart Interview. Among younger respondents (current age of 19-39), the impact of both types of abuse on major depression was extremely strong during adolescence and then markedly declined during later stages of life. Among older respondents (current age of 40-59), the impact of both types of abuse on major depression was strong during adolescence and then marginally declined during later stages of life. The effects of both types of abuse on suicidality were weaker but more consistently observed across the life course among both the younger and older respondents. Gender-related abuse is a major mental health problem among MTF transgender persons, particularly during adolescence. As these individuals mature, however, the consequences of this abuse appear less severe, which may represent the development of moderately effective mechanisms for coping with this abuse.
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              Hormone-treated transsexuals report less social distress, anxiety and depression.

              The aim of the present study was to evaluate the presence of symptoms of current social distress, anxiety and depression in transsexuals. We investigated a group of 187 transsexual patients attending a gender identity unit; 120 had undergone hormonal sex-reassignment (SR) treatment and 67 had not. We used the Social Anxiety and Distress Scale (SADS) for assessing social anxiety and the Hospital Anxiety and Depression Scale (HADS) for evaluating current depression and anxiety. The mean SADS and HADS scores were in the normal range except for the HAD-Anxiety subscale (HAD-A) on the non-treated transsexual group. SADS, HAD-A, and HAD-Depression (HAD-D) mean scores were significantly higher among patients who had not begun cross-sex hormonal treatment compared with patients in hormonal treatment (F=4.362, p=.038; F=14.589, p=.001; F=9.523, p=.002 respectively). Similarly, current symptoms of anxiety and depression were present in a significantly higher percentage of untreated patients than in treated patients (61% vs. 33% and 31% vs. 8% respectively). The results suggest that most transsexual patients attending a gender identity unit reported subclinical levels of social distress, anxiety, and depression. Moreover, patients under cross-sex hormonal treatment displayed a lower prevalence of these symptoms than patients who had not initiated hormonal therapy. Although the findings do not conclusively demonstrate a direct positive effect of hormone treatment in transsexuals, initiating this treatment may be associated with better mental health of these patients. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                27 February 2018
                2018
                : 9
                : 53
                Affiliations
                [1] 1Healing Concepts, LLC , Hollywood, FL, United States
                [2] 2Embodied Liberation , South Portland, ME, United States
                [3] 3Integrated Health Psychology Training Program, Wright Institute , Berkeley, CA, United States
                Author notes

                Edited by: Rebecca Thwing Emeny, Geisel School of Medicine, United States

                Reviewed by: Jana Chihai, Nicolae Testemiţanu State University of Medicine and Pharmacy, Moldova; Maia P. Smith, St. George’s University, Grenada

                *Correspondence: Paul C. Briggs, healingconcepts@ 123456bellsouth.net

                Specialty section: This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2018.00053
                5835108
                ea675c97-91c6-4057-bf52-2026948ff480
                Copyright © 2018 Briggs, Hayes and Changaris.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 13 July 2017
                : 07 February 2018
                Page count
                Figures: 7, Tables: 6, Equations: 0, References: 49, Pages: 18, Words: 12967
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                social injustice,somatic experiencing®,transgender,discrimination,resilience,groupwork

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