Symposia
LGBQT+
John E. Pachankis, Ph.D.
Susan Dwight Bliss Professor of Public Health (Social and Behavioral Sciences)
Yale School of Public Health
New Haven, Connecticut
Audrey Harkness, Ph.D.
Research Assistant Professor
University of Miami
Miami, Florida
Erin McConocha, MPH
PhD Student
University of Tennessee at Knoxville
Knoxville, Tennessee
Roxanne Winston, MPH, MSN, RN
DNP Candidate
Columbia University
New York, NY
Oluwaseyi Adeyinka, MD, MPH
Medical Student
New York University Grossman School of Medicine
New York, NY
Kriti Behari, MA
Postgraduate Fellow
Yale School of Public Health
New York, NY
Timothy J. Sullivan, M.A.
Doctoral Candidate
Stony Brook University
Stony Brook, New York
Denise Esserman, PhD
Associate Professor
Yale University
New Haven, CT
Kirsty A. Clark, Ph.D.
Assistant Professor
Vanderbilt University
Nashville, Tennessee
Richard Richard Bränström, PhD
Associate professor, licensed psychologist
Department of Clinical Neuroscience, Karolinska Institutet, Sweden
Stockholm, Stockholms Lan, Sweden
Mark Hatzenbuehler, Ph.D.
John L Loeb Associate Professor of the Social Sciences
Harvard University
Cambridge, Massachusetts
Steven A. Safren, Ph.D., ABPP
Professor of Psychology
University of Miami
University of Miami, Florida
Objectives: LGBTQ-affirmative CBT represents a promising tool for helping sexual minorities cope with the challenges of stigma, with implications for the mental and behavioral health comorbidities facing this population. This study represents one of the few efficacy tests of LGBTQ-affirmative CBT, and by using strong comparisons and a 1-year follow-up, its most rigorous test to date. The treatment tested here is based on an LGBTQ-affirmative adaptation of the Unified Protocol guided by the psychological mediation framework and intended to transdiagnostically address the comorbid outcomes affecting sexual minority young adult men.
Methods: Across two sites (NYC and Miami), 254 young gay and bisexual men (M age=26.6; 42.5% Hispanic/Latino, 16.9% Black/African American) with major depression and/or an anxiety disorder diagnosis and past-90-day HIV-transmission risk behavior were randomized to receive (1) LGBTQ-affirmative CBT, (2) LGBTQ-affirmative community treatment-as-usual, or (3) single-session HIV testing/counseling. Assessments of mental (e.g., depression, anxiety), behavioral (e.g., alcohol use, drug use), and sexual (e.g., HIV-transmission risk behavior) health occurred at baseline and 4-, 8-, and 12-month follow-up.
Results: All conditions were associated with strong and sustained reductions across outcomes. Consistent with its transdiagnostic basis, LGBTQ-affirmative CBT demonstrated greater reductions in comorbidity across mental, sexual, and behavioral outcomes (depression, anxiety, alcohol use, drug use, HIV-transmission risk behavior) compared to community treatment-as-usual (OR=.30, 95% CI: .04, .57) and HIV testing/counseling (OR=.21, 95% CI: -.01, .44) at 12-month follow-up. Greater reductions were found for each of these pre-registered outcomes examined individually for participants who received LGBTQ-affirmative CBT vs. the other two conditions, although statistical significance was generally not achieved when applying the false discovery rate for multiple outcomes. Treatment-effect heterogeneity analyses are ongoing to identify for whom these interventions were most effective and to facilitate optimal client matching to the three conditions.
Conclusions: This study represents the strongest efficacy test of LGBTQ-affirmative CBT to date. Implications for integration within existing LGBTQ-affirmative services and settings will be reviewed, as well as statistical power considerations when assessing the multiple, co-occurring outcomes relevant to this population’s health.