Brief transdiagnostic cognitive behavioral therapy and expressive writing for hazardous drinking and posttraumatic stress symptoms among sexual and gender minority adults: Pilot trial protocol

Background: Sexual minority cisgender women, transgender men and women, and nonbinary or gender diverse (SMW/TGD) people experience disproportionately high rates of hazardous drinking and posttraumatic stress symptoms, due in part to elevated exposure to trauma, stigma-related stressors and related adaptations, and barriers to accessing affirming care. Existing integrated alcohol-trauma interventions have rarely been evaluated or culturally adapted for SMW/TGD people, underscoring the need for scalable, culturally responsive approaches for this population. This protocol describes development and pilot testing of Recovery through Inhibitory learning, Self-Efficacy promoting, problem-solving, and community building (RISE), a brief, culturally responsive telehealth intervention integrating selected Unified Protocol modules with exposure-based expressive writing for trauma-exposed SMW/TGD adults with hazardous drinking and at least subthreshold PTSD symptoms. Methods: = 30). RISE includes four adapted Unified Protocol sessions followed by five days of expressive writing about trauma, stigma, or other adverse experiences with clinician check-ins. Feasibility, acceptability, implementation indicators, and preliminary clinical outcomes will be assessed through self-report and clinician-administered measures. Conclusion: This study will generate preliminary data regarding feasibility, acceptability, and clinical promise of a brief, scalable intervention addressing hazardous drinking, posttraumatic stress, and stigma-related stressors and related adaptations among SMW/TGD populations. Findings will inform refinement of RISE and a future fully powered randomized controlled trial. Trial registration number: Registered on 15 October 2025 (ClinicalTrials.gov identifier: NCT07217795).