Current Projects

Compassion Cultivation Training among Gender and Sexual Minorities

Principal Investigator: Jessie Simonetti, M.S.

Co-Investigators: Kimberly F. Balsam, Ph.D., & Matthew Skinta, Ph.D., ABPP

Description: This study is a randomized, controlled trial of an empirically-based psychoeducation program called Compassion Cultivation Training (CCT).  This program was recently developed by Stanford University’s Center for Compassion and Altruism Research & Education to help train individuals on how to cultivate compassion and improve resilience. Currently, there are no published studies on the impact of any formal compassion training program, including CCT, with gender and sexual minorities (GSM). To address this gap, this study proposes to examine the influence of CCT on reducing emotional distress (i.e. depression, anxiety, stigma, shame) and improving well-being (i.e. mindfulness, compassion) among GSM adults. The groups were conducted in 2018 and data are currently being analyzed. The purpose of this study is to utilize CCT to shift awareness and everyday practices of compassion to not only be utilized in moments of deep suffering, but also as an active anchor or stance in daily life. Through CCT, the investigators hope to explore ways to strengthen resilience in this vulnerable population.

The Enby Project: Understanding Minority Stress and Resilience among Non-binary People
Principal Investigators: Em Matsuno, Ph.D., Kimberly F. Balsam, Ph.D., Nat Bricker, B.A., and Elizabeth Savarese, B.A.
Description: The aim of The Enby Project is to adapt the minority stress model (Meyer, 2003) by identifying the specific minority stressors that non-binary people experience and what helps them manage those stressors, with the ultimate goal of developing and validating the first non-binary minority stress and resilience scale. Having this assessment tool is crucial in understanding the relationship between minority stressors, resilience factors, and mental health outcomes as well as evaluating the impact of interventions on reducing minority stress and increasing resilience for non-binary people. Non-binary participants will be recruited online to participate in one of four focus groups with 4-8 participants each, two of which will be limited to people of color only. Additionally, individual interviews will be held with approximately 6 non-binary individuals who are identified as community leaders within non-binary communities. Data will be collected, and thematic analysis will be conducted to identify themes and adapt the minority stress model in Spring of 2020.

Gender Kaleidoscope Study

Principal Investigators: Arielle Webb, M.S., Kimberly F. Balsam, Ph.D., & Elizabeth Savarese, B.A.

Description: The Gender Kaleidoscope Study aims to examine gender in all of its myriad forms within LGBTQ communities, with a special focus on individuals whose gender identity and expression fall outside of the binary of man/woman (for example, genderqueer, non-binary, and androgynous genders).  We are currently collecting data in a large national from 450 adults to explore gender identity and expression, sexual identity, relationships, well-being, stressors and resilience among diverse LGBTQ people. This study includes longitudinal data collection to examine how changes in the sociocultural environment and individual life experiences impact well-being over time. 


Resilience and Well-being in LGBTQ Latinx Individuals

Principal Investigator: Itzel Anaya, B.A.

Co-Investigators: Kimberly F. Balsam, Ph.D., Alinne Barrera, Ph.D., & Teceta Tormala, Ph.D.

Description: Gender and sexual minority (GSM) Latinx immigrants experience multiple minority stressors related to their immigration status, racial/ethnic identity, sexual orientation and/or gender identities.  Prior research suggests that these individuals also possess unique strengths that can help them overcome these adverse life experiences. This study will recruit GSM Latinx individuals, including bilingual and monolingual Spanish speakers, in order to characterize stressors and resilience factors. A survey of GSM Latinx Californians will assess sexual and gender identities, perceived experiences of discrimination, well-being, mental health outcomes, and bicultural identity integration, as well as differences between monolingual and bilingual GSM Spanish speakers, and first and second-generation GSM Latinx individuals.

CLEAR Small Grants Program Study: Is Dialectical Behavior Therapy a Good Fit for Transgender and Gender Non-Binary Patients? 

Principal Investigator and Grant Recipient: Rachel Weiler, M.S., M.Sc. 

Description: This study will empirically examine Dialectical Behavior Therapy (DBT) as a possible approach to reducing suicidality and emotion dysregulation in transgender and gender non-binary (TGNB) populations. In addition to quantitative data on the effectiveness of DBT for TGNB adults, we will also collect qualitative data that could help providers better tailor this treatment to the TGNB population. DBT been proposed as potentially well-suited treatment for addressing the link between the TGNB experience of invalidation and suicidal behavior, but the goodness of fit between treatment and population has not yet been tested empirically. TGNB patients enrolled in a DBT Skills Group at the Stanford University School of Medicine outpatient psychiatric clinic to participate in this research. A focus group at the end of treatment will gather information about participants’ subjective experience of DBT treatment, while self-report measures will generate quantitative indices of changes pre- and post-group participation in emotion regulation and suicidality. This study will help providers select and modify a potentially effective treatment for TGNB patients struggling with emotion dysregulation and suicidal thoughts and behaviors.


Principal Investigators: Kimberly Balsam, Ph.D., Vinisha Rana, M.A., Sarah Burdge, PsyD.

Description: This project is a partnership between CLEAR and Outlet, a program of Adolescent Counseling Services that provides mental health counseling and support services to LGBTQ youth on the Bay Area Peninsula and provides training and psychoeducation for schools and communities to become more LGBTQ-friendly.  CLEAR faculty and students will work on site at ACS to develop intake measures, analyze existing program data, and seek to document the process of change in therapy as well as identify areas for program improvement.  Adolescents are at particular risk for adverse outcomes and Outlet provides comprehensive affirming services to mitigate these risks.

Cognitive and Risk Variables Associated with Gender Study

Principal Investigators: Janna Holmes, M.S., Briahna Yuodsnukis, B.S., Brian Maruyama, & Kimberly F. Balsam, Ph.D.

Description: This study aims to examine differences in interpersonal behaviors, emotions, and mental performance according to gender and sex assigned at birth. Specific measures of well-being, personality traits, impulsivity, aggression, substance use, and cognitive performance are being administered via an online survey of 100 transgender women, 100 transgender men, 100 cisgender women, and 100 transgender men.  Exploring gender differences in a mixed transgender/cisgender sample will inform the development of culturally competent assessment strategies for transgender populations and will highlight both similarities and differences among transgender people and their cisgender counterparts.  Data collection launched in 2019.




Stress and Resilience in Italian Transgender Populations

Principal Investigator: Cristiano Scandurra, Ph.D.

Co-Investigators: Kimberly F. Balsam, Ph.D., Rylan Testa, Ph.D., Pasquale Dolce, Ph.D., Vincenzo Bochicchio, Ph.D., Chiara Cavara, Ph.D.

Description: This study represents a partnership between CLEAR researchers and researchers at the University of Naples in Italy.  The Gender Minority Stress and Resilience Scale, which was developed by CLEAR and published in 2015, was translated into Italian and administered along with other measures of stress, trauma, and mental health and well-being to a sample of 203 transgender and non-binary individuals living in Italy.  This study is the largest sample to date of this marginalized population in Italy and results will inform assessment, clinical practice and research in Italy and with Italian-speaking populations regarding the unique needs of TGNB individuals.

Civil Union Project Longitudinal Enhanced Study (CUPPLES)

Principal Investigator: Kimberly F. Balsam, Ph.D

Co-Investigator: Esther Rothblum, Ph.D.

Other Investigators and Collaborators: Ellen Riggle, Ph.D., Sherry Rotosky, Ph.D., Ted Beauchaine, Ph.D., Robert Wickham, Ph.D., Lisa M. Brown, Ph.D., Jennifer Clark, M.A.

Description: The CUPPLES study is a longitudinal study of same-sex and heterosexual couples that began in 2002, with subsequent data collection time points in 2005 and 2013-14. Originally called the Vermont Civil Union Project, this was the first study to examine same-sex couples in state-recognized relationships. The “civil union couples” will always be the first “legal” same-sex couples in the U.S. We are currently planning wave 4 of data collection in order to continue this longest running longitudinal study of same-sex and heterosexual couples in the U.S. At time 3, our sample was on average age 57, and thus we expect that at wave 4 the majority of our participants will be over 60 and facing issues of retirement, physical health concerns, and other developmental issues facing older adults. We are specifically interested in how our cohort will cope with the challenges that aging brings, individually and within their intimate partnerships.  Similar to our previous waves of data collection, we will look at gender and sexual orientation differences in these processes, as well as the role of minority stress and other life stressors on mental health and psychosocial functioning.  We will add measures of physical health and capitalize on the dyadic nature of our cohort by using partners to report on each other’s’ health and well-being.

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