VA has identified military sexual trauma (MST) as one of its highest priorities. MST is associated with increased prevalence of PTSD and depression, substance use disorders, suicide, difficulties maintaining relationships and employment, and homelessness. Yet important gender differences have been identified among MST survivors and many man may experience stigma and shame related to masculinity and sexuality. While gender-based shame appears central to MST-related distress and treatment underutilization, gender has often been overlooked in establishing evidence-based approaches, and no VA MST-related treatment has been developed specifically for men. To address this critical service gap, this study will collect data on improving treatment strategies and patient engagement for men with histories of MST. It will seek to develop strategies for enhancing a 12-session, gender-tailored group therapy for men MST survivors previously developed and implemented by the principal investigator. It will interview Veteran participants and mental health clinicians, conduct a pilot randomized trial, and evaluate feasibility within the VA, with the long-term goal of national implementation
comprehend and sign the informed consent form
report a history of MST
agree to complete research instruments
Because we are looking for a range of impact among men MST survivors, participants will not be excluded based on psychiatric diagnosis
severe suicidal or homicidal ideation, defined using the Columbia Suicide Severity Rating Scale (C-SSRS) and behavioral flags per chart review
severe and uncontrolled substance abuse (identified through current treatment of a substance use disorder in chart)
illness that inhibits engagement in study procedures (e.g., inability to attend in-person visits)
inability to self-consent to participate
Parallel
Men's MST Group
Behavioralsee above
Present-Centered Group Therapy
Behavioralsee above
The Recovery Assessment Scale
The Recovery Assessment Scale (RAS) is a 41-question forced choice 5-level Likert rating scale, designed to assess recovery, with emphasis on agency, hope, and belongingness, and shame-reduction-key constructs postulated to impact and be expressive of psychological distress and intra- and inter-personal avoidance.The RAS is the most widely used instrument to measure recovery and has good internal consistency, test-retest reliability, and interrater reliability. The scale ranges with a minimum score of 24 and a maximum score of 120; higher values signifying higher recovery.
External and Internal Shame Scale
External and Internal Shame Scale (EISS) assesses global shame experience, with attention to its external and internal dimensions, relevant to men's MST. The scale consists of eight items, and measures four central shame domains: inferiority/inadequacy, sense of exclusion, uselessness/emptiness and criticism/judgment. This scale is found to have internal consistency and concurrent validity. The scale ranges with a minimum score of 0 and a maximum score of 32; higher values signifying higher levels of shame.
General Belongingness Scale
General Belongingness Scale (GBS), a 12-item measure rated on a 7-point Likert scale, assesses a general sense of belonging, another indication of interpersonal distress pertaining to MST. This scale is a reliable and valid brief measure of general belongingness, and shows good cross-cultural validity. The scale ranges with a minimum score of 0 and a maximum score of 72; higher values signifying higher levels of belongingness.
Post-Traumatic Checklist for The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)
The PCL-5 is a 20-item non-MST specific self-report measure that assesses the DSM-5 symptoms of PTSD, a common indicator of MST-related distress. Each symptom is rated on a 5-point Likert scale assessing distress of each symptom. The PCL-5 has high reliability and validity, and provides a total and cluster symptom severity score corresponding with DSM-5 diagnostic criteria. The scale ranges with a minimum score of 0 and a maximum score of 80; higher values signifying higher levels of post-traumatic stress.
Patient Health Questionnaire-9
Patient Health Questionnaire-9 (PHQ-9) is a widely used brief, 9-item instrument for screening, diagnosing, monitoring, and measuring the severity of depression over the course of two weeks. The PHQ-9 is a reliable and valid measure of depression severity that assess DSM criteria of depression, including suicidality. PHQ-9 has high cross-cultural validity and is often used in health care research. The scale ranges with a minimum score of 0 and a maximum score of 27; higher values signifying higher levels of depression.
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