A transdiagnostic minority stress treatment approach for gay and bisexual men's syndemic health conditions
Open accessAbstract
Developing and deploying separate treatments for separate conditions seems ill-suited to intervening upon the co-occurring, and possibly functionally similar, psychosocial conditions facing gay and bisexual men. This article argues for the need to create transdiagnostic interventions that reduce multiple syndemic conditions facing gay and bisexual men at the level of their shared source in minority stress pathways. This article first reviews psychosocial syndemic conditions affecting gay and bisexual men, then suggests pathways that might link minority stress to psychosocial syndemics based on recent advancements in emotion science, psychiatric nosology, and cognitive-affective neuroscience, and finally suggests cross-cutting psychosocial treatment principles to reduce minority stress-syndemic pathways among gay and bisexual men. Because minority stress serves as a common basis of all psychosocial syndemic conditions reviewed here, locating the pathways through which minority stress generates psychosocial syndemics and employing overarching treatment principles capable of simultaneously alleviating these pathways will ultimately create a transdiagnostic approach to improving gay and bisexual men's health. Clinical research and training approaches are suggested to further validate the pathways suggested here, establish the efficacy of treatment approaches tied to those pathways, and generate effective methods for disseminating a transdiagnostic minority stress treatment approach for gay and bisexual men's psychosocial syndemic health.
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Claims the paper makes
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- Premisecitation
Minority stress adds to general life stress to compromise psychosocial health among individuals predisposed to adverse outcomes through personal vulnerability factors.
“Minority stress, then, adds to the psychosocial burden of general life stress to compromise psychosocial health among individuals who are otherwise predisposed to adverse psychosocial health through personal vulnerability factors.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Dohrenwend, 2000 source
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- Premisecitation
These psychosocial health disparities often co-occur.
“These psychosocial health disparities frequently co-occur (Parsons et al., 2012; Stall & Purcell, 2000)”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
Gay, bisexual, and other men who have sex with men are disproportionately affected by body image disturbance and eating disorders compared with heterosexual men.
“(4) body image disturbance and eating disorders (Austin et al., 2004; Russell & Keel, 2002)”
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Substance use problems are associated with chronic expectations of gay-related rejection and internalized homophobia.
“substance use problems are associated with chronic expectations of gay-related rejection and internalized homophobia (Brubaker, Garrett, & Dew, 2009; Green & Feinstein, 2012; Pachankis, Hatzenbuehler, & Starks, 2014b)”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation
Minority stressors add to general life stress to increase risk of psychosocial syndemic conditions among gay and bisexual men.
“These stressors, uniquely experienced by sexual minority individuals, additively combine with general life stress (Meyer, Schwartz, & Frost, 2008) to put gay and bisexual men at particular risk of experiencing psychosocial syndemic health conditions (Hamilton & Mahalik, 2009; Hatzenbuehler, Nolen-Hoeksema, & Erickson, 2008c)”
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- Premisecitation
Depression and anxiety are associated with minority stressors including victimization, discrimination, rejection expectations, internalized homophobia, and concealment.
“depression and anxiety are associated with minority stressors including gay-related victimization, discrimination, chronic expectations of gay-related rejection, internalized homophobia, and sexual orientation concealment (Feinstein, Goldfried, & Davila, 2012; Pachankis, Newcomb, Feinstein, & Bernstein, 2014c)”
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- cites Pachankis et al., 2014c
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- Premisecitation
Sexual orientation disparities in permissive substance use norms are associated with elevated substance use in gay compared to heterosexual men.
“sexual orientation disparities in permissive substance use norms are associated with elevated rates of substance use in gay, compared to heterosexual, men (Cochran, Grella, & Mays, 2012; Hatzenbuehler, Corbin, & Fromme, 2008a)”
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- cites Hatzenbuehler et al., 2008a
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- Premisecitation
Shared genetic, neurological, and behavioral pathways underlie many stress-related psychosocial problems in the general population.
“shared genetic, neurological, and behavioral pathways underlie many stress-related psychosocial problems in the general population (Wilamowska et al., 2010)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Wilamowska et al., 2010 source
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- Interpretationcitation
Each of the psychosocial syndemic conditions is associated with minority stress.
“Strong and continually growing evidence suggests that each of the psychosocial syndemic conditions noted above is associated with the disproportionate stigma-based stress, known as minority stress (Meyer, 2003), borne by sexual minority, compared to heterosexual, men.”
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- Premisecitation
Gay, bisexual, and other men who have sex with men are disproportionately affected by sexual compulsivity compared with heterosexual men.
“(5) sexual compulsivity (Baum & Fishman, 1994; Missildine, Feldstein, Punzalan, & Parsons,2005)”
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- cites Missildine et al., 2005 source
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- Interpretationreasoning
Because minority stress is a common basis of the reviewed syndemic conditions, interventions targeting the pathways through which minority stress produces them could alleviate them all at once.
“Because minority stress serves as a common basis of all psychosocial syndemic conditions reviewed here, intervention approaches that target the pathways through which minority stress produces these conditions could alleviate them all at once.”
Quote in the paperSubstantial claim- Rests on an assumption: Targeting shared minority stress pathways will simultaneously alleviate multiple syndemic conditions among gay and bisexual men.
- Premisecitation
Gay, bisexual, and other men who have sex with men are disproportionately affected by substance use problems compared with heterosexual men.
“(2) substance use problems (Green & Feinstein, 2012)”
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- Premisecitation
Gay, bisexual, and other men who have sex with men are disproportionately affected by depression and anxiety compared with heterosexual men.
“Gay, bisexual, and other men who have sex with men are disproportionately burdened by several psychosocial health problems compared to heterosexual men, including (1) depression and anxiety (Mays & Cochran, 2001)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Mays & Cochran, 2001 source
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- Premisecitation
These co-occurring psychosocial problems additively increase risk for HIV risk behavior and infection.
“and additively confer risk for HIV risk behavior and infection (Brennan, Craig, & Thompson, 2012; Klostermann, Kelley, Milletich, & Mignone, 2011; West, 2012; Wilton, 2009)”
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Strict conformity to masculine norms in some gay communities is associated with a composite of syndemic health risks including substance use, body image disturbance, and HIV risk behaviors.
“the strict conformity to masculine norms perpetuated by some gay communities (Taywaditep, 2001) is associated with a composite of syndemic health risks, including substance use, body image disturbance, and HIV risk behaviors (Brennan et al., 2012; Courtenay, 2000; Hamilton & Mahalik, 2009; Pachankis, Westmaas, & Dougherty, 2011)”
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Several studies show associations between gay and bisexual men's degree of exposure to the gay community and syndemic conditions such as eating disorders, substance use, and HIV risk behavior.
“Several studies support the unhealthy nature of these community-driven stressors by uncovering associations between gay and bisexual men’s degree of exposure to the gay community and syndemic conditions, such as eating disorders (Feldman & Meyer, 2007), substance use (Green & Feinstein, 2012), and HIV risk behavior (Egan et al., 2011).”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationreasoning
At the population level, minority stress translates stigmatizing social structures into poor health for sexual minorities.
“At the population level, minority stress in the form of gay-related victimization, discrimination, chronic expectations of gay-related rejection, internalized homophobia, and sexual orientation concealment translates stigmatizing social structures into poor health for sexual minorities.”
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Minority stress theory identifies stigmatizing social structures as the primary driver of stress-sensitive psychosocial disparities among sexual minorities.
“minority stress theory recognizes the foremost role of stigmatizing social structures in driving stress-sensitive psychosocial disparities among sexual minorities (Meyer, 2003)”
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- Interpretationcitation
The co-occurring psychosocial problems among gay and bisexual men form a syndemic.
“these conditions have been described as forming a syndemic, or simultaneous and synergistic epidemic, surrounding gay and bisexual men (Stall & Purcell, 2000)”
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- Premisecitation
Body image disturbance and eating disorders are associated with gay-related rejection expectations, internalized homophobia, and sexual orientation-based victimization.
“Body image disturbance and eating disorders are associated with gay-related rejection expectations, internalized homophobia, and sexual orientation-based victimization (Kimmel & Mahalik, 2005)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kimmel & Mahalik, 2005 source
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- Interpretationcitation
Depression, anxiety, substance use, intimate partner violence, body image concerns, and sexual compulsivity may represent final behavioral outcomes of the same or similar underlying neurological, cognitive, affective, and interpersonal stress pathways.
“depression and anxiety, substance use, intimate partner violence, body image concerns, and sexual compulsivity could be argued to represent final behavioral outcomes of the same or similar underlying neurological, cognitive, affective, and interpersonal stress pathways”
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Gay, bisexual, and other men who have sex with men are disproportionately affected by intimate partner violence compared with heterosexual men.
“(3) intimate partner violence (Balsam, Rothblum, & Beauchaine, 2005; Tjaden, Thoennes, & Allison, 1999)”
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Experiences of loss are associated with depressive symptoms, substance use, and other psychosocial health problems among the general population and gay and bisexual men specifically.
“Experiences of loss, in turn, are associated with depressive symptoms, substance use, and several other psychosocial health problems among the general population and gay and bisexual men specifically (Folkman, Chesney, Collette, Boccellari, & Cooke, 1996; Martin & Hetrick, 1988; Sikkema, Kochman, DiFranceisco, Kelly, & Hoffmann, 2003)”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation
Hypervigilance in the form of expectations of gay-related rejection is associated with depression, social anxiety, substance use, sexual compulsivity, and intimate partner violence among gay and bisexual men.
“Hypervigilance in the form of expectations of gay-related rejection has been shown to be associated with depression, social anxiety, substance use, sexual compulsivity, and intimate partner violence among gay and bisexual men (Carvalho et al., 2011; Feinstein et al., 2012; Pachankis et al., 2008, 2014b, 2014c, in press)”
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Cognitive avoidance mediates the relationship between minority stress experiences such as discrimination and depressed and anxious mood among sexual minority individuals.
“has been shown to mediate the relationship between minority stress experiences, such as discrimination, and depressed and anxious mood among sexual minority individuals (Hatzenbuehler, Nolen-Hoeksema, & Dovidio, 2009)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hatzenbuehler et al., 2009
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- Premisecitation
Gay and bisexual men are disproportionately exposed to multiple types of victimization, violence, and abuse across the lifespan compared to heterosexual men.
“gay and bisexual men are disproportionately exposed to multiple types of victimization, violence, and abuse across the lifespan, including childhood sexual abuse, peer assault, parental physical abuse, and parental rejection, compared to heterosexual men (Balsam et al., 2005; Friedman, Marshal, Stall, Cheong, & Wright, 2008; Russell, Ryan, Toomey, Diaz, & Sanchez, 2011)”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationreasoning
Specific RDoC mechanisms with preliminary promise as minority stress-syndemic pathways include disruptions of negative valence systems, positive valence systems, and social functioning.
“Specific RDoC mechanisms possessing preliminary promise as minority stress–syndemic pathways include disruptions of negative valence systems (i.e., avoidance, hypervigilance, loss), positive valence systems (i.e., approach motivation, reward learning, habit), and social functioning (i.e., disrupted attachment, low agency, social submission, poor social communication, low self-knowledge).”
Quote in the paperSubstantial claim - Premisecitation
Avoidance may manifest as emotional numbing through substance abuse, compulsive or risky sexual behavior, or other impulsive behavior to escape painful affective experiences.
“Avoidance might manifest in emotional numbing through substance abuse, compulsive or risky sexual behavior, or other forms of impulsive behavior enacted to escape painful affective experiences (Batten, Follette, & Aban, 2002; Gratz, Bornovalova, Delany-Brumsey, Nick, & Lejuez, 2007; Paul, Catania, Pollack, & Stall, 2001)”
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Strong evidence exists that stress of the type to which gay and bisexual men are disproportionately exposed from an early age disrupts neurobiological stress pathways, manifesting in impairments in motivational systems.
“Strong evidence exists that stress, of the type to which gay and bisexual men are disproportionately exposed from an early age, disrupts neurobiological stress pathways, manifesting in impairments in these motivational systems (Sinha, 2008)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sinha, 2008
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- Premisecitation
Ongoing experiences with discrimination, harassment, ambiguously stigmatizing social encounters, and sexual orientation concealment may predispose gay and bisexual men to chronic hypervigilance.
“Ongoing, including daily, experiences with discrimination, harassment, ambiguously stigmatizing social encounters, and sexual orientation concealment may predispose gay and bisexual men to chronic hypervigilance (Major & O’Brien, 2005; Pachankis, 2007)”
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- cites Pachankis, 2007
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- Premisecitation
Cognitive avoidance such as rumination or worry emerges from early and ongoing stress of the type disproportionately faced by gay and bisexual men.
“Cognitive avoidance, such as rumination or worry (Fresco, Frankel, Mennin, Turk, & Heimberg, 2002), represents another avoidance strategy emerging from early and ongoing stress of the type disproportionately faced by gay and bisexual men (Hatzenbuehler, McLaughlin, & Nolen-Hoeksema, 2008b)”
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- cites Hatzenbuehler et al., 2008b
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- Premisecitation
Psychosocial treatments that address shared pathways have been shown effective across psychosocial problems.
“psychosocial treatments that address these shared pathways have been shown to be effective across psychosocial problems (e.g., Ellard, Fairholme, Boisseau, Farchione, & Barlow 2010; Farchione et al., 2012)”
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- cites Farchione et al., 2012
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- Premisecitation
Depression and anxiety have been argued to reflect impairments in motivational systems involving reward learning and habit.
“Depression and anxiety have also been argued to reflect impairments in motivational systems involving reward learning and habit (e.g., Eshel & Roisere, 2010)”
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- Premisecitation
Gay and bisexual men, especially the AIDS generation, often experienced acute loss of friends, partners, and community.
“gay and bisexual men, especially of the so-called AIDS generation, often experienced an acute loss of friends, partners, and community (Halkitis, 2013)”
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- Interpretationcitation
Emotional, cognitive, and behavioral avoidance rooted in early and ongoing minority stress represents one possible pathway uniting minority stress with gay and bisexual men's psychosocial syndemics.
“Thus, emotional, cognitive, and behavioral avoidance, rooted in early and ongoing minority stress, represents one possible pathway uniting minority stress with gay and bisexual men’s psychosocial syndemics.”
Quote in the paperSubstantial claim - Interpretationcitation
Several RDoC mechanisms might operate as pathways through which minority stress generates syndemic conditions because they associate with both minority stress and syndemic conditions, meeting a necessary but insufficient precondition of statistical mediation.
“Several RDoC mechanisms might specifically operate as pathways through which minority stress generates gay and bisexual men’s psychosocial syndemic conditions in that they demonstrate associations with both minority stress and syndemic conditions, as depicted in Fig. 1, thereby meeting one necessary, although insufficient, precondition of statistical mediation (MacKinnon, 2008)”
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- Interpretationreasoning
Threat hypervigilance represents a promising syndemic pathway related to both minority stress and multiple syndemic conditions that may be amenable to transdiagnostic intervention.
“Thus, threat hypervigilance represents another promising syndemic pathway related to both minority stress and multiple syndemic conditions that may be amenable to transdiagnostic intervention approaches.”
Quote in the paperSubstantial claim - Premisecitation
Emerging evidence from social neuroscience and experimental manipulations of stigma-related threat suggests that hypervigilance for stigma-related threat can deplete the self-regulation necessary to stave off psychosocial difficulties.
“Emerging evidence from the social neuroscience of stigma and experimental manipulations of stigma-related threat suggests that hypervigilance for stigma-related threat can deplete the self-regulation necessary to stave off psychosocial difficulties (Derks, Inzlicht, Kang, 2008; Inzlicht, McKay, & Aronson, 2006)”
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Loss is endemic to several accounts of gay and bisexual men's identity development and community attachment.
“Loss is endemic to several accounts of gay and bisexual men’s identity development and community attachment.”
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Cognitive avoidance through mental disengagement, including fatalistic beliefs about HIV infection, mediates the association between internalized homophobia and condomless sex.
“cognitive avoidance through mental disengagement, including fatalistic beliefs about HIV infection, has been shown to mediate the association between internalized homophobia and condomless sex (Yi, Sandfort, & Shidlo, 2010)”
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- Premisecitation
Psychosocial difficulties such as depression, anxiety, substance abuse, intimate partner violence, body image disturbance and eating disorders, and sexual compulsivity involve failures of self-regulation, particularly likely under threatening circumstances.
“psychosocial difficulties such as depression, anxiety, substance abuse, intimate partner violence, body image disturbance and eating disorders, and sexual compulsivity have been argued to involve failures of self-regulation, particularly likely to be activated under threatening circumstances”
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Coming out involves loss of certain roles as one embarks on an uncharted life path compared to heterosexual traditions and milestones.
“Coming out also involves the loss of certain roles as one embarks on an uncharted life path compared to the more standard traditions, milestones, and expectations of heterosexuality (Siegel & Lowe, 1994)”
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- Premisecitation
Several minority stressors are associated with disrupted attachment among gay and bisexual men.
“Several minority stressors are associated with disrupted attachment among gay and bisexual men.”
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Acute stressors such as childhood sexual abuse, peer assault, parental physical abuse, and parental rejection exacerbate fear responding across the lifespan, including emotional, cognitive, and behavioral avoidance.
“These acute stressors have been shown to exacerbate fear responding across the lifespan (Bremner et al., 2005; Teicher et al., 2003), including emotional, cognitive, and behavioral forms of avoidance (Foa & Kozak, 1986; Marx & Sloan, 2002)”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationcitation
In stigmatizing social climates marked by peer or parental rejection, gay and bisexual men might develop poor emotion regulation strategies, including inability to trust their own emotions as valid sources of wants, needs, or desires, or to adaptively act on them.
“In the context of stigmatizing social climates, marked by peer or parental rejection, gay and bisexual men might develop poor emotion regulation strategies, including an inability to trust their own emotions as valid sources of their wants, needs, or desires, or to adaptively act on their emotions.”
Quote in the paperSubstantial claim - Premisecitation
Fears of rejection, a key component of insecure attachment, predict low condom use assertion with implications for HIV infection.
“Fears of rejection, for example, which represent a key component of insecure attachment (Downey & Feldman, 1996), predict low condom use assertion with clear implications for HIV infection (Hart & Heimberg, 2005)”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationcitation
Rumination and pessimism likely represent the cognitive components of avoidance and hypervigilance.
“rumination and pessimism likely represent the cognitive components of avoidance and hypervigilance (Borkovec, Ray, & Stober, 1998; Stapinski, Abbott, & Rapee, 2010)”
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Research showing that minority stress is associated with emotional suppression among sexual minority individuals provides initial support for the hypothesis that gay and bisexual men develop poor emotion regulation strategies.
“Research showing that minority stress is associated with emotional suppression among sexual minority individuals provides initial support for this hypothesis (Hatzenbuehler et al., 2009)”
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- Premisecitation
Daily experiences of minority stress are associated with more emotional suppression among sexual minority individuals.
“research showing that daily experiences of minority stress are associated with more emotional suppression among sexual minority individuals (Hatzenbuehler et al., 2009)”
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- Premisecitation
Animal research shows that persistent, uncontrollable stress is associated with socially submissive behavior.
“animal research shows that persistent, uncontrollable stress is also associated with socially submissive behavior (Gardner, Thrivikraman, Lightman, Plotsky, & Lowry, 2005; Williams & Lierle, 1986)”
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Emerging evidence suggests that sexual minority individuals might have poorer emotional self-knowledge than heterosexuals.
“While emerging evidence suggests that sexual minority individuals might have poorer emotional self-knowledge than heterosexuals (Hatzenbuehler et al., 2008b)”
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- Premisecitation
Research with general population samples demonstrates that low emotional self-knowledge is associated with substance use problems, eating and body image disturbance, intimate partner violence, and sexual compulsivity.
“Research conducted with general population samples demonstrates that low emotional self-knowledge is associated with substance use problems (Michael, 1990), eating and body image disturbance (Bydlowski et al., 2005), intimate partner violence (Winters, Clift, & Dutton, 2004), and sexual compulsivity (Reid, Carpenter, Spackman, & Willes, 2008)”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationreasoning
Attachment processes represent a plausible syndemic pathway given consistent relationships between attachment and minority stress and between attachment and syndemic outcomes.
“Given consistent relationships between attachment processes and minority stress, on one hand, and attachment processes and syndemic outcomes, on the other, attachment processes represent a plausible syndemic pathway.”
Quote in the paperSubstantial claim - Premisecitation
Social learning theory and research show that persistent exposure to relatively uncontrollable social stressors instills a diminished sense of agency for coping with future stressors.
“Social learning theory and research show that persistent exposure to relatively uncontrollable social stressors instills a diminished sense of agency for coping with future stressors (Chorpita & Barlow, 1998)”
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- Premisecitation
Discovering and navigating one's non-heterosexual sexual orientation in relative isolation from an early age can represent a persistent and uncontrollable stressor.
“Even discovering and navigating one’s non-heterosexual sexual orientation in relative isolation from an early age can represent a persistent and uncontrollable stressor (Pachankis, 2007; Pachankis & Hatzenbuehler, 2013)”
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- cites Pachankis & Hatzenbuehler, 2013 source
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- Premisecitation
Local and national discriminatory laws, policies, and community attitudes communicate the social inferiority of gay and bisexual men by treating them as less deserving of rights and opportunities afforded to heterosexuals.
“local and national discriminatory laws, policies, and community attitudes affecting gay and bisexual men communicate the social inferiority of gay and bisexual men by treating them as less deserving of the same rights and opportunities afforded to heterosexuals (Hatzenbuehler, 2010; Pachankis et al., 2014a)”
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- cites Pachankis et al., 2014a
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- Premisecitation
Gay and bisexual men are particularly likely to encounter persistent and uncontrollable stressors from an early age.
“Because of their socially marginalized status, gay and bisexual men are particularly likely to encounter persistent and uncontrollable stressors from an early age (Balsam et al., 2005; Friedman et al., 2008; Russell et al., 2011)”
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Gay and bisexual adolescents demonstrate lower awareness of their emotional states compared to heterosexual adolescents.
“research showing that gay and bisexual adolescents demonstrate lower awareness of their emotional states compared to heterosexual adolescents (Hatzenbuehler et al., 2008b)”
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- Interpretationreasoning
Most of these psychological mediators are related to those included in the RDoC's list of possible pathways.
“Most of these psychological mediators are related to those included in the RDoC’s list of possible pathways reviewed above.”
Quote in the paperNot a substantial claim - Interpretationnone given
Gay and bisexual men might demonstrate poorer emotion regulation abilities than heterosexual men.
“Given the evidence reviewed above that gay and bisexual men might demonstrate poorer emotion regulation abilities than heterosexual men and that these difficulties are related to both minority stress and multiple psychosocial syndemic health conditions, another potentially effective principle of transdiagnostic syndemic treatments for gay and bisexual men includes the enhancement of emotion”
Quote in the paperNot a substantial claim - Premisecitation
Sexual minority individuals may lack the protective attributional processes that other stigmatized individuals have because their stigma is invisible and typically not shared by parents and early visible role models.
“Further, sexual minority individuals may not have access to the same protective attributional processes that other stigmatized individuals possess by virtue of their stigma being invisible and typically not shared by parents and other early visible role models (Crocker & Major, 1989).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Crocker & Major, 1989 source
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- Interpretationreasoning
Treatment approaches that encourage healthy emotion regulation can reduce the emotional impact of minority stress through improving the self-knowledge pathway.
“Therefore, treatment approaches that facilitate stress coping through encouraging healthy emotion regulation (e.g., Barlow et al., 2011; Greenberg & Pascual-Leone, 2006; Linehan, 1993; Webb, Miles, & Sheeran, 2012) have the potential to reduce the emotional impact of minority stress through improving the self-knowledge pathway, for example.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Barlow et al., 2011
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- cites Greenberg & Pascual-Leone, 2006 source
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- cites Linehan, 1993
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- Interpretationreasoning
Psychosocial syndemic conditions among gay and bisexual men are potentially united by shared minority stress pathways.
“The above review suggests that developing separate treatments for separate psychosocial syndemic conditions might be unduly inefficient given that syndemic conditions, by definition, co-occur, and are potentially united by the shared minority stress pathways reviewed above.”
Quote in the paperSubstantial claim - Interpretationreasoning
Normalizing the distress caused by minority stress and moving blame toward society provides an initial platform to reduce the cognitive-affective and behavioral pathways linking minority stress to syndemic conditions.
“Normalizing the multiple forms of distress caused by minority stress and moving blame for this distress toward society rather than oneself provides an initial platform from which to reduce the adverse cognitive-affective and behavioral pathways reviewed above that unite minority stress with gay and bisexual men’s psychosocial syndemics.”
Quote in the paperSubstantial claim - Study design and conductcitation
The eight psychosocial treatment principles offered were derived from expert clinician consensus and input from gay and bisexual men experiencing several syndemic factors.
“These example principles were garnered from expert clinician consensus and the input of gay and bisexual men who were experiencing several psychosocial syndemic factors including depression and anxiety, substance use, sexual compulsivity, and HIV risk behavior, as described elsewhere (Pachankis, 2014).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pachankis, 2014
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- Premisecitation
Generalization of assertiveness skills across life domains has direct implications for health, such as condom use assertion.
“The generalization of assertiveness skills across life domains has direct implications for health, for example in the case of condom use assertion (e.g., Hart & Heimberg, 2005).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hart & Heimberg, 2005 source
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- Premisecitation
Experiential avoidance permeates poor psychosocial health, including the syndemic conditions facing gay and bisexual men.
“Experiential avoidance permeates poor psychosocial health (Aldao et al., 2010), including the psychosocial syndemic conditions facing gay and bisexual.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Aldao et al., 2010 source
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- Interpretationcitation
Helping gay and bisexual men systematically confront a hierarchy of feared interpersonal situations can foster a healthy assertive interpersonal stance that minority stress can otherwise compromise.
“Therefore, helping gay and bisexual men systematically confront a hierarchy of feared interpersonal situations, such as open self-expression, sexual orientation disclosure, male intimacy, and acknowledgment of personal imperfection and vulnerability, can foster a healthy, assertive interpersonal stance that early and ongoing experiences with minority stress can otherwise compromise (Pachankis, 200”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pachankis, 2009 source
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- Interpretationreasoning
Promoting assertive communication could improve the poor social communication and social submission pathways because assertiveness is contrary to both.
“In addition to improving syndemic health through targeting the avoidance pathway, promoting assertive communication could also yield salubrious effects through improving the poor social communication and social submission pathways, given that assertiveness is contrary to both.”
Quote in the paperSubstantial claim - Premisecitation
Stigma often operates in unseen ways to jeopardize the health of sexual minority individuals.
“Stigma often operates in unseen ways to jeopardize the health of sexual minority individuals (Hatzenbuehler, 2010).”
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- Interpretationnone given
Early and ongoing minority stress can teach gay and bisexual men that they are weak, overly emotional, deviant, or inferior compared to heterosexual men.
“Early and ongoing experiences with minority stress can teach gay and bisexual men that they are weak, overly emotional, deviant, or inferior compared to heterosexual men.”
Quote in the paperSubstantial claim - Interpretationreasoning
Restructuring minority stress-related cognitive biases can reduce several potential syndemic pathways including avoidance, hypervigilance, habit, disrupted attachment, and low agency.
“In this way, restructuring minority stress-related cognitive biases can reduce several potential syndemic pathways such as avoidance, hypervigilance, habit, disrupted attachment, and low agency.”
Quote in the paperNot a substantial claim - Interpretationcitation
Emotion regulation approaches such as mindful acceptance and valuing delayed rewards can reduce emotion-driven impulsive behaviors by interrupting positive valence pathways of approach motivation, reward learning, and habit.
“Further, emotion regulation approaches, such as mindful acceptance and tolerance of impulsive urges (Ostafin & Marlatt, 2008) and valuing delayed rewards (Bickel & Marsch, 2001), can also reduce emotion-driven impulsive behaviors through interrupting the positive valence pathways of approach motivation, reward learning, and habit.”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
Such approaches are grounded in contemporary learning models of fear exposure that show efficacy across emotion-driven behaviors.
“Such approaches are grounded in contemporary learning models of fear exposure that show efficacy across emotion-driven behaviors (e.g., Mineka & Zinbarg, 2006).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Mineka & Zinbarg, 2006 source
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- Interpretationcitation
Social isolation likely represents a behavioral avoidance component of fear.
“social isolation likely represents a behavioral avoidance component of fear (Cacioppo et al., 2000)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Cacioppo et al., 2000
Not checked in the free run.
- Interpretationreasoning
Standard cognitive restructuring can be adapted to reduce minority stress-fueled cognitive biases in treating gay and bisexual men's syndemics.
“Therefore, to treat gay and bisexual men’s psychosocial syndemics, standard cognitive restructuring approaches can be adapted to specifically reduce minority stress-fueled cognitive biases.”
Quote in the paperSubstantial claim - Premisecitation
Emotion awareness, regulation, and acceptance are basic components of psychosocial health.
“Emotion awareness, regulation, and acceptance form the basic components of psychosocial health (Aldao, Nolen-Hoeksema, & Schweizer, 2010).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Aldao, Nolen-Hoeksema, & Schweizer, 2010 source
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- Premisecitation
Intervention manuals prescribe rote application of techniques intended to ensure internal validity in treatment studies and allow little room for overarching principles to flexibly guide case conceptualization.
“However, intervention manuals prescribe the rote application of techniques intended to ensure internal validity in treatment studies and allow little room for considering how overarching principles can flexibly guide case conceptualization built around the underlying mechanisms relevant to each individual and the psychosocial syndemic conditions he is experiencing (Goldfried & Wolfe, 1996).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Goldfried & Wolfe, 1996 source
Not checked in the free run.
- Interpretationreasoning
Educating gay and bisexual men facing syndemic conditions about historical and contemporary feats of their communities may instill hope and optimism for alleviating minority stress.
“Educating gay and bisexual men who are facing syndemic conditions—men who may be particularly unlikely to espouse such resilience—about the remarkable historical and contemporary feats shown by their communities may instill a sense of hope and optimism for alleviating minority stress.”
Quote in the paperSubstantial claim - Premisecitation
Sexual minority sexuality remains relatively unaddressed in mainstream sources of sex education such as parents and schools.
“Further, given the stigmatizing nature of same-sex sexuality (Herek, 2004), sexual minority sexuality remains relatively unaddressed in mainstream sources of sex education, such as from parents and schools (e.g., Kubicek, Beyer, Weiss, Iverson, & Kipke, 2010).”
Quote in the paperNot a substantial claim0 of 2 sources checked - Interpretationreasoning
Psychosocial intervention approaches that affirm healthy, rewarding expressions of sexuality can potentially reduce pathways linking minority stress with poor sexual health and other syndemic conditions.
“Psychosocial intervention approaches that affirm healthy, rewarding expressions of sexuality can potentially reduce the pathways reviewed here that are argued to potentially unite minority stress with poor sexual health and other psychosocial syndemic health conditions.”
Quote in the paperSubstantial claim - Premisecitation
Sexual minorities are disproportionately less likely to experience supportive relationships compared to heterosexuals.
“While supportive relationships have the ability to protect sexual minorities against the adverse psychosocial effects of minority stress (e.g., Hershberger & D’Augelli, 1995; Rosario, Schrimshaw, & Hunter, 2009), sexual minorities are disproportionately less likely to experience such support compared to heterosexuals (Plöderl & Fartacek, 2005; Safren & Heimberg, 1999).”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationreasoning
Without knowing treatment mechanisms, it is difficult or impossible to ascertain common mechanisms shared across treatment approaches that can be synthesized to treat multiple co-occurring conditions.
“However, without knowing the mechanisms through which a treatment works, it is difficult, if not impossible, to ascertain the common mechanisms shared across treatment approaches that can be coherently synthesized to treat multiple co-occurring conditions, as in the case of gay and bisexual men’s psychosocial syndemic health conditions.”
Quote in the paperSubstantial claim - Interpretationreasoning
Disrupted attachment, avoidance, loss, poor social communication, and social submission are pathways through which minority stress might compromise healthy relationships to produce syndemic health threats such as depression, anxiety, substance use, intimate partner violence, and sexual compulsivity.
“As reviewed above, disrupted attachment, avoidance, loss, poor social communication, and social submission all represent pathways through which minority stress might compromise healthy relationships to produce syndemic health threats, such as depression and anxiety, substance use, intimate partner violence, and sexual compulsivity.”
Quote in the paperNot a substantial claim - Premisecitation
Supportive relationships can protect sexual minorities against adverse psychosocial effects of minority stress.
“While supportive relationships have the ability to protect sexual minorities against the adverse psychosocial effects of minority stress (e.g., Hershberger & D’Augelli, 1995; Rosario, Schrimshaw, & Hunter, 2009), sexual minorities are disproportionately less likely to experience such support compared to heterosexuals (Plöderl & Fartacek, 2005; Safren & Heimberg, 1999).”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisereasoning
Flexible treatment approaches driven by principle-driven case conceptualization are contrary to the RCT approach, which is largely considered the standard for psychosocial intervention research.
“Further, flexible treatment approaches driven by principle-driven case conceptualization are contrary to the randomized controlled trial (RCT) approach, largely considered the standard by which all psychosocial intervention research should be judged.”
Quote in the paperSubstantial claim - Premisecitation
The RCT approach largely avoids exploration of change mechanisms because the key question is typically whether treatment reduced discrete symptoms compared to control, not how it worked.
“Further, the RCT approach to intervention research largely avoids the exploration of change mechanisms, given that the key research question in RCTs is typically whether the treatment reduced discrete symptoms compared to a control treatment, not understanding the mechanisms through which the treatment worked (Westen et al., 2004).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Westen et al., 2004 source
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- Interpretationreasoning
Psychosocial treatment approaches that help gay and bisexual men identify supportive community connections and build healthy relationships can reduce these pathways and improve psychosocial health.
“Therefore, psychosocial treatment approaches that help gay and bisexual men identify supportive community connections and build healthy relationships can potentially reduce these pathways to improve psychosocial health.”
Quote in the paperSubstantial claim - Premisecitation
Preliminary efficacy exists for sexual health promotion interventions that adopt some of these approaches to improving sexual health.
“Preliminary efficacy exists for sexual health promotion interventions that adopt some of these approaches to improving sexual health (e.g., Mustanski, Greene, Ryan, & Whitton, 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Mustanski, Greene, Ryan, & Whitton, 2014 source
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- Interpretationreasoning
The intervention field's historic tendency to develop and deploy separate treatments for separate problems seems ill-suited to intervening upon overlapping psychosocial conditions among gay and bisexual men.
“Given accumulating evidence for the shared processes underlying numerous psychosocial problems among gay and bisexual men, the intervention field’s historic tendency to develop and deploy separate treatments for separate problems seems ill-suited to intervening upon the overlapping psychosocial conditions facing this population.”
Quote in the paperNot a substantial claim - Premisecitation
Syndemic conditions are ultimately perpetuated by structural factors such as discriminatory institutions.
“Given that syndemic conditions are ultimately perpetuated by structural factors, such as discriminatory institutions (Singer et al., 2006), the treatment approaches promoted here recognize that the ultimate alleviation of syndemic conditions will flow from changing social structures rather than only promoting stigma coping among gay and bisexual men themselves (Meyer, 2003).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Singer et al., 2006
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- cites Meyer, 2003 source
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- Interpretationcitation
Incorporating minority stress treatment principles into internet-based and mobile delivery counseling programs and public sector health clinics can facilitate dissemination to rural, concealed, or low-income gay and bisexual men.
“For example, incorporating these minority stress treatment principles into internet-based and mobile delivery counseling programs (Pachankis, Lelutiu-Weinberger, Golub, & Parsons, 2013) and into public sector health clinics (Hellman & Klein, 2004) can facilitate dissemination of these treatment principles to rural, concealed, or low-income gay and bisexual men.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Pachankis, Lelutiu-Weinberger, Golub, & Parsons, 2013 source
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- cites Hellman & Klein, 2004
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- Interpretationreasoning
The ultimate alleviation of syndemic conditions will flow from changing social structures rather than only promoting stigma coping among gay and bisexual men.
“Given that syndemic conditions are ultimately perpetuated by structural factors, such as discriminatory institutions (Singer et al., 2006), the treatment approaches promoted here recognize that the ultimate alleviation of syndemic conditions will flow from changing social structures rather than only promoting stigma coping among gay and bisexual men themselves (Meyer, 2003).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Meyer, 2003 source
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- Classified as probably not a substantial claim. 24
- May combine two claims. 42
Probably not a substantial claim: may not pass S4 (based). May combine two claims.
Findingnone givenStudies generally have not investigated whether gay and bisexual men experience proportionate disruptions in positive valence systems compared to heterosexual men and whether minority stress experiences are associated with such disruptions.
“While studies generally have not investigated whether gay and bisexual men experienced is proportionate disruptions in positive valence systems compared to heterosexual men and whether minority stress experiences in particular are associated with such disruptions”
Quote in the paperNot a substantial claimMay combine two claims.
Findingnone givenMost of the hypothesized pathways identified above possess demonstrated relationships with both minority stress and gay and bisexual men's psychosocial syndemic conditions, but only scant evidence exists that these pathways serve as mediators of the stress-syndemic relationship.
“while most of the hypothesized pathways identified above possess demonstrated relationships with both minority stress and gay and bisexual men’s psychosocial syndemic conditions, only scant evidence exists that these possible pathways in fact serve as mediators of the stress–syndemic relationship.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationIntimate partner violence among gay and bisexual men is associated with stigma-based rejection sensitivity for victims and perpetrators, and with internalized homophobia and concealment for perpetrators.
“Intimate partner violence among gay and bisexual men is associated with stigma-based rejection sensitivity for both victims and perpetrators (Carvalho, Lewis, Derlega, Winstead, & Viggiano, 2011) as well as internalized homophobia and concealment for perpetrators (Edwards & Sylaska, 2013)”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
InterpretationcitationThe gay community can internalize societal stigma and perpetuate additional stress among its members.
“the gay community can internalize societal stigma and perpetuate additional stress among its community members”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pachankis, 2014
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PremisecitationCommunity-driven stressors include conformity to masculine standards, permissive substance use norms, ready availability of sex partners, and excessive focus on achievement and competition.
“Examples of these community-driven stressors include conformity to masculine standards, permissive substance use norms, ready availability of sex partners, and excessive focus on achievement and competition, all of which have been shown to be associated with psychosocial syndemic health outcomes in recent studies.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationDiscriminatory laws, policies, and institutions are hypothesized to operate through psychosocial stressors to produce adverse health among sexual minorities.
“They are hypothesized to operate through the psychosocial stressors described above to yield adverse health among sexual minorities (Hatzenbuehler, 2010)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hatzenbuehler, 2010 source
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PremisecitationPreliminary evidence suggests that some gay and bisexual men have achievement-oriented and competition-focused self-worth, which is associated with unhealthy eating behavior, interpersonal behavior, and mental health.
“preliminary evidence suggests that the self-worth of some gay and bisexual men is particularly achievement-oriented and competition-focused, a focus which is associated with insalubrious eating behavior, interpersonal behavior, and mental health (Pachankis & Hatzenbuehler, 2013)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Pachankis & Hatzenbuehler, 2013 source
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PremisecitationIn a recent qualitative study, most gay and bisexual participants reported that many unique stressors came from other gay men and affected their health.
“the majority of gay and bisexual participants in one recent qualitative study noted that many of their unique stressors stem from other gay men and that these stressors affected their health (Pachankis, 2014)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pachankis, 2014
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Classified as probably not a substantial claim. May combine two claims.
PremisecitationThe coming out process involves an exit from heterosexuality and loss of heterosexual privilege.
“the coming out process has been argued to involve an exit of heterosexuality (Cochran, 2001; D’Augelli, 1998) and the attendant loss of heterosexual privilege (e.g., Badgett, 1995; Tilcsik, 2011)”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe RDoC is currently a work-in-progress and not intended as a clinical tool.
“Currently, a work-in-progress and only intended to guide the description of psychosocial problems in research studies, the RDoC is not presently intended to serve as a clinical tool (Sanislow et al., 2010)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Sanislow et al., 2010
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Interpretationnone givenMinority stress consistently demonstrates significant associations with each of the possible social pathways (disrupted attachment, low agency, social submission, poor social communication, low self-knowledge), which in turn are associated with gay and bisexual men's syndemic conditions.
“As reviewed below, minority stress consistently demonstrates significant associations with each of these possible social pathways, which in turn are associated with gay and bisexual men’s syndemic conditions.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe RDoC framework lists component mechanisms underlying multiple psychosocial conditions and recognizes no exclusive one-to-one correspondence between conditions and pathways.
“The resulting framework, the Research Domain Criteria (RDoC), lists the component mechanisms underlying multiple psychosocial conditions, recognizing that there is not an exclusive one-to-one correspondence between psychosocial conditions and their pathways (Insel et al., 2010; Sanislow et al., 2010)”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Insel et al., 2010
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- cites Sanislow et al., 2010
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PremisecitationThese impairments, marked by impulsivity under stress, are associated with substance abuse, other addictive behaviors, and eating disturbances.
“These impairments, marked by impulsivity in the face of stress, for example, are in turn associated with substance abuse, other addictive behaviors, and eating disturbances (Dawe & Loxton, 2004; Fox, Bergquist, Gu, & Sinha, 2010; Hyman, Malenka, & Nestler, 2006)”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationBehavioral avoidance such as unassertive interpersonal behavior is associated with minority stress such as parental rejection and with HIV risk behavior in the form of condom use non-assertion.
“Behavioral forms of avoidance, such as unassertive interpersonal behavior, have been shown to be closely associated with minority stress, such as parental rejection of one’s sexual orientation (Pachankis, Goldfried, & Ramrattan, 2008) and to be associated with HIV risk behavior in the form of condom use non-assertion (Hart & Heimberg, 2005)”
Quote in the paperSubstantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationHatzenbuehler (2009) proposes a psychological mediation framework that includes psychological variables that statistically mediate associations between minority stress and anxiety, depression, and alcohol use problems.
“Hatzenbuehler (2009) proposes a psychological mediation framework that includes psychological variables that statistically mediate associations between minority stress and anxiety, depression, and alcohol use problems.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Hatzenbuehler, 2009
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PremisecitationFindings from general adolescent samples show that social rejection confers risk for poor emotion awareness and that the relationship between social rejection and mental health outcomes is prospectively mediated by poor emotion awareness.
“findings from general adolescent samples showing that social rejection confers risk for poor emotion awareness—a form of poor self-knowledge—and that the relationship between social rejection and mental health outcomes is prospectively mediated by poor emotion awareness (e.g., McLaughlin, Hatzenbuehler, & Hilt, 2009)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites McLaughlin et al., 2009 source
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Probably not a substantial claim: may not pass S4 (based). May combine two claims.
Interpretationnone givenIn disorders of emotion regulation, individuals avoid experiencing or expressing painful emotions, which drives behaviors to alleviate emotional discomfort in the short term although they yield ineffective long-term behavioral patterns.
“In these disorders of emotion regulation, individuals avoid experiencing or expressing painful emotions, which then drives behaviors to alleviate emotional discomfort in the short-term although they yield in effective long-term behavioral patterns.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
InterpretationreasoningDisrupted attachment may result from negative valence pathways such as avoidance, hypervigilance, and loss, forming a sequence of syndemic pathways.
“It is also possible that disrupted attachment may result from negative valence pathways (e.g., avoidance, hypervigilance, loss), forming of a sequence of syndemic pathways.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationInsecure attachment demonstrates clear links with several syndemic conditions experienced by gay and bisexual men, possibly through its association with unassertive communication.
“Insecure attachment demonstrates clear links with several of the syndemic conditions experienced by gay and bisexual men, possibly through its association with unassertive communication (Pachankis et al., 2008)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pachankis et al., 2008 source
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationCoping motives and positive alcohol expectancies mediate the minority stress-alcohol use disorder symptom relationship.
“These variables include coping motives and positive alcohol expectancies as mediators of the minority stress—alcohol use disorder symptom relationship (Hatzenbuehler et al., 2008c)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Hatzenbuehler et al., 2008c
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InterpretationreasoningMinority stress can erode gay and bisexual men's sense of agency, yield poor social communication, and encourage submissive social behaviors.
“Minority stress can also erode gay and bisexual men’s sense of agency, yield poor social communication, and encourage submissive social behaviors.”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationRumination, social isolation, social support, pessimism, and self-esteem mediate the minority stress-depression and anxiety symptoms relationship.
“rumination, social isolation, social support, pessimism, and self-esteem as mediators of the minority stress—depression and anxiety symptoms relationship (Diaz, Ayala, Bein, Henne, & Marin, 2001; Hatzenbuehler et al., 2009; Hershberger & D’Augelli, 1995)”
Quote in the paperNot a substantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationLow agency is related to depression and anxiety, addictive behaviors, eating disorders and body image disturbance, and intimate partner violence.
“low agency is related to depression and anxiety (Abramson, Seligman, & Teasdale, 1978; Mineka & Zinbarg, 2006), addictive behaviors (DiClemente, Fairhurst, Piotrowski, 1995), eating disorders and body image disturbance (Fairburn, Shafran, & Cooper, 1999), and intimate partner violence (Felson & Outlaw, 2007)”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
InterpretationreasoningLow agency and communication deficits might represent plausible syndemic pathways, while socially submissive behavior awaits further empirical evidence.
“Given their associations with minority stress and syndemic conditions, low agency and communication deficits might represent plausible syndemic pathways, while socially submissive behavior awaits further empirical evidence supporting its role in this model.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationSexual orientation concealment, internalized homophobia, and lack of maternal support are associated with both avoidant and anxious attachment.
“sexual orientation concealment (Mohr & Fassinger, 2003), internalized homophobia (Sherry, 2007), and lack of maternal support of one’s sexual orientation (Mohr & Fassinger, 2003) are associated with both avoidant and anxious attachment”
Quote in the paperSubstantial claim0 of 2 sources checkedMay combine two claims.
InterpretationcitationThe proposed minority stress treatment principles complement standard CBT principles for stress-driven emotional disorders and can likely be integrated into standard CBT approaches.
“These principles complement standard cognitive-behavioral treatment (CBT) principles for treating stress-driven emotional disorders in the general population and can likely be seamlessly integrated into standard CBT approaches such as cognitive restructuring, emotional and behavioral exposure, mindfulness, self-monitoring, and relapse prevention (e.g., Linehan, 1993; Marlatt & Donovan, 2005; Menni”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Linehan, 1993
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- cites Marlatt & Donovan, 2005
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- cites Mennin & Farach, 2007 source
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PremisecitationCognitive biases such as fears of gay-related rejection may have been adaptive in early development but may be presently maladaptive in safer contexts and may impair relationships with heterosexuals and other gay and bisexual men.
“While the development of cognitive biases, such as fears of gay-related rejection, may have been adaptive across some gay and bisexual men’s early development because it kept them safe from harm, such biases may be presently maladaptive especially in safer contexts (Pachankis & Goldfried, 2006) and might impair healthy relationships both with heterosexuals (e.g., Pachankis et al., 2008) and other”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationAgency is central to self-esteem.
“whereas agency is central to self-esteem (Kernis, 1995)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kernis, 1995 source
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PremisecitationBehavioral unassertiveness is a core component of avoidance for some gay and bisexual men and is closely related to both minority stress and syndemic outcomes.
“Behavioral unassertiveness represents a core component of avoidance for some gay and bisexual men and is closely related to both minority stress and syndemic outcomes (e.g., Pachankis et al., 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pachankis et al., 2008 source
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Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationPositive alcohol expectancies are related to reward learning.
“Positive alcohol expectancies are certainly related to reward learning (Goldman, 2002)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Goldman, 2002 source
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InterpretationreasoningGay and bisexual men may not readily recognize minority stress as the source of their psychosocial difficulties and may incorrectly attribute their distress to personal failings rather than stigmatizing social forces.
“Thus, gay and bisexual men may not readily recognize the potential source of their psychosocial difficulties in minority stress and may in stead incorrectly attribute their distress to personal failings rather than stigmatizing social forces.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationBiased beliefs about being weak, overly emotional, deviant, or inferior feature prominently in internalized homophobia and rejection hypervigilance, which are associated with poor psychosocial syndemic health.
“These biased beliefs feature prominently in internalized homophobia and rejection hypervigilance, which are associated with poor psychosocial syndemic health (e.g., Huebner et al., 2002; Kimmel & Mahalik, 2005; Newcomb & Mustanski, 2010; Pachankis et al., 2014c, in press; Ratti et al., 2000).”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone givenThe suitability of behavioral skills for open self-expression and disclosure depends on the safety of the context and would be inappropriate in most hostile climates.
“Of course, the suitability of these behavioral skills heavily depends on the safety of the context; open self-expression and disclosure would be inappropriate in most hostile climates.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningDiscussing how minority stress-driven cognitive biases may have outlived their original utility might facilitate reworking these cognitions.
“Therefore, discussing the ways in which minority stress-driven cognitive biases may have outlived their original utility might facilitate the eventual reworking of these cognitions.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe efficacy of infusing standard CBT with minority stress-reducing principles to reduce minority stress-syndemic pathways is currently being tested in a randomized controlled trial.
“The efficacy of infusing standard CBT with these potential minority stress-reducing principles to reduce minority stress–syndemic pathways is currently being tested in a randomized controlled trial (Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015
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InterpretationreasoningEmotional numbing, excessive worry and rumination, and behavioral unassertiveness are potentially related to minority stress and implicated in the syndemic conditions reviewed.
“As reviewed above, emotional numbing, excessive worry and rumination, and behavioral unassertiveness are all potentially related to minority stress and implicated in the syndemic conditions reviewed here.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationGay and bisexual men often develop their sexual orientation in relative isolation without early support from parents and peers, so they cannot benefit from early socialization about strengths and protections of sexual minority status, unlike visible minorities.
“Because gay and bisexual men often develop their sexual orientation in relative isolation without the early support of parents and peers, they therefore cannot benefit from early socialization regarding the strengths and protections afforded by their sexual minority status, unlike visible minorities (e.g., Crocker & Major, 1989).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Crocker & Major, 1989 source
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InterpretationreasoningTreatment approaches that help gay and bisexual men confront painful emotions, memories, or interpersonal situations in safe contexts can weaken the threat of these events, reducing the avoidance pathway and improving the self-knowledge pathway to reduce syndemic risk.
“Therefore, treatment approaches that help gay and bisexual men confront painful emotions, memories, or interpersonal situations in safe contexts can potentially weaken the threat of these events, thereby reducing the avoidance pathway and improving the self-knowledge pathway to reduce the risk of syndemic conditions.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningReducing hypervigilance may not be appropriate for all gay and bisexual men in all contexts, such as those living in pervasively discriminatory or criminalizing settings.
“On the other hand, reducing hypervigilance may not be appropriate for all gay and bisexual men in all contexts, such as men living in pervasively discriminatory or criminalizing settings where danger represents an unfortunate and unjust reality.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningEmotion regulation difficulties among gay and bisexual men are related to both minority stress and multiple psychosocial syndemic health conditions.
“Given the evidence reviewed above that gay and bisexual men might demonstrate poorer emotion regulation abilities than heterosexual men and that these difficulties are related to both minority stress and multiple psychosocial syndemic health conditions, another potentially effective principle of transdiagnostic syndemic treatments for gay and bisexual men includes the enhancement of emotion”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationAdapted cognitive restructuring could increase awareness of how minority stress becomes internalized and present contradictory evidence highlighting gay and bisexual men's unique strengths.
“This adapted cognitive restructuring approach could increase gay and bisexual men’s awareness of the specific ways that minority stress can become internalized and the unhealthy impact this internalization can have, while presenting contradictory evidence highlighting gay and bisexual men’s unique strengths (e.g., Lin & Israel, 2012).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Lin & Israel, 2012 source
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PremisecitationIntervention manuals are likely less-than-helpful to practicing clinicians, who are unlikely to find prescriptive manuals practical given their beliefs about client complexity, their treatment sophistication, and the importance of non-specific factors.
“Further, another final product of an RCT—the intervention manual—is likely to be less-than-helpful to practicing clinicians, who are unlikely to find prescriptive manuals practical given their beliefs about (1) the complexity of their clients’ presenting issues, (2) the relative sophistication of their treatment practices compared to the presumed rote guidance offered in manuals, and (3) the”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pachankis & Goldfried, 2007a
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PremisecitationSeveral current trends in clinical training and research need to be overcome for a principle-based approach to succeed, including reliance on technique-focused treatment manuals and privilege afforded RCTs over other intervention research approaches.
“Several current trends in clinical training and research will need to be overcome for a principle-based approach to succeed, including the field’s reliance on technique-focused treatment manuals and the privilege afforded randomized controlled trials over other intervention research approaches (Hershenberg & Goldfried, in press).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hershenberg & Goldfried, in press
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PremisecitationThe LGBT community has demonstrated an ability to create non-biological families-of-choice and advocate for itself in the face of an often indifferent mainstream society.
“For example, the LGBT community has demonstrated an impressive ability to create non-biological families-of-choice and advocate for itself in the face of an often indifferent mainstream society (e.g., Trapence et al., 2012; Weeks, Heaphy, & Donovan,2001).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Trapence et al., 2012
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- cites Weeks, Heaphy, & Donovan, 2001 source
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Premisenone givenIn RCTs, whole treatment packages are compared, treatments are delivered according to manual-specified techniques, and reductions in discrete symptoms from pre- to post-intervention are the final goal.
“In RCTs, whole treatment packages are compared to each other, each treatment is delivered according to the techniques specified in the treatment manual, and reductions in discrete symptoms from pre-intervention to post-intervention represent the final goal.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningEducating gay and bisexual men facing syndemic conditions about historical and contemporary strengths of sexual minority communities can provide an important, often missing source of identity-related support.
“Thus, educating gay and bisexual men who face psychosocial syndemic conditions about the historical and contemporary strengths of sexual minority communities can provide an important, often missing, source of identity-related support.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningMinority stress impairs gay and bisexual men's sexual health and may operate through several syndemic pathways including avoidance, hypervigilance, approach motivation, reward learning, habit, submissive social behaviors, social communication, disrupted attachment, and agency.
“Thus, minority stress impairs gay and bisexual men’s sexual health and may operate through several of the above-reviewed syndemic pathways, including avoidance, hypervigilance, approach motivation, reward learning, habit, submissive social behaviors, social communication, disrupted attachment, and agency, to do so.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationGay and bisexual men often first become aware of same-sex attractions during adolescence, when they may lack supportive resources for managing sexual feelings in stigmatizing contexts.
“Gay and bisexual men often first become aware of same-sex attractions during adolescence (Rosario et al., 2006), when they may not have the supportive resources necessary for managing sexual feelings in stigmatizing contexts.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rosario et al., 2006
Not checked in the free run.
May combine two claims.
InterpretationcitationDevelopmental factors likely combine with minority stress, masculine role norms, and availability of sex partners in gay male communities to put gay and bisexual men at risk of multiple sexual health problems compared to heterosexual men, including sexual compulsivity, erectile difficulties, and HIV infection.
“These developmental factors likely combine with minority stress (Zamboni & Crawford, 2007), masculine role norms (Courtenay, 2000), and the ready availability of sex partners in gay male communities (Baum & Fishman, 1994; Missildine et al., 2005) to put gay and bisexual men at risk of multiple sexual health problems compared to heterosexual men, including sexual compulsivity (Missildine et al., 2”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
InterpretationreasoningPsychosocial approaches that facilitate resilience could buffer gay and bisexual men against syndemic pathways through which minority stress compromises health.
“In this way, psychosocial approaches that facilitate resilience could buffer gay and bisexual men against any syndemic pathway reviewed above through which minority stress compromises health.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationIntervention manuals originally intended to describe research are now often assumed to be prescriptive guides to real-world clinical practice.
“Too often, intervention manuals, originally intended to describe what takes place in research studies, are now often assumed to be prescriptive guides to real-world clinical practice (Westen et al., 2004).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Westen et al., 2004 source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationcitationBarriers to principle-based approaches can potentially be overcome by recognizing the benefit of finer-grained analyses of change mechanisms and adopting a principle-based approach to training clinicians.
“While strong contextual factors perpetuate both the application of RCT methodology in psychosocial intervention research (e.g., Goldfried & Wolfe, 1996) and the proliferation of separate treatment manuals for separate psychosocial conditions (Goldfried, 1980), these barriers can potentially be overcome through (1) recognizing the benefit of finer-grained analyses of change mechanisms in psy”
Quote in the paperNot a substantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
Interpretationnone givenLocating pathways through which minority stress generates syndemics and employing treatment principles to alleviate them will create a unified transdiagnostic approach to improving gay and bisexual men's health while potentially reducing stigmatizing social forces.
“In sum, locating the pathways through which minority stress generates psychosocial syndemics and employing treatment principles capable of alleviating these pathways will ultimately create a unified, transdiagnostic approach to improving gay and bisexual men’s health while potentially also reducing the stigmatizing social forces that impair health in the first place.”
Quote in the paperNot a substantial claim- Rests on an assumption: Activism by stigmatized individuals has successfully abolished stigmatizing social structures throughout history.
May combine two claims.
PremisecitationSocial structures are ultimately composed of individuals, and individuals hold the power to change those structures.
“Lest social structures be seen as ironclad forces impervious to change, it should be noted that social structures are ultimately composed of individuals, with individuals holding the power to change those structures (Bourdieu, 1990).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bourdieu, 1990
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationTo ultimately improve conditions of social inequality, all individuals must change, including those who derive status and power from stigmatizing others.
“Nonetheless, to ultimately improve conditions of social inequality, all individuals must change, including those who derive status and power from stigmatizing others (Carter & Reardon, 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Carter & Reardon, 2014
Not checked in the free run.
May combine two claims.
PremisecitationPromoting stigma coping can change social structures through positive intergroup contact, greater visibility of stigmatized individuals, and encouraging stigmatized individuals to advocate for structural change.
“Promoting stigma coping can also change social structures through promoting positive intergroup contact, and greater visibility of stigmatized individuals, and encouraging stigmatized individuals to be advocates for structural change (Cook, Purdie-Vaughns, Meyer, & Busch, 2014).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Cook, Purdie-Vaughns, Meyer, & Busch, 2014 source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningCost-effective and wide-reaching delivery platforms can ensure that the proposed guidance reaches the most disenfranchised members of the community.
“Cost-effective and wide-reaching delivery platforms can ensure that the type of guidance proposed here, typically disseminated through resource-intensive one-on-one or small group counseling, reaches the most disenfranchised members of the community.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationcitationThe evidence-based platform of this proposed treatment approach could be incorporated into existing LGBT-affirmative psychotherapy services.
“The evidence-based platform of this proposed treatment approach could also be incorporated into existing LGBT-affirmative psychotherapy services (e.g., Hellman & Klein, 2004), which would represent a particularly apt future direction given that the principles reviewed here largely derived from the wisdom of community practitioners and gay and bisexual men who have received their services (Pachank”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Hellman & Klein, 2004
Not checked in the free run.
- cites Pachankis, 2014
Not checked in the free run.
The paper relies on this without support.
Findings from general population samples about stress-related pathways and transdiagnostic treatment effects apply to gay and bisexual men.
“While studies generally have not investigated whether gay and bisexual men experienced is proportionate disruptions in positive valence systems compared to heterosexual men and whether minority stress experiences in particular are associated with such disruptions”
The paper relies on this without support.
Targeting shared minority stress pathways will simultaneously alleviate multiple syndemic conditions among gay and bisexual men.
“Because minority stress serves as a common basis of all psychosocial syndemic conditions reviewed here, intervention approaches that target the pathways through which minority stress produces these conditions could alleviate them all at once.”
The paper relies on this without support.
The RDoC mechanisms that associate with both minority stress and syndemic conditions are modifiable by psychosocial treatment.
“Preliminary evidence for these RDoC domains operating as minority stress–syndemic pathways is reviewed below with the goal of encouraging future research into the validity of these pathways and their potential to be modified by psychosocial treatment approaches”
The paper relies on this without support.
The gay community's internalization of societal stigma constitutes a form of minority stress.
“the ways in which social structures shape the nature and experience of gay communities themselves might also serve as a form of minority stress”
The paper relies on this without support.
Activism by stigmatized individuals has successfully abolished stigmatizing social structures throughout history.
“Activism on the part of stigmatized individuals has successfully abolished stigmatizing social structures throughout history, and while the minority stress treatment approach advocated here does not demand that change in stigmatizing structures solely rely on gay and bisexual men, it does empower them to challenge those structures in a way that promotes health.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Pachankis identified "overarching treatment principles" stemming from the minority stress model, which have been successfully used in interventions designed to address syndemic conditions experienced by gay and bisexual men and alcohol misuse among sexual minority women.
“Pachankis [33] identified “overarching treatment principles” stemming from the minority stress model, which have been successfully used in interventions designed to address syndemic conditions experienced by gay and bisexual men and alcohol misuse among sexual minority women [34,35].”
From Minority stress theory: Application, critique, and continued relevance (2023) · cites this paper as [33]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Social submission is presented as both established and unverified
MinorThe first passage says each proposed social pathway is associated with minority stress and syndemic conditions, which includes social submission. The later passage says social submission still lacks evidence supporting its role in the model.
“As reviewed below, minority stress consistently demonstrates significant associations with each of these possible social pathways, which in turn are associated with gay and bisexual men’s syndemic conditions.”
“Given their associations with minority stress and syndemic conditions, low agency and communication deficits might represent plausible syndemic pathways, while socially submissive behavior awaits further empirical evidence supporting its role in this model.”
The citation lists haven’t been fetched yet
References 211 · Cited by 205
Research works printed but not linked: 3
- Carter, P. L., & Reardon, S. F. (2014). Inequality matters: A William T. Grant Foundation inequality paper. New York, NY: William T. Grant Foundation.
- Siegel, S., & Lowe, E. (1994). Uncharted lives: Understanding the life passages of gay men. New York, NY: Plume.
- World Health Organization. (2006). Defining sexual health. Report of a technical consultation on sexual health, January 2002. Geneva: World Health Organization.
- Authors
- Pachankis, J. E.
- Affiliations
- Yale University (US)
- Corresponding author
- Pachankis, John E.
- ORCID
- Pachankis, John E.
- Venue
- Archives of Sexual Behavior
- Published
- 2015-06-30
- Volume
- 44
- Issue
- 7
- Pages
- 1843-1860
- ISSN
- 0004-0002 (ISSN-L)
- 1573-2800
- PMC
- PMC4560958
- OpenAlex
- W814518141
- Cited by
- 205
- References
- 211
- Citations by year
- 2026: 22 · 2025: 11 · 2024: 26 · 2023: 19 · 2022: 37 · 2021: 15 · 2020: 18 · 2019: 14 · 2018: 15 · 2017: 20 · 2016: 5 · 2015: 3
- FWCI
- 23.45
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Archives of Sexual Behavior (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH096607, P30MH062294)
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- minority stress, transdiagnostic treatment, gay and bisexual men, psychology of emotion, psychiatric classification, treatment dissemination, sexual minority mental health
- MeSH terms
- Bisexuality, Humans, Male, Minority Groups, Social Environment, Stress, Psychological, Homosexuality, Male, Men's Health
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