Project Summary

LGBTQ+ people have high rates of post-traumatic stress disorder (PTSD), often accompanied by other mental health problems, and experience unique risks such as discrimination and prejudice that may contribute to PTSD. Unfortunately, there have been no research studies to identify which PTSD treatments work the best for LGBTQ+ people.

This study will compare two PTSD treatments that are known to work but haven’t been tested in LGBTQ+ people: cognitive processing therapy (CPT) and STAIR narrative therapy (SNT) to find out which ones work the best for LGBTQ+ people in real world settings. This study would help LGBTQ+ patients and their providers to select PTSD treatments because they would know which treatments work best.

For this study the study team would enroll 400 LGBTQ+ individuals, enrolling 80 each of the following groups:

  • Cisgender gay or bisexual (or sexual minority) men
  • Cisgender lesbian or bisexual (or sexual minority) women
  • Gender expansive or non-binary individuals of any sexual orientation 
  • Transgender women of any sexual orientation 
  • Transgender men of any sexual orientation.

Participants will receive either CPT or SNT in a university-affiliated community-based clinic that specializes in LGBTQ+ mental health. Participants will be recruited from urban, suburban and rural settings, with at least 200 participants from suburban or rural areas. At least 200 participants will be racial or ethnic minority in addition to being LGBTQ+.

The study team will follow participants at zero months (before treatment), and three, six, and 12 months. We will examine how much PTSD symptoms get better in each of the treatments, we anticipate that PTSD symptoms will get better for patients in both treatments. The study team also think that more people will stay in SNT treatment meaning that less people will leave treatment early. They also will look at if a participant’s minority stress experiences (such as experiencing discrimination and concealing LGBTQ+ identity) and use of drugs or alcohol will make the treatments work less well.

We will look at if both treatments improve depression symptoms and improve quality of life. We expect that participants will be highly satisfied with both treatments. We are going to look at if these treatments work for all of the LGBTQ+ individuals in the study, and also will see if they work within portions of the LGBTQ+ community considered separately including cisgender sexual minority men, cisgender sexual minority women, gender expansive or non-binary individuals, transgender women, transgender men, among people who live in urban versus rural or suburban areas, and among racial and ethnic minority LGBTQ+ people.

During this study we will have a stakeholder advisory board that will give us feedback that will include clinicians and administrators. We will also have a patient leadership team that will meet with our team monthly to give our team feedback on the patient perspective on all aspects of the study. We will let people know about what we found in the study through multiple methods, including providing training to providers in the final year of the project and creating videos and other materials to inform patient choices and clinic and clinician practices.

This study will guide clinical decision-making and health care organizations’, clinicians’, and patients’ selections of PTSD treatments by identifying their effectiveness for LGBTQ+ patients. 

Project Information

Annesa Flentje, Ph.D.
The Regents of the University of California, San Francisco

Key Dates

60 months
June 2023


Award Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 28, 2024