Advisor(s)
Sarah MacCarthy
Committee Member(s)
Ann Elizabeth Montgomery
Gabe Miller
Gregory Pavela
Peter Hendricks
Sonya Heath
School
School of Public Health
Document Type
Dissertation
Department (new version)
Public Health
Date of Award
9-11-2025
Abstract
Sexual and gender minority (SGM) individuals face significant disparities in mental and physical health compared to their heterosexual and cisgender counterparts, due in part to chronic exposure to distal and proximal minority stressors. Shame – a self-focused characterized by a global sense of personal deficiency or unworthiness – has emerged as a key intrapersonal mechanism linking minority stressors to adverse health outcomes. This dissertation explores the role of shame in SGM health inequities and investigates the emerging potential of psychedelics to reduce shame and improve health and wellbeing in these populations. This three-paper dissertation begins with a scoping review (Paper 1) that synthesizes empirical evidence on the effects of shame among SGM individuals in the U.S. Findings reveal that shame is consistently associated with distal and proximal minority stressors, general psychological processes, maladaptive coping behaviors (e.g., substance use, sexual compulsivity), and adverse physical and mental health outcomes. However, few interventions directly target shame in this population. The second paper draws on nationally representative data to examine the prevalence and predictors of major life changes following psychedelic use. Results indicate that 18.4% of adults who endorsed lifetime psychedelic reported at least one major life change, with SGM individuals significantly more likely to report changes related to sexual orientation or gender identity. The third paper analyzes trends in hallucinogen use among people living with HIV (PLHIV) across multiple U.S. sites. Findings show rising hallucinogen use, especially among younger, White, and sexual minority participants, and highlight significant regional variation in use patterns. Together, these studies provide conceptual and empirical support for a novel hypothesis: psychedelic-assisted interventions may help reduce shame related to sexual orientation and gender identity, thereby promoting adaptive coping strategies and improving health outcomes among SGM individuals. This dissertation offers a foundation for future longitudinal and intervention studies, including the development of culturally responsive psychedelic-assisted interventions that center SGM experiences and target shame as a modifiable mechanism of change.
ProQuest ID
Recommended Citation
Carlisle, Nicholas, "Turn On, Tune In, Drop Shame: Exploring The Unique Therapeutic Potential Of Psychedelics For Sexual And Gender Minority Populations" (2025). All ETDs from UAB. 7380.
https://digitalcommons.library.uab.edu/etd-collection/7380
