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Cited by 619LGBTQ Health, Identity, and PolicyAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesHIV/AIDS Research and Interventions

LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach

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Pachankis, John E., Hatzenbuehler, Mark L., Rendina, H. Jonathon, Safren, Steven A., Parsons, Jeffrey T.·2015·Journal of Consulting and Clinical Psychology
DOI 10.1037/ccp0000037PMC PMC4573250
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Abstract

OBJECTIVES: We tested the preliminary efficacy of a transdiagnostic cognitive-behavioral treatment adapted to improve depression, anxiety, and co-occurring health risks (i.e., alcohol use, sexual compulsivity, condomless sex) among young adult gay and bisexual men. Treatment adaptations focused on reducing minority stress processes that underlie sexual orientation-related mental health disparities. METHOD: Young gay and bisexual men (n = 63; M age = 25.94) were randomized to immediate treatment or a 3-month waitlist. At baseline, 3-month, and 6-month assessments, participants completed self-reports of mental health and minority stress and an interview of past-90-day risk behavior. RESULTS: Compared to waitlist, treatment significantly reduced depressive symptoms (b = -2.43, 95% CI: -4.90, 0.35, p < .001), alcohol use problems (b = -3.79, 95% CI: -5.94, -1.64, p < .001), sexual compulsivity (b = -5.09, 95% CI: -8.78, -1.40, p < .001), and past-90-day condomless sex with casual partners (b = -1.09, 95% CI: -1.80, -0.37, p < .001), and improved condom use self-efficacy (b = 10.08, 95% CI: 3.86, 16.30, p < .001). The treatment yielded moderate and marginally significant greater improvements than waitlist in anxiety symptoms (b = -2.14, 95% CI: -4.61, 0.34, p = .09) and past-90-day heavy drinking (b = -0.32, 95% CI: -0.71, 0.07, p = .09). Effects were generally maintained at follow-up. Minority stress processes showed small improvements in the expected direction. CONCLUSION: This study demonstrated preliminary support for the first intervention adapted to address gay and bisexual men's co-occurring health problems at their source in minority stress. If found to be efficacious compared to standard evidence-based treatments, the treatment will possess substantial potential for helping clinicians translate LGB-affirmative treatment guidelines into evidence-based practice. (PsycINFO Database Record

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  • Condomless anal sex was assessed over the past 30 days rather than a longer period to reduce retrospective recall bias, but this may have limited variability in HIV-transmission-risk acts.

    “condomless anal sex was assessed across the past 30 days rather than over a longer period (Pachankis, Hatzenbuehler, et al., 2015) so as to guard against retrospective recall bias introduced by reporting across longer periods. Yet, this decision might have limited variability in HIV-transmission-risk acts.”

    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, Hatzenbuehler, et al., 2015

    The Method section (Primary Outcome Measures) says condomless anal sex was assessed over the past 90 days, not 30 days. The Analytic plan likewise describes the outcome as a past-90-day count. The cited paper therefore contradicts the assessment period attributed to it. (LLM, conf=0.92)

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  • Pachankis identified "overarching treatment principles" stemming from the minority stress model, which have been successfully used in interventions designed to address syndemic conditions experienced by gay and bisexual men and alcohol misuse among sexual minority women.

    “Pachankis [33] identified “overarching treatment principles” stemming from the minority stress model, which have been successfully used in interventions designed to address syndemic conditions experienced by gay and bisexual men and alcohol misuse among sexual minority women [34,35].”

    From Minority stress theory: Application, critique, and continued relevance (2023) · cites this paper as [35]

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  • Only one randomized controlled trial has been conducted with sexual minority young people to test a CBT-based intervention targeting mental health outcomes-ESTEEM.

    “To the authors’ knowledge, only one randomized controlled trial has been conducted with sexual minority young people to test a CBT-based intervention targeting mental health outcomes—ESTEEM (Effective Skills to Empower Effective Men) [31,32,33].”

    From Findings from a feasibility study of an adapted cognitive behavioral therapy group intervention to reduce depression among lgbtq (Lesbian, gay, bisexual, transgender, or queer) young people (2019) · cites this paper as [33]

    The Method (Procedure; page unavailable) reports that 63 participants were randomized, and the Discussion describes ESTEEM as a CBT-based treatment that improved depressive symptoms in young gay and bisexual men. This identifies the cited study as a trial of the kind described, but the paper does not establish that it was the only such trial among all sexual minority young people. (LLM, conf=0.82)

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  • Treatment effects for mental and behavioral problems, minority stress, and universal risk factors were in the expected direction and consistent with previous research on LGBTQ-affirmative CBT and psychosocial interventions for sexual minority individuals.

    “Overall, treatment effects for mental and behavioral problems and minority stress and universal risk factors were in the expected direction and consistent with previous research on LGBTQ-affirmative CBT specifically (Craig, Eaton, et al., 2021; Pachankis, Hatzenbuehler, et al., 2015; Pachankis, McConocha, et al., 2020) and psychosocial interventions focused on sexual minority individuals’ co-occur”

    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, Hatzenbuehler, et al., 2015

  • The tailoring process incorporated suggestions from the literature where comparable interventions have been successfully tested with the LGBTQ+ community.

    “We have also incorporated other suggestions from the literature [25,26], where comparable interventions have been successfully tested with the LGBTQ+ community.”

    From An Internet-Based Intervention to Increase the Ability of Lesbian, Gay, and Bisexual People to Cope With Adverse Events: Single-Group Feasibility Study (2024) · cites this paper as [26]

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Research works printed but not linked: 3

  1. Herbst JH Sherba RT Crepaz N DeLuca JB Zohrabyan L Stall RD HIV/AIDS Prevention Research Synthesis Team 2005 A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men Journal of Acquired Immune Deficiency Syndromes 39 2 228 241 15905741
  2. Operario D Yang MF Reisner SL Iwamoto M Nemoto T 2014 Stigma and the syndemic of HIV-related health risk behaviors in a diverse sample of transgender women Journal of Community Psychology 42 5 544 557
  3. Sobell LC Sobell MB 1992 Timeline Follow–back: A technique for assessing self– reported alcohol consumption Litten RZ Allen JP Measuring Alcohol Consumption: Psychosocial and Biological Methods Totowa, NJ Humana Press

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Related

Authors
Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T.
Affiliations
  • Yale University (US)
  • Columbia University (US)
  • Harvard University (US)
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2015-10
Volume
83
Issue
5
Pages
875-889
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/ccp0000037
PMC
PMC4573250
OpenAlex
W2274662974
Cited by
619
References
67
Citations by year
2026: 41 · 2025: 54 · 2024: 66 · 2023: 56 · 2022: 87 · 2021: 60 · 2020: 67 · 2019: 70 · 2018: 45 · 2017: 45 · 2016: 22 · 2015: 6
FWCI
64.36
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R34-MH096607, K24 MH094214)
Topics
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
minority stress, gay and bisexual men, young men, depression, anxiety, alcohol consumption, compulsive sexual behavior, unprotected sex, condom use self-efficacy, transdiagnostic treatment, cognitive behavioral therapy, health risk behaviors, treatment efficacy, waitlist control, sexual minority mental health
MeSH terms
Adolescent, Adult, Mental Disorders, Bisexuality, Follow-Up Studies, Humans, Male, Minority Groups, Risk-Taking, Stress, Psychological, Cognitive Behavioral Therapy, Treatment Outcome, Homosexuality, Male, Young Adult, Self Report

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