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Cited by 88LGBTQ Health, Identity, and PolicyOptimism, Hope, and Well-beingChild and Adolescent Psychosocial and Emotional Development

Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada

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Craig, Shelley L., Eaton, Andrew D., Leung, Vivian W. Y., Iacono, Gio, Pang, Nelson, Dillon, Frank, Austin, Ashley, Pascoe, Rachael +1 more·2021·BMC Psychology
DOI 10.1186/s40359-021-00595-6PMC PMC8183324
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Abstract

Objective: This study tested the efficacy of AFFIRM, a brief affirmative cognitive-behavioural group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY). Method: SGMY ( n = 138; M age = 22.44) were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organisations or an 8-week waitlisted control. At baseline, post-intervention or post-waitlist, participants completed self-reported assessments of depression, hope, coping, and stress appraisal. Implementation outcomes of feasibility and acceptability were also assessed. Results: Compared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms ( b = − 5.79, p = .001) as well as increased reports of hope (agency: b = 0.84, p = .001; pathway: b = 0.79, p = .001), and coping by emotional support ( b = 0.59, p < .001), instrumental support ( b = 0.67, p < .001), positive framing ( b = 0.59, p < .001), humour ( b = 0.36, p = .014), planning ( b = 0.49, p < .001) as well as reflective coping ( b = 0.27, p = .009). Intervention participants were also less likely to perceive stress as a threat ( b = − 0.43, p = .001), and more likely to perceive stress as challenge ( b = 0.67, p < .001) and have the resources to deal with that stress ( b = 0.38, p = .016) in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition (8.5%) and high levels of engagement and acceptability (e.g. 99% agreed intervention was relevant to their lives). Over 63% of the community organizations that participated in the training hosted AFFIRM at least once during the study. Conclusions: Results demonstrate efficacy for the community-based implementation of an affirmative clinical intervention designed for SGMY to address depression and foster coping with universal and minority stressors.

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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 Craig, Eaton, et al., 2021

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Micro-skill intervention research is lacking in areas of transgender- and gender-minority-specific care.

    “Micro-skill intervention research is lacking in areas of transgender- and gender-minority-specific care.”

    From Proposed Self-as-Context Interventions for Gender Minority Clients (2025) · cites this paper as Craig et al., 2021

    The Affirmative cognitive behavioural therapy section says AFFIRM was developed to address a lack of evidence-informed programs tailored to sexual and gender minority youths’ mental health needs. That supports a general intervention-research gap, but the paper does not identify a lack of micro-skill research specifically in transgender- and gender-minority-specific care (searched: micro-skills and gender-minority-specific interventions). (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Studies indicate a possible need for conceptualizing gender dysphoria's role in ruminative patterns of anxiety and depression.

    “Although studies show the possible need for tailored interventions and conceptualization of gender dysphoria’s role in ruminative patterns of anxiety and depression, specific interventions are sparse (Craig et al., 2021; Skinta, 2020).”

    From Proposed Self-as-Context Interventions for Gender Minority Clients (2025) · cites this paper as Craig et al., 2021

    The Discussion calls for tailored interventions, and the Present study section describes a dearth of research on affirmative CBT in community settings. Neither passage addresses gender dysphoria’s role in ruminative patterns of anxiety and depression, so the claim’s specific conceptual point is not supported by this paper. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • AFFIRM is tailored to LGBTQIA+ identifying youth overall and lacks specific intervention tools aimed at reducing distress in transgender and other gender-minority identifying individuals.

    “AFFIRM is tailored to LGBTQIA+ identifying youth overall and lacks specific intervention tools aimed at reducing distress in transgender and other gender-minority identifying individuals.”

    From Proposed Self-as-Context Interventions for Gender Minority Clients (2025) · cites this paper as Craig et al., 2021

    The Affirmative cognitive behavioural therapy section (page unavailable) describes AFFIRM as designed for a range of sexual and gender minority youth, supporting the first part of the claim. It does not say that AFFIRM lacks tools specific to transgender or other gender-minority youth; indeed, it describes strategies for challenging stigmatising messages and explicitly gives transphobia as an example. The claim about what the intervention lacks is therefore not established by this paper. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • LGBTQ-affirmative ICBT demonstrated comparatively greater improvements in emotion dysregulation, extending previous intervention research on LGBTQ-affirmative CBT mechanisms and consistent with its theoretical basis.

    “LGBTQ-affirmative ICBT also demonstrated comparatively greater improvements in emotion dysregulation. This finding extends the relatively scant previous intervention research that has examined the efficacy of LGBTQ-affirmative CBT on potential intervention mechanisms, in which factors such as hope and optimism have been found to be impacted (Craig, Eaton, et al., 2021; Craig, Leung, et al., 2021).”

    From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Craig, Eaton, et al., 2021

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Authors
Craig, S. L., Eaton, A. D., Leung, V. W. Y., Iacono, G., Pang, N., Dillon, F., Austin, A., Pascoe, R., & Dobinson, C.
Affiliations
  • University of Toronto (CA)
  • University of Regina (CA)
  • University of Connecticut (US)
  • Arizona State University (US)
  • Barry University (US)
  • Planned Parenthood Toronto (CA)
Corresponding author
Craig, Shelley L.
ORCID
Venue
BMC Psychology
Publisher
Springer Science and Business Media LLC
Published
2021-06-07
Volume
9
Issue
1
Pages
94-94
ISSN
2050-7283 (ISSN-L)
DOI
10.1186/s40359-021-00595-6
PMC
PMC8183324
OpenAlex
W3172568062
Cited by
88
References
18
Citations by year
2026: 11 · 2025: 24 · 2024: 22 · 2023: 18 · 2022: 9 · 2021: 4
FWCI
12.98
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • oURspace (University of Regina) (submittedVersion, cc-by)
Funders
  • Public Health Agency of Canada (#1718-HQ-000697, PHAC #1718-HQ-000697)
  • Ontario HIV Treatment Network
  • Public Health Agency
  • Social Sciences and Humanities Research Council of Canada (895-2018-1000, SSHRC #895-2018-1000)
Topics
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
  • Social Sciences › Psychology › Applied Psychology › Optimism, Hope, and Well-being
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
sexual and gender minority youth, adolescents and young adults, depression, hope, coping, stress appraisal, minority stress, community-based implementation, treatment acceptability
MeSH terms
Sexual and Gender Minorities, Adolescent, Adult, Cognition, Humans, Ontario, Psychotherapy, Group, Cognitive Behavioral Therapy, Young Adult

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