(PS10-21) Implementing evidence-based cognitive behavioral interventions for PTSD with sexual and gender minority individuals: Insights from community therapists in a large comparative effectiveness study

Abstract Text: Sexual and gender minority (SGM) individuals experience higher rates of posttraumatic stress disorder (PTSD) than their heterosexual and cisgender counterparts. Data on interventions for SGM individuals with PTSD are currently limited. LIFESCAPE is a randomized comparative effectiveness study of two cognitive behavioral therapies, Cognitive Processing Therapy (CPT) and STAIR Narrative Therapy (SNT), for the treatment of PTSD in SGM populations. We conducted qualitative semi-structured interviews with nine community mental health therapists implementing treatments in LIFESCAPE to investigate the barriers and facilitators to learning and implementing CPT and SNT in community settings, as well as factors influencing intervention delivery. Study therapists included individuals with master’s or PhD level degrees, most of whom had limited or no prior formal experience delivering manualized interventions. After a two-day training and weekly expert consultation, therapists implemented the LIFESCAPE interventions for a range of several months to one year. Inductive thematic analysis generated four major themes: expectations for intervention efficacy, intervention barriers and facilitators, population-based intervention tailoring, and evaluating intervention credibility in community settings. Therapists reported both initial skepticism regarding the ability of the study interventions to treat PTSD in community settings and later positive experiences with participant responsiveness to the interventions. Expectations for the interventions’ efficacy in treating PTSD in SGM populations was high among interventionists after the completion of initial sessions, including with clients who reported experiences of minority stress related or unrelated to Criterion A traumas. Barriers to implementation included the resource requirements needed to achieve fidelity in learning the interventions and client-related factors affecting consistent attendance. Treatment facilitators included therapeutic rapport and ongoing case consultation. Intervention adaptations included therapist discussion of the effects of structural stigma on SGM individuals; however, several therapists reported that no major changes to the interventions were necessary. Reported barriers to uptake of manualized CBT interventions among community therapists included difficulty assessing intervention credibility.