How Masculinity and Treatment Impact Posttraumatic Stress Disorder Recovery in Sexual Minority Men With Sexual Trauma: Findings From a Randomized Clinical Trial

Sexual violence and associated risk of posttraumatic stress disorder (PTSD) are pressing and pervasive public health issues. Sexual minority men, or men whose sexual orientation is not exclusively heterosexual, are at heightened risk for both sexual violence and PTSD compared to heterosexual men. Regardless of sexual orientation, stigma surrounding sexual violence and masculinity norms can interfere with trauma processing and treatment, suggesting a need for treatments that target these factors to improve PTSD outcomes. In this study, 356 men with sexual trauma exposure were randomized to either motivational interviewing (MI) or peer-delivered MI plus affirmative care (MI + AC) adapted to be more affirming for sexual minority men. In this secondary data analysis, we hypothesized that the masculinity scores on self-reliance and emotional control would be negatively associated with PTSD symptoms and that participants in the MI + AC group would experience greater PTSD symptom reduction. Findings from the structural equation models revealed that PTSD symptoms decreased over time for both groups (β = −.19, p < .001) and that self-reliance mediated reductions in PTSD over time (β = .03, p = .013). However, these effects were not moderated by treatment type (β = −.01, p = .402). These results highlight self-reliance as a relevant treatment target for enhancing treatments for sexual trauma-exposed sexual minority men.