Transgender and gender expansive (TGE) adults in the United States experience disproportionately high rates of mental health difficulties, notably depressive and anxiety symptoms. These disparities have been linked to stigma-related stressors and to reduced access to competent, affirming health care. The authors note that legislative and systemic barriers can further restrict access to formalized supports. Interventions that can be broadly disseminated, accessed at no cost, and address stigma-related processes are therefore of clinical and public health interest.
This trial was a randomized controlled study testing a self-administered online expressive writing intervention called RECLAIM (Reflections to (re)Claim an Affirmed Identity to Improve Mental Health). The approach used expressive writing techniques targeted at reducing internalized anti-TGE stigma and enhancing perceived community connectedness, with the goal of reducing depressive and anxiety symptoms and improving well-being.
The trial enrolled 115 TGE community adults and randomized participants to one of three study conditions: two RECLAIM intervention arms and one expressive writing active control arm. The manuscript reports both between-group comparisons over time and within-group analyses examining interaction effects between time and condition to characterize treatment trajectories.
The sample comprised 115 adults who identify as transgender or gender expansive. Participants were randomized across three conditions (two intervention variants of RECLAIM and one active expressive writing control). The abstract does not provide additional demographic breakdowns, eligibility criteria, recruitment methods, adherence rates, or attrition statistics; those details were not reported in the source abstract.
RECLAIM was delivered as a self-administered online expressive writing program designed to address internalized stigma and affirm identity. Two distinct RECLAIM conditions were evaluated alongside an expressive writing active control group. The abstract identifies expressive writing as the therapeutic modality but does not describe session length, number of writing sessions, prompts used, or any facilitator involvement; those operational details were not reported in the abstract.
Primary outcomes reported in the abstract include symptoms of depression and anxiety, measures of internalized anti-TGE stigma, and perceived community connectedness. Analytic approaches included between-group comparisons across study arms to evaluate differential improvement over time, as well as within-group analyses examining time-by-condition interaction effects to assess differences in trajectories of response for each condition. The abstract does not specify the exact instruments or scales used to measure these constructs, nor does it report effect sizes, confidence intervals, or statistical test values.
Between-group analyses indicated that all three study groups experienced similar levels of improvement in mental health over time; no arm demonstrated a clear advantage on those between-group comparisons according to the abstract. However, within-group effects analyzing time by condition revealed notable differences in the overall trajectories of treatment or control effects, implying that patterns of change across the measurement period varied by condition. Specific numerical results, magnitude of change, and statistical significance values were not detailed in the abstract.
Despite the comparable between-group improvements, the authors interpret the pattern of findings as offering preliminary empirical support for the efficacy of RECLAIM in reducing depressive and anxiety symptoms, lowering internalized anti-TGE stigma, and improving community connectedness among TGE adults.
The trial emphasizes the potential for an online, self-administered expressive writing program to address mental health needs in TGE populations, particularly when access to affirming clinical services is constrained. The intervention’s format is notable for scalability and low cost. The abstract frames findings as preliminary, suggesting that further research is needed to confirm efficacy and to elaborate which components or delivery features drive observed effects.
The abstract does not report detailed limitations such as sample representativeness, retention, adherence, measurement instruments, or long-term follow-up. These omissions should be considered when interpreting the study’s conclusions; readers are referred to the full manuscript for granular methodological and statistical detail.
This randomized controlled trial is registered at ClinicalTrials.gov under identifier NCT05782868. The study is published in American Psychologist: Am Psychol. 2026 Sep;81(6):986-1000. DOI: 10.1037/amp0001639. Authors listed include Elliot Tebbe, Amelia Zepnick, Roger Brown (School of Nursing, University of Wisconsin–Madison) and Annesa Flentje (School of Nursing, University of California, San Francisco).
For clinicians and researchers, the trial highlights an accessible, expressive writing–based option—RECLAIM—that may help reduce psychological distress and stigma and increase community connectedness in TGE adults, while underscoring the need for additional trials reporting detailed methodology and longer-term outcomes.