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Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation
Abstract
Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.
... Previous literature highlighted a considerable number of proper therapies for improving mental health among LGBTQ individuals. Among these therapies, some of the most common are related to cognitive-behavioral therapy (Ross et al., 2007), LGBTQaffirmative cognitive -behavioral therapy (Craig et al., 2013), creative arts therapy (Pelton-Sweet & Sherry, 2008), expressive writing therapy (Pachankis & Goldfried, 2010), attachment-based family therapy (Diamond et al., 2013), and positive psychologybased interventions (Lytle et al., 2014). ...
... Based on this approach, specific CBT therapies were developed for gay (Craig et al., 2013) and transgender (Austin & Craig, 2015) individuals. It was suggested that gay and transgender individuals who are exposed to homophobic and transphobic attitudes might develop negative cognitions about themselves which can lead to lower self-esteem, anxiety, and depression (Budge et al., 2010;Kidd et al., 2011). ...
... It was suggested that gay and transgender individuals who are exposed to homophobic and transphobic attitudes might develop negative cognitions about themselves which can lead to lower self-esteem, anxiety, and depression (Budge et al., 2010;Kidd et al., 2011). For instance, using the Affirmative Cognitive -Behavioral Therapy (ACBT; Austin & Craig, 2015;Craig et al., 2013), which generally comprises eight sessions, gay and transgender individuals under the effect of negative attitudes and behaviors on their well-being, and learn how thoughts influences emotions, subsequently developing alternative thinking. Moreover, ACBT helps clients to affirm their sexual orientation and gender non-conformity, enabling them to accept and integrate their identity. ...
Previous studies concerning LGBTQ individuals' experiences found significant challenges, including discrimination, prejudice, and violence. Given these experiences, researchers are preoccupied with the examination of the potential adverse effects on the physical and mental health of LGBTQ individuals and the effective strategies to reduce these negative outcomes. In this short narrative review, we discuss some of the specific interventions aimed to improve the mental health of LGBTQ individuals, especially among the youth. More specifically, we discuss the theoretical framework and empirical evidence related to LGBTQ-Affirmative Cognitive-Behavioral Therapy, Creative Writing and Expressive Wiring Therapy, Attachment-based Family Therapy, and LGBTQ Relationally-based Positive Psychology.
... This helps with distinguishing problems that arise from the environment (i.e. society) and those that may stem from dysfunctional beliefs (Craig et al., 2013). It presents an opportunity for clinicians to provide psychoeducation to acknowledge and support service users in understanding that their experience is a normal response to minority stress and explore their views on systemic oppression (Pachankis et al., 2022b). ...
Previous research that explored sexual minority service users’ experiences of accessing NHS Talking Therapies for Anxiety and Depression Services highlighted the need for specific sexual orientation training. Inconsistent or lack of training may contribute to disparities in treatment outcomes between sexual minority service users and heterosexual service users. The aim of the study was to explore clinicians’ competencies working with sexual minority service users, their experiences of sexual orientation training, their view of current gaps in training provision, and ways to improve training. Self-reported sexual orientation competency scales and open-ended questions were used to address the aims of the study. Participants ( n =83) included Psychological Wellbeing Practitioners (PWPs) and high-intensity CBT therapists (HITs). Responses on competency scales were analysed using Kruskal–Wallis tests and thematic analysis was used to analyse qualitative responses. Participants who identified as 25–29 years old had higher scores on the knowledge scale than 45+-year-olds. Bisexual participants also had higher scores on the knowledge subscale than heterosexual participants. Three over-arching themes were identified: (a) training received on sexual minority issues by Talking Therapies clinicians, (b) clinicians’ experiences of accessing and receiving sexual minority training, and (c) perceived gaps in current sexual minority training and ways to improve training. Findings were linked to previous literature and recommendations to stakeholders are made throughout the Discussion section with the view of improving sexual orientation training.
Key learning aims
(1) To understand current training provision of sexual orientation training across NHS Talking Therapies courses and services in England.
(2) To consider clinicians’ experiences of challenges and barriers that may prevent them from accessing or implementing sexual orientation training in clinical practice.
(3) To understand clinicians’ views of the current gaps in training and ways to improve training provision.
(4) To make recommendations to NHS Talking Therapies for Anxiety and Depression courses and services in ways to improve training on sexual orientation to better meet the learning needs of clinicians and service users.
... Gender-affirming psychological therapies integrate processes related to the biopsychosocial model and the management of sources of stress that historically can affect the quality of life of transgender patients. These perspectives assume that gender expression is problematic when it takes place outside of standardized social patterns, leaving aside the strengthening of the group and individual relational networks that favor care Austin et al., 2018;Budge et al., 2021;Craig et al., 2013;Edwards-Leepper et al., 2016;Israel et al., 2021;Knutson et al., 2021;Matsuno, 2019;Oransky et al., 2019;Strauss et al., 2019;Walton & Baker, 2019). ...
... Gender-affirming psychological therapies integrate processes related to the biopsychosocial model and the management of sources of stress that historically can affect the quality of life of transgender patients. These perspectives assume that gender expression is problematic when it takes place outside of standardized social patterns, leaving aside the strengthening of the group and individual relational networks that favor care Austin et al., 2018;Budge et al., 2021;Craig et al., 2013;Edwards-Leepper et al., 2016;Israel et al., 2021;Knutson et al., 2021;Matsuno, 2019;Oransky et al., 2019;Strauss et al., 2019;Walton & Baker, 2019). ...
A Latinx LGBTIQ+ affirmative psychological interventions overview is presented. An analysis of the chapters and a discussion of their contributions will be oriented to understand a located Latinx perspective in psychological LGBTQ+ affirmative interventions.KeywordsLatinxLGBTQ+Affirmative interventionsLatin AmericaUnited States
... Gender-affirming psychological therapies integrate processes related to the biopsychosocial model and the management of sources of stress that historically can affect the quality of life of transgender patients. These perspectives assume that gender expression is problematic when it takes place outside of standardized social patterns, leaving aside the strengthening of the group and individual relational networks that favor care (Austin et al., 2017;Austin et al., 2018;Budge et al., 2021;Craig et al., 2013;Edwards-Leepper et al., 2016;Israel et al., 2021;Knutson et al., 2021;Matsuno, 2019;Oransky et al., 2019;Strauss et al., 2019;Walton & Baker, 2019). ...
This chapter explains how the tensions between the classifications derived from sex and the multidimensional character of gender have an impact on the conceptions and understandings of “sexual identity” and “gender identity” and its impact on social experiences related to the rejection and reaffirmation of identity in the case of women with trans life experiences. It also describes experiences of gender identity awareness and self-determination from the perspective of the trans women participating in the study. Methods: Narrative study conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups developed between June 2019 and March 2020. Data were analyzed using thematic analysis at Atlas Ti cloud program and Consensual Qualitative Research. Results: The women’s narratives account for some thematic categories regarding: (a) Socio-cultural aspects in the construction and expression of gender identities, (b) Tension between sexual and gender, (c) Awareness and self-determination of identity, and (d) Affirmative pathways and recognition. It reveals socio-cultural aspects in the construction and expression of gender identities corresponding to the hegemonic cis-patriarchal system present in Colombia. Conclusions: Approaches are required to weave in other intersubjective complexities regarding sexual and gender identities in particular contexts, and that urgently allow for the construction of affirmative processes and recognition that expand traditional and hegemonic categories, including language and socio-cultural practices, such as affirmative language, for example, asking and using appropriate pronouns. In the life experiences of the participants, sexual and gender identities are constitutive of human and social processes aimed at possible coexistence. These processes respond to forms of classification consistent with the cis-hetero patriarchal system. As far as this study is concerned, the socio-cultural dimension of the construction of gender identities is the one that alludes to “the disciplining of bodies” based on social practices related to beauty, health, and the binary references of femininity and masculinity.KeywordsRejectionTransgenderGender identityGender equity
The acronym ‘LGBTQ+’ collapses gender and sexuality diversity, at the same time as it treats these as mutually exclusive categories. The collapsing of gender and sexuality often means that trans people are overlooked, while the treatment of gender and sexuality as mutually exclusive often means that trans people’s sexualities are ignored. This chapter explores what it means to work with sexuality diverse trans people in the context of therapeutic practice.
INTRODUÇÃO: A histórica estigmatização e marginalização da população LGBTQIA+, produzida e reproduzida socialmente, deixa esta população mais suscetível ao sofrimento psíquico e ao desenvolvimento de transtornos mentais, OBJETIVO: Nesse sentido, toma-se como objetivo discutir as possibilidades da Psicologia Afirmativa para a redução do sofrimento psíquico da população LGBTQIA+. MÉTODOS: Trata-se de uma revisão narrativa da literatura. RESULTADOS: Os estudos relatam sobre as contribuições da Psicologia Afirmativa aos atendimentos da população LGBTQIA+. CONCLUSÃO: É fundamental que a população LGBTQIA+ receba atendimento integral, humanizado e que respeite as suas particularidades e necessidades. Para isso, faz-se necessário o reconhecimento da sociedade enquanto produtora e disparadora do sofrimento psíquico desta população. A Psicologia Afirmativa possui um importante papel neste sentido. Palavras-chave: LGBTQIA+, Psicologia Afirmativa, Saúde Mental.
Objective: Adolescents and young adults are at risk for non-suicidal self-injury (NSSI) and suicidal behavior. This study examined intrapersonal (depressive symptoms, self-criticism) and family (perceived family functioning, parenting style, parental attachment) factors associated with reported history of NSSI in a college sample. Method: Participants included 111 undergraduate students (Mage = 20.2) from a private, nonprofit university. Data were collected via online survey. Hierarchical logistic regression analysis was conducted. Results: The final model was statically significant, Nagelkerke R2 = .40, suggesting a robust association between the predictors and history of NSSI. Self-criticism and unhealthy family functioning were significant predictors of NSSI behaviors after controlling for study variables and demographic characteristics. Reported history of engaging in NSSI was positively correlated with parent alienation, unhealthy family functioning, self-criticizing behaviors, and depressive symptoms. Conclusion: College mental health providers should be familiar with risk factors of NSSI as well as strategies to address self-criticism.
Introduction
Sexual and gender minority young people (SGMY) experience mental health disparities and are overlooked in mental health practice and research. Self-compassion is a protective factor that promotes youth psychological well-being. This study examines SGMY perceptions of self-compassion and their experiences participating in self-compassion practices.
Methods
SGMY (n = 30) ages 16–29 participated in empirically supported self-compassion practices. Using grounded theory, researchers uncovered three themes.
Results
SGMY indicated that (1) the practice of self-compassion may help SGMY cope with internal/external homo/bi/transphobia, (2) cultivating self-compassion can enhance well-being, and (3) self-compassion can support coping with difficult thoughts and emotions.
Conclusion
Self-compassion may be a helpful approach for SGMY. Implications for SGMY mental health are explored.
The first British textbook for therapists to address working with LGB cllients
Abstract
Background: Lesbian, gay and bisexual (LGB) people may be at higher risk of mental
disorders than heterosexual people.
Method: We conducted a systematic review and meta-analysis of the prevalence of mental
disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people.
We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of
Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography
of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature
databases for articles published January 1966 to April 2005. We also used Google and Google
Scholar and contacted authors where necessary. We searched all terms related to homosexual,
lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate
self harm. We included papers on population based studies which contained concurrent
heterosexual comparison groups and valid definition of sexual orientation and mental health
outcomes
Results: Of 13706 papers identified, 476 were initially selected and 28 (25 studies) met
inclusion criteria. Only one study met all our four quality criteria and seven met three of these
criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people.
Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual
people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and
anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5
times higher in lesbian, gay and bisexual people (RR range 1.54-2.58) and alcohol and other
substance dependence over 12 months was also 1.5 times higher (RR range 1.51-4.00).
Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women
were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61;
drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97-5.92),
while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR
4.28, CI 2.32, 7.88).
Conclusions: LGB people are at higher risk of mental disorder, suicidal ideation, substance
misuse, and deliberate self harm than heterosexual people.
In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
Cognitive variables that predict favorable treatment outcomes in adolescents with depression include higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions at baseline. 10,14,22 In an analysis of TADS data, cognitive distortions at baseline were also shown to moderate the effects of combined CBT and fluoxetine, such that adolescents with high levels of cognitive distortion were more likely to experience incremental benefits from CBT as part of combination treatment. 31 In an analysis of the Brent study, hopelessness was found to mediate the predictive effects of referral source on outcome across 3 types of psychotherapy. 14 The only variables that have been found to mediate the results of CBT specifically are negative automatic thoughts, and in a small subclinical sample, dysfunctional attitudes, which suggests that a reduction in these variables may be important mechanisms of change in CBT. 17,23 Mediational analyses have not yet been conducted on the TADS data, which precludes conclusions about the mechanisms of change in pharmacological and combination treatments. Further research is needed to uncover the specific strategies used in therapy that reframe negative cognition, modify dysfunctional beliefs, and improve depressive symptoms.
There is a need for gay and lesbian affirmative psychotherapy in a society in which gay men and lesbians endure prejudice and discrimination. Using a phenomenological model informed by feminist methodology, this study investigated the gay male client's experience of gay affirmative therapy. The participants shared their experiences in in-depth interviews. Phenomenological analysis revealed certain therapist qualities which were experienced as affirmative. Findings showed that with sensitivity, imagination, and experience, the heterosexual therapist can be gay affirmative; the gay therapist may more readily serve as a role model. Results are compared with other research, and recommendations are offered for future inquiry.
Client self-determination may be the most confounding concept in the intellectual underpinnings of social work. While self-determination is accorded utmost esteem in the profession, its meaning and application are clouded. A number of existing justifications for self-determination concepts are outlined. However, serious questions have been raised concerning the primacy and efficacy of the self-determination principle from a number of sources. This critique covers four general areas: limitations in client capacity to make choices, external restraints that inhibit choice, other values that may have primacy, and other professional considerations that influence practice behavior. An alternative conceptual perspective is proposed.
Research has demonstrated that rates of depression are elevated among lesbian, gay, bisexual and transsexual (LGBT) people as a result of social stigmatization. However, few studies have investigated interventions which address the proposed causes of depression for LGBT people (i.e., internalized and external oppression). This study tested a cognitive behavioural therapy-based group intervention for LGBT people living with depression, which was delivered based on anti-oppression principles and included sessions on coming out and internalized homophobia. Participants demonstrated statistically significant reductions in symptoms of depression, and statistically significant increases in self-esteem, following the intervention. Implications for service delivery to LGBT people are discussed.