"It Would Be a Program That is Made for Me and Sees Me": Adapting an Online, Cognitive Behavioral and...

There are limited psychosocial interventions that address the unique sexual concerns of transgender women. We adapted eSense, an eight-module online program designed to teach psychosocial skills focused on addressing sexual challenges in cisgender women, into eSense TRANScend, tailored for trans women. The program includes two treatment arms, cognitive behavioral therapy (CBT) and mindfulness-based therapy (MBT). This article describes the adaptation process and associated changes made to each arm. Participants were recruited from an LGBTQ+-serving community health center. Eligible participants were assigned male or intersex at birth, identified with transfeminine identities, and were at least 18 years old. For both arms, participants reviewed the intervention content and provided feedback via focus groups and surveys. Data from eight CBT participants and five MBT participants were analyzed via rapid analysis. Across both arms, participants emphasized three key areas for adaptation: Adding educational content about effects of gender-affirming care on sexual function/pleasure; increasing inclusivity of language, relationship types, and anatomy; and depicting the diverse experiences of trans women. In CBT, participants highlighted integrating trans-specific content into cognitive exercises. In MBT, participants suggested addressing the role of gender identity and dysphoria in body-focused mindfulness practices. Future work will evaluate feasibility and acceptability of eSense TRANScend.