Expressive writing to reduce depressive and anxiety symptoms among sexual minority veterans: Study design for a pilot randomized controlled trial.

BACKGROUND: Sexual minority veterans (e.g., gay, lesbian, bisexual) are at increased risk for depression and anxiety due in part to the experience of sexual minority stressors. However, few interventions target distress related to sexual minority stressors, and even fewer have been tested in Veterans Health Administration (VHA). Brief, easy to implement interventions, such as expressive writing-based interventions, that target distress related to sexual minority stressors are needed to reduce disparities in depression and anxiety.

METHOD: We describe the design of a two-phase study consisting of an open trial and a pilot randomized controlled trial (RCT) comparing Expressive Writing on Minority Stressors (EWMS) and a neutral writing condition among sexual minority veterans. The EWMS protocol will be iteratively refined in a case series (n = 10) and then tested in a pilot randomized control trial (RCT; n = 54). Aims of the pilot RCT are to: 1) demonstrate feasibility and acceptability of study procedures and EWMS using quantitative and qualitative data; and 2) examine preliminary trends in depressive and anxiety symptoms to inform the design of a future, fully powered efficacy trial. Participants will be assessed at baseline, posttreatment, and 3 months after treatment. Qualitative exit interviews will be conducted to inform refinements to the intervention with an eye towards usefulness, satisfaction, and implementation.

CONCLUSIONS: This pilot RCT will inform the first fully powered clinical trial to test an individually delivered intervention for sexual minority veterans to reduce depressive and anxiety symptoms associated with minority stress.