Inclusion of sexual‐ and gender‐minoritized individuals in randomized clinical trials of first‐line treatments for posttraumatic stress disorder: A systematic literature review

Clinical treatment guidelines consistently recommend cognitive processing therapy (CPT), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) for posttraumatic stress disorder (PTSD). The efficacy of these interventions among sexual- and/or gender-minoritized (SGM) individuals has not been thoroughly investigated within randomized clinical trials (RCTs), despite known elevations in exposure to potentially traumatic events and PTSD symptoms relative to cisgender heterosexual individuals. We conducted a systematic literature review to examine the frequency with which SGM adults were enrolled in RCTs of CPT, PE, and EMDR and investigate these interventions' efficacy in reducing PTSD symptoms among SGM adults. We searched eight databases to identify RCTs published before August 7, 2025. The inclusion criteria were: written in English; RCT investigating the impact of CPT, PE, or EMDR on PTSD symptoms; utilized a standardized PTSD measure; reported PTSD outcome data; and enrolled individuals who were at least 18 years old. Literature reviews, case studies, protocols, and non-peer reviewed articles were excluded. Our search returned 1,821 unique records, with 519 meeting all eligibility criteria. Ten records reported sexual orientation and gender identity (SOGI) information and enrolled at least one SGM individual. Among studies that reported SOGI information, 12.1% and 2.2% of participants identified as sexual- and gender-minoritized, respectively. Results highlight that SOGI information is underreported in PTSD treatment research, posing significant challenges in determining the relative efficacy of these treatments and the extent to which SGM-affirmative adaptations are necessary. We offer recommendations for clinicians and researchers, including consistent reporting of full SOGI data.