Transgender adolescents are at heightened risk for depression and suicidality. Over half of these adolescents are diagnosed with depression and experience suicide ideation, while almost half engage in self-injurious behavior, and up to half attempt suicide. These rates are two to five times that of cisgender peers, likely due to minority stressors such as internalized transphobia, not being affirmed for their gender identity, and fear of discrimination that these adolescents face in their daily lives. Although current treatments including puberty blockers, hormone replacement therapy, and psychotherapy somewhat alleviate the experience of gender dysphoria, the emotional toll of transitioning from one gender to another is enormously psychologically taxing, and little has been done to address the specific psychological needs of this population. Self-compassion, which is associated with lower depression, anxiety, and higher resilience in teens, can be cultivated through empirically-grounded interventions that introduce and practice skills of treating oneself with kindness and acceptance. The primary goal of this study is to test the feasibility and acceptability of a modified, online mindful self-compassion program tailored to address the unique psychological needs of transgender adolescents at high risk for suicide. A secondary goal is to target reduction of suicide ideation via depression and explore moderators to this pathway. Grounded in mindfulness and focused on cultivating self-compassion, Mindful Self-Compassion for Teens (MSC-T) is an evidence-based intervention that reduces psychopathology (i.e., depression, anxiety, and stress) and enhances resilience and life satisfaction in adolescents. Specific aims of the study are to: 1) Tailor MSC-T protocols and curriculum to meet the unique needs of transgender adolescents. We will create an advisory committee of diverse transgender adolescents who have already taken MSC-T, transgender young adults, counselors who work with transgender adolescents, and stakeholders in the transgender community. Using qualitative methods, we will refine protocols and training content for transgender adolescents to create Mindful Self-Compassion for Transgender Adolescents (MSC-TA). New exercises will be created, and existing modules will be appropriately modified. Exercises or meditations not relevant to the needs of transgender adolescents will be eliminated. 2) Evaluate feasibility and acceptability of MSC-TA and whether specific TA characteristics may be associated with differences in acceptability. After implementing MSC-TA in 2 cohorts (n=30), feasibility will be determined by attendance and retention data; acceptability will be determined by post-intervention interviews and an Intervention Satisfaction Survey (ISS). Differences in acceptability (i.e., relevant to transgender subgroup, age, time since disclosure) will be assessed. 3) Explore preliminary psychosocial outcomes of MSC-TA. Reduction in suicide ideation is the primary target of the intervention, and mental health outcomes including depression, self-harm, and resilience will be investigated. We hypothesize that suicide ideation will be reduced, as well as depression and self-harm; whereas resilience will increase post-intervention. Potential moderators of intervention effects (i.e., interpersonal needs [thwarted belongingness/perceived burdensomeness], minority stressors [i.e, internalized transphobia) will be examined. Findings from this feasibility study will inform the design of a future fully-powered randomized controlled trial with significant implications for addressing suicide ideation and the overall emotional health of transgender adolescents.
