The goal of this clinical trial is to test the effectiveness of conducting a support group in the Metaverse designed to develop and/or improve resilience in gender diverse people. By exploring the impact of different social challenges in a virtual environment, the main question it aims to answer is whether this approach on conducting support group sessions with gender diverse people will strengthen their resilience and associated abilities (self-compassion) compared to a control group and a waitlist.
Transgender and nonbinary individuals with a stable gender-identity or questioning
Presence of acute psychiatric instability (e.g., acute psychotic symptomatology or acute suicide risk)
Not being part of the transgender population
Younger than 18
Parallel
Metaverse group
BehavioralThe activities will be conducted in a Metaverse platform with immersive features. Each session is divided into two parts (\~2 hours duration). First, a specific social context will be represented (environmental features and static avatars) and a microaggression scenario (adapted for the chosen context) will be described. Participants are engaged in the conversation by the moderator in order to identify various psychological manifestations regarding the context (according to the SORC model) and to come up with solutions for the main, model avatar (part of the research team). Second, the debriefing part of the session will allow participants to talk about their own experiences alongside specific self-compassionate exercises. Repeated measurements will be required: pre-intervention, mid-intervention, post-intervention and at follow-up (after 3 months).
Online asynchronously
BehavioralThe activities will be conducted asynchronously in an online platform where participants will be guided by the moderator through the same type of activities. First, a social context with specific microaggressions will be presented in a text format followed by the same requirements for participants (identifying various psychological manifestations regarding the context and coming up with solutions for the problematic situation). Second, participants will have the transcripts of several self-compassionate exercises to be done independently. A discussion forum will also require their active engagement. Repeated measurements will be required pre-interventions, mid-intervention, post-intervention and at follow-up (3 months).
Gender-affirmation
Assessing changes in levels of comfort and satisfaction related to gender identity with The Psychological Gender Affirmation Scale which contains 5 items, ranging from 1 - Not at all to 5 - Extremely. Higher scores indicate better outcomes.
Resilience
Assessing changes in resilient attitudes from a general perspective with the Brief Resilience Scale (6 items on a 5-point Likert response scale, ranging from 1 - Strongly disagree to 5 - Strongly agree) and from a specific view of gender minority resilience with the Gender Minority Stress and Resilience Measure. Only the resilience items will be selected from the 58-items scale (5 items for Community connectedness and 8 items for Pride). Responses range from 0 - Strongly disagree to 4 - Strongly agree. Higher scores indicate better outcomes.
Stress and mental health correlates
Assessing changes in perceived distal (Discrimination, Rejection and Victimization - 17 items) and proximal stress factors (Non-affirmation of gender identity, Internalized transphobia, Nondisclosure and Negative future expectations - 28 items) with the Gender Minority Stress and Resilience Measure (selecting only stress-related items) and in mental health symptoms with the Depression, Anxiety, Stress Scale (DASS), containing 21 items. Higher scores mean worse outcomes.
Coping mechanisms
Assessing changes in approached coping mechanisms with the Trans and Nonbinary Coping Measure containing 28 items and 6 subscales with both adaptive and maladaptive types of coping, on a 5-point Likert scale (1 - I do not do this to 5 - I almost always do this). Scoring significance depends on the nature of the coping mechanisms.
Mood changes
Short mood check questions for the beggining and end of the sessions with items from The World Health Organization-Five Well-Being Index (6-point Likert scale).
Attitudes toward self
Changes in self-focused attention specific to gender minorities with the Gender Identity Reflection and Rumination Scale, containing 15 items on a 4-point Likert scale (1 - almost never to 4 - almost always). Higher scores for reflection mean better outcomes.
Assertive attitude
Changes in assertiveness are assessed with the Short Form of the Simple Rathus Assertiveness Scale, with 19 items on a 6-point Likert response format (1 - very unlike me to 6 - very much like me). Higher scores mean better outcomes.
Self-efficacy
Assessing enhacement in self-efficay with the General Self-Efficacy Scale with 10 items on a 4-point Likert scale (1 - Not true at all to 4 - Exactly true). Higher scores mean better outcomes.
Gender dysphoria
Gender dysphoric symptoms are assessed pre-intervention (at baseline) to establish an initial level of gender-dysphoria for participants with the Gender Preoccupation and Stability Questionnaire containing 14 items with a 5-point response Likert scale. Higher scores mean increased gender dysphoria.
Psychiatric problems
The DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure is used for a primary screening process at baseline to identify potential elevated psychiatric problems. Higher scores mean worse mental health conditions.
Microaggressions
Past experiences of microaggressions are assessed with two scales, one for binary transgender participants (Gender Identity Microaggressions Scale) containing 14 items, and one for nonbinary transgender participants (The Nonbinary Gender Microaggressions) Scale containing 23 items. Higher scores mean negative experiences with microaggresions.
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