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Psychedelic-assisted therapy among sexual and gender minority communities

Abstract

Although research on psychedelic-assisted therapy (PAT) is rapidly expanding, the clinical trial literature has been criticized for its underrepresentation of sexual and gender minority (SGM) and racial communities. Accordingly, there is a pressing need to study the outcomes of PAT in minoritized communities and its effects on the mental health disparities among SGM communities. Here we discuss the potential relevance of minority stress theory and its principles as they relate to PAT for SGM communities. Furthermore, we propose a theoretical framework integrating minority stress theory and its extensions with prominent models of psychedelic action, highlighting the potential of PAT to plasticize entrenched cognitive and behavioral patterns associated with minority stress. Future research should explore the mechanisms by which PAT may interact with minority stress processes and the potential benefits of SGM-affirmative adaptations of PAT. The integration of minority stress theory into PAT research may enrich our understanding of its therapeutic mechanisms while tailoring a promising intervention to individuals disproportionately excluded from effective care.

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Fig. 1: The psychological mediation framework.
Fig. 2: The REBUS model and CANAL.
Fig. 3: An integrative theoretical framework.

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References

  1. Luoma, J. B., Chwyl, C., Bathje, G. J., Davis, A. K. & Lancelotta, R. A meta-analysis of placebo-controlled trials of psychedelic-assisted therapy. J. Psychoactive Drugs 52, 289–299 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nutt, D. & Carhart-Harris, R. The current status of psychedelics in psychiatry. JAMA Psychiatry 78, 121–122 (2021).

    Article  PubMed  Google Scholar 

  3. Marks, M. The varieties of psychedelic law. Neuropharmacology. 226, 109399 (2023).

    Article  PubMed  Google Scholar 

  4. Aday, J. S. et al. Psychedelic commercialization: a wide-spanning overview of the emerging psychedelic industry. Psychedelic Med. 1, 150–165 (2023).

    Article  Google Scholar 

  5. Dixon Ritchie, O., Donley, C. N. & Dixon Ritchie, G. From prohibited to prescribed: the rescheduling of MDMA and psilocybin in Australia. Drug Sci. Policy Law 9, 10.1177/20503245231198472 (2023).

    Article  Google Scholar 

  6. Barnett, B. S. et al. American psychiatrists’ opinions about classic hallucinogens and their potential therapeutic applications: a 7-year follow-up survey. Psychedelic Med 2, 1–9 (2023).

    Article  Google Scholar 

  7. Aday, J. S. et al. Great expectations: recommendations for improving the methodological rigor of psychedelic clinical trials. Psychopharmacology 239, 1989–2010 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Michaels, T. I., Purdon, J., Collins, A. & Williams, M. T. Inclusion of people of color in psychedelic-assisted psychotherapy: a review of the literature. BMC Psychiatry 18, 245 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  9. George, J. R., Michaels, T. I., Sevelius, J. & Williams, M. T. The psychedelic renaissance and the limitations of a White-dominant medical framework: a call for indigenous and ethnic minority inclusion. J. Psychedelic Stud. 4, 4–15 (2020).

    Article  Google Scholar 

  10. Morales, J., Quan, E., Arshed, A. & Jordan, A. Racial disparities in access to psychedelic treatments and inclusion in research trials. Psychiatr. Ann. 52, 494–499 (2022).

    Article  Google Scholar 

  11. Stauffer, C. S., Brown, M. R., Adams, D., Cassity, M. & Sevelius, J. MDMA-assisted psychotherapy; inclusion of transgender and gender diverse people in the frontiers of PTSD treatment trials. Front. Psychiatry 13, 932605 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sevelius, J. Psychedelic-assisted therapy with transgender and gender diverse individuals. MAPS Bull. Spring 29, 39–41 (2019).

    Google Scholar 

  13. Ching, T. H. W. Intersectional insights from an MDMA-assisted psychotherapy training trial: an open letter to racial/ethnic and sexual/gender minorities. J. Psychedelic Stud. 4, 61–68 (2020).

    Article  Google Scholar 

  14. Mitchell, J. M. et al. MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nat. Med. 14, 2473–2480 (2023).

    Article  Google Scholar 

  15. Ching, T. H. et al. MDMA-assisted therapy for posttraumatic stress disorder: a pooled analysis of ethnoracial differences in efficacy and safety from two Phase 2 open-label lead-in trials and a Phase 3 randomized, blinded placebo-controlled trial. J. Psychopharmacol. Oxf. Engl. 36, 974–986 (2022).

    Article  Google Scholar 

  16. Inserra, A., De Gregorio, D. & Gobbi, G. Psychedelics in psychiatry: neuroplastic, immunomodulatory and neurotransmitter mechanisms. Pharmacol. Rev. 73, 202–277 (2021).

    Article  PubMed  Google Scholar 

  17. Carhart-Harris, R. L. & Friston, K. J. REBUS and the anarchic brain: toward a unified model of the brain action of psychedelics. Pharmacol. Rev. 71, 316–344 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Doss, M. K. et al. Models of psychedelic drug action: modulation of cortical-subcortical circuits. Brain 145, 441–456 (2022).

    Article  PubMed  Google Scholar 

  19. Wolff, M. et al. Learning to let go: a cognitive-behavioral model of how psychedelic therapy promotes acceptance. Front. Psychiatry https://doi.org/10.3389/fpsyt.2020.00005 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Davis, A. K., Barrett, F. S. & Griffiths, R. R. Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. J. Context. Behav. Sci. 15, 39–45 (2020).

    Article  Google Scholar 

  21. Ko, K., Knight, G., Rucker, J. J. & Cleare, A. J. Psychedelics, mystical experience and therapeutic efficacy: a systematic review. Front. Psychiatry 13, 917199 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Frost, D. M. & Meyer, I. H. Minority stress theory: application, critique and continued relevance. Curr. Opin. Psychol. 51, 101579 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Meyer, I. H. Prejudice, social stress and mental health in lesbian, gay and bisexual populations: conceptual issues and research evidence. Psychol. Bull. 129, 674–697 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bränström, R. Minority stress factors as mediators of sexual orientation disparities in mental health treatment: a longitudinal population-based study. J. Epidemiol. Community Health 71, 446–452 (2017).

    Article  PubMed  Google Scholar 

  25. Youth Risk Behavior Survey Data Summary & Trends Report: 2011–2021 (Centers for Disease Control and Prevention, 2021).

  26. Depa, N. et al. Mental health disparities amongst sexual-minority adolescents of the US—a national survey study of YRBSS-CDC. Psychiatry Res. 314, 114635 (2022).

    Article  PubMed  Google Scholar 

  27. Plöderl, M. & Tremblay, P. Mental health of sexual minorities. a systematic review. Int. Rev. Psychiatry 27, 367–385 (2015).

    Article  PubMed  Google Scholar 

  28. Turban, J. L., Dolotina, B., King, D. & Keuroghlian, A. S. Sex assigned at birth ratio among transgender and gender diverse adolescents in the United States. Pediatrics 150, e2022056567 (2022).

    Article  PubMed  Google Scholar 

  29. Fagrell Trygg, N., Gustafsson, P. E. & Månsdotter, A. Languishing in the crossroad? A scoping review of intersectional inequalities in mental health. Int. J. Equity Health 18, 115 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ching, T. H. W., Finkelstein-Fox, L., Lee, S. Y. & Watson, R. J. Effects of sexual and gender minority stress on depressive symptoms among adolescents of color in the United States. Cultur. Divers. Ethnic Minor. Psychol https://doi.org/10.1037/cdp0000562 (2022).

    Article  PubMed  Google Scholar 

  31. Hatzenbuehler, M. L. & Pachankis, J. E. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual and transgender youth: research evidence and clinical implications. Pediatr. Clin. North Am. 63, 985–997 (2016).

    Article  PubMed  Google Scholar 

  32. Mongelli, F. et al. Minority stress and mental health among LGBT populations: an update on the evidence. Minerva Psichiatr. 60, 27–50 (2019).

    Article  Google Scholar 

  33. Semlyen, J., King, M., Varney, J. & Hagger-Johnson, G. Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry 16, 67 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  34. Brooks, V. R. Minority Stress and Lesbian Women (Lexington Books, 1981); https://cir.nii.ac.jp/crid/1130282271372632320

  35. Cyrus, K. Multiple minorities as multiply marginalized: applying the minority stress theory to LGBTQ people of color. J. Gay Lesbian Ment. Health 21, 194–202 (2017).

    Article  Google Scholar 

  36. Hendricks, M. L. & Testa, R. J. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model. Prof. Psychol. Res. Pract. 43, 460–467 (2012).

    Article  Google Scholar 

  37. White Hughto, J. M., Reisner, S. L. & Pachankis, J. E. Transgender stigma and health: a critical review of stigma determinants, mechanisms and interventions. Soc. Sci. Med. 147, 222–231 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hatzenbuehler, M. L. How does sexual minority stigma ‘get under the skin’? A psychological mediation framework. Psychol. Bull. 135, 707–730 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hatzenbuehler, M. L., Phelan, J. C. & Link, B. G. Stigma as a fundamental cause of population health inequalities. Am. J. Public Health 103, 813–821 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lattanner, M. R., Pachankis, J. E. & Hatzenbuehler, M. L. Mechanisms linking distal minority stress and depressive symptoms in a longitudinal, population-based study of gay and bisexual men: a test and extension of the psychological mediation framework. J. Consult. Clin. Psychol. 90, 638–646 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Pachankis, J. E., Hatzenbuehler, M. L., Klein, D. N. & Bränsträm, R. The role of shame in the sexual-orientation disparity in mental health: a prospective population-based study of multimodal emotional reactions to stigma. Clin. Psychol. Sci. https://doi.org/10.1177/21677026231177714 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Katz-Wise, S. L., Sarda, V., Austin, S. B. & Harris, S. K. Longitudinal effects of gender minority stressors on substance use and related risk and protective factors among gender minority adolescents. PLoS ONE 16, e0250500 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Diamond, L. M. & Alley, J. Rethinking minority stress: a social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations. Neurosci. Biobehav. Rev. 138, 104720 (2022).

    Article  PubMed  Google Scholar 

  44. Feinstein, B. A. The rejection sensitivity model as a framework for understanding sexual minority mental health. Arch. Sex. Behav. 49, 2247–2258 (2020).

    Article  PubMed  Google Scholar 

  45. Hatzenbuehler, M. L., McLaughlin, K. A. & Nolen-Hoeksema, S. Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents. J. Child Psychol. Psychiatry 49, 1270–1278 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  46. Pachankis, J. E., Goldfried, M. R. & Ramrattan, M. E. Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. J. Consult. Clin. Psychol. 76, 306–317 (2008).

    Article  PubMed  Google Scholar 

  47. Dyar, C. & London, B. Longitudinal examination of a bisexual-specific minority stress process among bisexual cisgender women. Psychol. Women Q. 42, 342–360 (2018).

    Article  Google Scholar 

  48. Sarno, E. L., Newcomb, M. E. & Mustanski, B. Rumination longitudinally mediates the association of minority stress and depression in sexual and gender minority individuals. J. Abnorm. Psychol. 129, 355–363 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  49. Dyar, C. et al. Prospective associations between bi+ minority stressors and internalizing symptoms: the mediating roles of general and group-specific processes. J. Consult. Clin. Psychol. 89, 845–855 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  50. Mereish, E. H. & Poteat, V. P. A relational model of sexual minority mental and physical health: the negative effects of shame on relationships, loneliness and health. J. Couns. Psychol. 62, 425–437 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  51. Rendina, H. J. et al. Extending the Minority Stress Model to incorporate HIV-positive gay and bisexual men’s experiences: a longitudinal examination of mental health and sexual risk behavior. Ann. Behav. Med. 51, 147–158 (2017).

    Article  PubMed  Google Scholar 

  52. Puckett, J. A., Newcomb, M. E., Garofalo, R. & Mustanski, B. The impact of victimization and neuroticism on mental health in young men who have sex with men: internalized homophobia as an underlying mechanism. Sex. Res. Soc. Policy 13, 193–201 (2016).

    Article  Google Scholar 

  53. Baams, L., Grossman, A. H. & Russell, S. T. Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay and bisexual youth. Dev. Psychol. 51, 688–696 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  54. Baams, L., Dubas, J. S., Russell, S. T., Buikema, R. L. & van Aken, M. A. G. Minority stress, perceived burdensomeness and depressive symptoms among sexual minority youth. J. Adolesc. 66, 9–18 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  55. Chang, C. J., Fehling, K. B. & Selby, E. A. Sexual minority status and psychological risk for suicide attempt: a serial multiple mediation model of social support and emotion regulation. Front. Psychiatry 11, 385 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  56. Mahon, C. P., Pachankis, J. E., Kiernan, G. & Gallagher, P. Risk and protective factors for social anxiety among sexual minority individuals. Arch. Sex. Behav. 50, 1015–1032 (2021).

    Article  PubMed  Google Scholar 

  57. Schwartz, D. R., Stratton, N. & Hart, T. A. Minority stress and mental and sexual health: examining the psychological mediation framework among gay and bisexual men. Psychol. Sex. Orientat. Gend. Divers. 3, 313–324 (2016).

    Article  Google Scholar 

  58. Cavnar, C. The effects of ayahuasca ritual participation on gay and lesbian identity. J. Psychoactive Drugs 46, 252–260 (2014).

    Article  PubMed  Google Scholar 

  59. Carhart-Harris, R. L. et al. Trial of psilocybin versus escitalopram for depression. N. Engl. J. Med. 384, 1402–1411 (2021).

    Article  PubMed  Google Scholar 

  60. LGBT Identification in U.S. Ticks Up to 7.1% Gallup.com (accessed 8 October 2023); https://news.gallup.com/poll/389792/lgbt-identification-ticks-up.aspx

  61. Friston, K. The free-energy principle: a unified brain theory? Nat. Rev. Neurosci. 11, 127–138 (2010).

    Article  PubMed  Google Scholar 

  62. Corlett, P. R., Mohanty, A. & MacDonald, A. W. What we think about when we think about predictive processing. J. Abnorm. Psychol. 129, 529–533 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  63. Sterzer, P. et al. The predictive coding account of psychosis. Biol. Psychiatry 1, 634–643 (2018).

    Article  Google Scholar 

  64. Alamia, A., Timmermann, C., Nutt, D. J., VanRullen, R. & Carhart-Harris, R. L. DMT alters cortical travelling waves. eLife 9, e59784 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  65. Timmermann, C. et al. Psychedelics alter metaphysical beliefs. Sci. Rep. 11, 22166 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  66. Daws, R. E. et al. Increased global integration in the brain after psilocybin therapy for depression. Nat. Med. 28, 844–851 (2022).

    Article  PubMed  Google Scholar 

  67. Singleton, S. P. et al. Receptor-informed network control theory links LSD and psilocybin to a flattening of the brain’s control energy landscape. Nat. Commun. 13, 5812 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  68. McGovern, H. T., Leptourgos, P., Hutchinson, B. T. & Corlett, P. R. Do psychedelics change beliefs? Psychopharmacology 239, 1809–1821 (2022).

    Article  PubMed  Google Scholar 

  69. Girn, M. et al. Serotonergic psychedelic drugs LSD and psilocybin reduce the hierarchical differentiation of unimodal and transmodal cortex. NeuroImage. 256, 119220 (2022).

    Article  PubMed  Google Scholar 

  70. Zeifman, R. et al. From Relaxed Beliefs Under Psychedelics (REBUS) to Revised Beliefs After Psychedelics (REBAS): Preliminary Development of the RElaxed Beliefs Questionnaire (REB-Q); https://doi.org/10.31234/osf.io/w8j6t

  71. Kafadar, E. et al. Modeling perception and behavior in individuals at clinical high risk for psychosis: support for the predictive processing framework. Schizophr. Res. 226, 167–175 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Fletcher, P. C. & Frith, C. D. Perceiving is believing: a Bayesian approach to explaining the positive symptoms of schizophrenia. Nat. Rev. Neurosci. 10, 48–58 (2009).

    Article  PubMed  Google Scholar 

  73. Carhart-Harris, R. L. et al. Canalization and plasticity in psychopathology. Neuropharmacology. 226, 109398 (2023).

    Article  PubMed  Google Scholar 

  74. Moran, R. J., Symmonds, M., Dolan, R. J. & Friston, K. J. The brain ages optimally to model its environment: evidence from sensory learning over the adult lifespan. PLoS Comput. Biol. 10, e1003422 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  75. Hebb, D. O. The Organization of Behavior; a Neuropsychological Theory (Wiley, 1949).

  76. Newcomb, M. E. & Mustanski, B. Internalized homophobia and internalizing mental health problems: a meta-analytic review. Clin. Psychol. Rev. 30, 1019–1029 (2010).

    Article  PubMed  Google Scholar 

  77. Goldbach, J. T. & Gibbs, J. J. Strategies employed by sexual minority adolescents to cope with minority stress. Psychol. Sex. Orientat. Gend. Divers. 2, 297–306 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  78. D’Augelli, A. R., Grossman, A. H., Hershberger, S. L. & O’Connell, T. S. Aspects of mental health among older lesbian, gay and bisexual adults. Aging Ment. Health 5, 149–158 (2001).

    Article  PubMed  Google Scholar 

  79. Szymanski, D. M. & Ikizler, A. S. Internalized heterosexism as a mediator in the relationship between gender role conflict, heterosexist discrimination and depression among sexual minority men. Psychol. Men Masculinity 14, 211–219 (2013).

    Article  Google Scholar 

  80. Feinstein, B. A., Goldfried, M. R. & Davila, J. The relationship between experiences of discrimination and mental health among lesbians and gay men: an examination of internalized homonegativity and rejection sensitivity as potential mechanisms. J. Consult. Clin. Psychol. 80, 917–927 (2012).

    Article  PubMed  Google Scholar 

  81. Tatum, A. K. & Ross, M. W. A longitudinal analysis of sexual minorities’ acceptance concerns and internalised homonegativity on perceived psychological stress. Psychol. Sex. 13, 331–343 (2022).

    Google Scholar 

  82. Herrick, A. L. et al. It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS Behav. 17, 1423–1430 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  83. Brisbin, C. D. et al. Treatment goals of sexual minority men in LGBTQ-affirmative CBT. Cogn. Behav. Pract. https://doi.org/10.1016/j.cbpra.2023.12.002 (2023).

  84. Rea, K. & Wallace, B. Enhancing equity-oriented care in psychedelic medicine: utilizing the EQUIP framework. Int. J. Drug Policy 98, 103429 (2021).

    Article  PubMed  Google Scholar 

  85. Pachankis, J. E., Soulliard, Z. A., Morris, F. & Seager van Dyk, I. A model for adapting evidence-based interventions to be LGBQ-affirmative: putting minority stress principles and case conceptualization into clinical research and practice. Cogn. Behav. Pract. 30, 1–17 (2023).

    Article  Google Scholar 

  86. Keefe, J. R. et al. Moderators of LGBQ-affirmative cognitive behavioral therapy: ESTEEM is especially effective among Black and Latino sexual minority men. J. Consult. Clin. Psychol. 91, 150–164 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  87. Pachankis, J. E. et al. LGBQ-affirmative cognitive-behavioral therapy for young gay and bisexual men’s mental and sexual health: a three-arm randomized controlled trial. J. Consult. Clin. Psychol. 90, 459–477 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  88. Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A. & Parsons, J. T. LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. J. Consult. Clin. Psychol. 83, 875–889 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  89. Lambe, J., Cerezo, A. & O’Shaughnessy, T. Minority stress, community involvement and mental health among bisexual women. Psychol. Sex. Orientat. Gend. Divers. 4, 218–226 (2017).

    Article  Google Scholar 

  90. Bruce, D., Harper, G. W. & Bauermeister, J. A. Minority stress, positive identity development and depressive symptoms: implications for resilience among sexual minority male youth. Psychol. Sex. Orientat. Gend. Divers. 2, 287–296 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  91. Lefevor, G. T., Smack, A. C. P. & Giwa, S. Religiousness, support, distal stressors and psychological distress among Black sexual minority college students. J. GLBT Fam. Stud. 16, 148–162 (2020).

    Article  Google Scholar 

  92. Challian, C., Bartlett, A., Manoni-Millar, S. & Ching, T. H. W. The future is queer: imagining queer-affirming MDMA-assisted therapy. MAPS Bulletin 31 (2021); https://maps.org/news/bulletin/the-future-is-queer-imagining-queer-affirming-mdma-assisted-therapy/

  93. Jaster, A. M. & González-Maeso, J. Mechanisms and molecular targets surrounding the potential therapeutic effects of psychedelics. Mol. Psychiatry 28, 3595–3612 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  94. Aday, J. S., Mitzkovitz, C. M., Bloesch, E. K., Davoli, C. C. & Davis, A. K. Long-term effects of psychedelic drugs: a systematic review. Neurosci. Biobehav. Rev. 113, 179–189 (2020).

    Article  PubMed  Google Scholar 

  95. Lepow, L., Morishita, H. & Yehuda, R. Critical period plasticity as a framework for psychedelic-assisted psychotherapy. Front. Neurosci 15, 710004 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  96. Nardou, R. et al. Psychedelics reopen the social reward learning critical period. Nature 618, 790–798 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  97. Flentje, A., Heck, N. C., Brennan, J. M. & Meyer, I. H. The relationship between minority stress and biological outcomes: a systematic review. J. Behav. Med. 43, 673–694 (2020).

    Article  PubMed  Google Scholar 

  98. Hatzenbuehler, M. L. & McLaughlin, K. A. Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay and bisexual young adults. Ann. Behav. Med. 47, 39–47 (2014).

    Article  PubMed  Google Scholar 

  99. Nicholson, A. A. et al. A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda. Eur. J. Psychotraumatol 13, 2002572 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  100. Hatzenbuehler, M. L., McLaughlin, K. A., Weissman, D. G. & Cikara, M. A research agenda for understanding how social inequality is linked to brain structure and function. Nat. Hum. Behav. 8, 20–31 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  101. Ching, T. H. W., Davis, A. K., Xin, Y. & Williams, M. T. Effects of psychedelic use on racial trauma symptoms and ethnic identity among Asians in North America. J. Psychoactive Drugs 55, 19–29 (2023).

    Article  PubMed  Google Scholar 

  102. Davis, A. K., Xin, Y., Sepeda, N. D., Garcia-Romeu, A. & Williams, M. T. Increases in psychological flexibility mediate relationship between acute psychedelic effects and decreases in racial trauma symptoms among people of color. Chronic Stress 5, 24705470211035607 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  103. Williams, M. T. et al. People of color in North America report improvements in racial trauma and mental health symptoms following psychedelic experiences. Drugs Abingdon Engl. 28, 215–226 (2021).

    PubMed  Google Scholar 

  104. Crenshaw, K. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics (Univ. Chicago); https://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8

  105. Hsieh, N. & Ruther, M. Sexual minority health and health risk factors: intersection effects of gender, race and sexual identity. Am. J. Prev. Med. 1, 746–755 (2016).

    Article  Google Scholar 

  106. Bauer, G. R. Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc. Sci. Med. 110, 10–17 (2014).

    Article  PubMed  Google Scholar 

  107. Bowleg, L. The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health. Am. J. Public Health 102, 1267–1273 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

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B.D.H. led the initial conceptualization. B.D.H., M.F. and C.T.M.A. contributed to the initial literary review and writing of the original draft. B.D.H., M.F., C.T.M.A. and J.L.T. contributed to review and editing of the paper.

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Correspondence to Brady D. Hanshaw.

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J.L.T. receives royalties from Springer Nature and Simon & Schuster, expert witness payments from the American Civil Liberties Union, research funding from The Sorensen Foundation, and a pilot research award from The American Academy of Child & Adolescent Psychiatry and its industry sponsors (Arbor & Pfizer). B.D.H., M.F. and C.T.M.A. declare no competing interests.

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Hanshaw, B.D., Fusunyan, M., Anderson, C.T.M. et al. Psychedelic-assisted therapy among sexual and gender minority communities. Nat. Mental Health 2, 636–644 (2024). https://doi.org/10.1038/s44220-024-00252-y

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  • DOI: https://doi.org/10.1038/s44220-024-00252-y

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