Guided LGBTQ-affirmative internet cognitive-behavioral therapy for sexual minority youth's mental health: A randomized controlled trial of a minority stress treatment approach

Pachankis, John E.; Soulliard, Zachary A.; Layland, Eric K.; Behari, Kriti; Seager van Dyk, Ilana; Eisenstadt, Benjamin E.; Chiaramonte, Danielle; Ljótsson, Brjánn; Särnholm, Josefin; Bjureberg, Johan

doi:10.1016/j.brat.2023.104403

Cited by 59LGBTQ Health, Identity, and PolicyDigital Mental Health InterventionsMental Health Treatment and Access

Guided LGBTQ-affirmative internet cognitive-behavioral therapy for sexual minority youth's mental health: A randomized controlled trial of a minority stress treatment approach

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Pachankis, John E., Soulliard, Zachary A., Layland, Eric K., Behari, Kriti, Seager van Dyk, Ilana, Eisenstadt, Benjamin E., Chiaramonte, Danielle, Ljótsson, Brjánn +2 more·2023·Behaviour Research and Therapy

DOI 10.1016/j.brat.2023.104403PMC PMC10601985

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Abstract

Objective LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses the adverse impacts of minority stress. However, this treatment has rarely been tested in randomized controlled trials with LGBTQ youth and never using an asynchronous online platform for broad reach. This study examined the feasibility, acceptability, preliminary efficacy, and multi-level stigma moderators of LGBTQ-affirmative internet-based CBT (ICBT). Method Participants were 120 LGBTQ youth (ages 16-25; 37.5% transgender or non-binary; 75.8% assigned female at birth; 49.2% non-Latino White) living across 38 U.S. states and reporting depression and/or anxiety symptoms. Participants were randomized to receive 10 sessions of LGBTQ-affirmative ICBT or only complete 10 weekly assessments of mental and behavioral health and minority stress; all completed measures of psychological distress, depression, anxiety, suicidal thoughts, alcohol use, and HIV-transmission-risk behavior at baseline and 4 and 8 months post-baseline; 20 LGBTQ-affirmative ICBT participants completed a qualitative interview regarding intervention acceptability. Results Participants randomized to LGBTQ-affirmative ICBT completed, on average, 6.08 (SD = 3.80) sessions. Participants reported that LGBTQ-affirmative ICBT was helpful and engaging and provided suggestions for enhancing engagement. Although most outcomes decreased over time, between-group comparisons were small and non-significant. LGBTQ-affirmative ICBT was more efficacious in…

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A recent US randomized controlled trial with sexual minority young adults found small, non-significant effects for LGBTQ-affirmative ICBT compared with assessment-only control, but larger and statistically significant comparative effects for participants in US locales with high normative anti-LGBTQ bias.
“In further support of this possibility, although a recent randomized controlled trial with sexual minority young adults across the US found small, non-significant effects for LGBTQ-affirmative ICBT compared to an assessment-only control, LGBTQ-affirmative ICBT’s comparative effects were larger and statistically significant for participants living in US locales with high degrees of normative anti-L”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Pachankis et al., 2023
When interventions are adapted to address the distinct needs of the stigmatized, emerging evidence suggests they are more efficacious under high structural stigma than under low structural stigma.
“however, when interventions are adapted to address the distinct needs of the stigmatized, some emerging evidence suggests an opposite effect – under conditions of high structural stigma, these adapted interventions are actually more efficacious than under conditions of low structural stigma (Pachankis et al., 2023).”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Pachankis et al., 2023
The rate of engagement in the ICBT condition was slightly higher than a similar US trial but lower than other studies of ICBT.
“This rate of engagement was slightly higher than a similar trial in the US (Pachankis et al., 2023), but lower than other studies of ICBT (Andrews et al., 2018).”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Pachankis et al., 2023
The present effect sizes for depression, anxiety, and alcohol use problems were much larger than those in the most similar previous US trial of LGBTQ-affirmative ICBT, which found no significantly greater improvement for these outcomes compared to assessment-only.
“However, the present effect sizes were much larger than those found in the most similar previous study of LGBTQ-affirmative ICBT delivered in the US using the same delivery platform, research design, and control condition. In that study, LGBTQ-affirmative ICBT yielded no significantly greater improvement in depression or anxiety symptoms or alcohol use problems compared to the assessment-only”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Pachankis et al., 2023
Treatment engagement did not significantly moderate the primary outcome of HIV-transmission-risk behavior, nor depression and anxiety, which was inconsistent with a similar US study.
“Treatment engagement did not yield significant moderating effects in the primary outcome of HIV-transmission-risk behavior, nor in depression and anxiety, which was inconsistent with a similar study in the U.S. (Pachankis et al., 2023).”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Pachankis et al., 2023

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Affirmative Cognitive Behavioral Therapy
Craig, D. S. L. (2026) · doi:10.1093/9780197778654.003.0001
Preface
Craig, D. S. L. (2026) · doi:10.1093/9780197778654.002.0006
Working With Specific Populations and Clinical Modalities
Austin, D. A., Yang, D. W., & Craig, D. S. L. (2026) · doi:10.1093/9780197778654.003.0004
Troubleshooting Common Clinical Challenges
Craig, S. L. (2026) · doi:10.1093/9780197778654.003.0005
Series Foreword
Muroff, J. R. (2026) · doi:10.1093/9780197778654.002.0005
Core Affirmative CBT Content and Clinical Strategies
Pascoe, R. V., Hui, D. J., & Craig, S. L. (2026) · doi:10.1093/9780197778654.003.0003
List of Figures and Tables
Craig, D. S. L. (2026) · doi:10.1093/9780197778654.002.0007
Affirmative CBT
Craig, D. S. L. (2026) · doi:10.1093/9780197778654.003.0002
The Nuts and Bolts of Affirmative CBT with Sexual and Gender Diverse Populations
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Authors: Pachankis, J. E., Soulliard, Z. A., Layland, E. K., Behari, K., Seager van Dyk, I., Eisenstadt, B. E., Chiaramonte, D., Ljótsson, B., Särnholm, J., & Bjureberg, J.
Affiliations: Yale University (US)
Karolinska Institutet (SE)
Region Stockholm (SE)
Corresponding author: Pachankis, John E.
ORCID: Pachankis, John E.
Soulliard, Zachary A.
Layland, Eric K.
Behari, Kriti
Eisenstadt, Benjamin E.
Chiaramonte, Danielle
Ljótsson, Brjánn
Särnholm, Josefin
Bjureberg, Johan
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2023-10
Volume: 169
Pages: 104403
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2023.104403
PMC: PMC10601985
OpenAlex: W4386570692
Cited by: 59
References: 83
Citations by year: 2026: 26 · 2025: 19 · 2024: 13 · 2023: 1
FWCI: 17.43
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 349 d)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: Behaviour Research and Therapy (acceptedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (T32MH020031, R01MH109413)
Topics: Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: internet-based cognitive behavioral therapy, sexual minority youth, minority stress, depression, anxiety, suicidal ideation, alcohol consumption, HIV transmission risk behavior, stigma, treatment acceptability, feasibility, psychological distress
MeSH terms: Sexual and Gender Minorities, Adolescent, Adult, Anxiety Disorders, Female, Humans, Male, Mental Health, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Internet, Young Adult

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Guided LGBTQ-affirmative internet cognitive-behavioral therapy for sexual minority youth's mental health: A randomized controlled trial of a minority stress treatment approach

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