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An AFFIRMative Cognitive Behavioral Intervention for Transgender Youth: Preliminary Effectiveness

November 2017
Professional Psychology Research and Practice 49(1)

DOI:10.1037/pro0000154

Authors:

Ashley Austin

Barry University

Shelley L Craig

University of Toronto

Sandra A. D'Souza

University of Toronto

Authentically expressing and navigating a transgender or gender nonconforming identity during adolescence can be a difficult and painful process. Using a transgender affirmative approach to clinical practice, psychologists and other mental health professionals can play a key role in supporting youth through this process. To date, there is a paucity of research exploring the impact of transgender affirmative interventions on well-being. The primary objective of this article is to present the results of a pilot study exploring the preliminary effectiveness and acceptability of AFFIRM, an affirmative cognitive–behavioral coping skills group intervention with transgender youth. This article will also describe transgender-specific considerations for delivering transgender affirmative interventions. The transgender subsample (N = 8) of participants in the study were between the ages of 16 and 18 and represented a diversity of intersecting racial/ethnic, sexual, and gender identities. Results indicate that AFFIRM was effective in significantly decreasing depression scores, and changes persisted through the 3-month follow-up. While changes in coping were not statistically significant, scores trended in a positive direction. Data indicate favorable responses to AFFIRM among transgender participants across a variety of dimensions of satisfaction. While findings are preliminary, they are promising, addressing a critical gap in intervention research aimed at decreasing depression and improving coping among transgender youth. Future controlled studies are needed to explore the efficacy of AFFIRM with larger samples of transgender youth.

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An AFFIRMative Cognitive Behavioral Intervention for Transgender

Youth: Preliminary Effectiveness

Ashley Austin, Shelley L. Craig, and Sandra A. D’Souza

Barry University School of Social Work

Authentically expressing and navigating a transgender or gender nonconforming identity during adoles-

cence can be a difficult and painful process. Using a transgender affirmative approach to clinical practice,

psychologists and other mental health professionals can play a key role in supporting youth through this

process. To date, there is a paucity of research exploring the impact of transgender affirmative

interventions on well-being. The primary objective of this article is to present the results of a pilot study

exploring the preliminary effectiveness and acceptability of AFFIRM, an affirmative cognitive–

behavioral coping skills group intervention with transgender youth. This article will also describe

transgender-specific considerations for delivering transgender affirmative interventions. The transgender

subsample (N⫽8) of participants in the study were between the ages of 16 and 18 and represented a

diversity of intersecting racial/ethnic, sexual, and gender identities. Results indicate that AFFIRM was

effective in significantly decreasing depression scores, and changes persisted through the 3-month

follow-up. While changes in coping were not statistically significant, scores trended in a positive

direction. Data indicate favorable responses to AFFIRM among transgender participants across a variety

of dimensions of satisfaction. While findings are preliminary, they are promising, addressing a critical

gap in intervention research aimed at decreasing depression and improving coping among transgender

youth. Future controlled studies are needed to explore the efficacy of AFFIRM with larger samples of

transgender youth.

Public Significance Statement

Our study examined the preliminary effectiveness of AFFIRM, an affirmative coping skills inter-

vention for transgender youth. Results indicate that transgender participants were highly satisfied

with the AFFIRM intervention and that it reduced their depression. Given the elevated risk of

depression, distress and suicide among transgender youth, the AFFIRM program holds promise for

improving well-being.

Keywords: affirmative, transgender, cognitive behavior therapy, outcomes

Over the last decade, mental and behavioral health researchers

and clinicians began to pay increasing attention to the mental

health care needs and experiences of transgender and gender

nonconforming youth populations. Transgender is an inclusive

term used to refer to individuals whose gender identity is not

consistent with social and cultural gender expectations associated

This article was published Online First November 30, 2017.

ASHLEY AUSTIN received her MSW and PhD in Social Welfare from

Florida International University. She is currently an Associate Professor at

Barry University School of Social Work and Distinguished Professor for

the Center for Human Rights and Social Justice. Her research and clinical

practice interests revolve around advancing well-being among transgender

and gender diverse individuals, with particular emphasis on the develop-

ment, testing and dissemination of affirmative practice approaches for the

transgender community.

SHELLEY L. CRAIG received her PhD in Social Welfare from Florida

International University. She is currently the Associate Dean, Academic

and an Associate Professor at the Factor-Inwentash Faculty of Social Work

at the University of Toronto and the Canada Research Chair in Sexual and

Gender Minority Youth (SGMY). Her areas of research and professional

interest include sexual and gender minorities, cognitive– behavioral ther-

apy, information and communication technologies, clinical practice and

implementation science.

SANDRA A. D’SOUZA received her HBSc in human biology and health

studies from the University of Toronto Scarborough. She is currently a

Master of Public Health Student at the Dalla Lana School of Public Health

at the University of Toronto, specializing in Social and Behavioural Health

Sciences (Health Promotion). Her areas of professional interest include

public health policy, health equity, youth engagement, and social determi-

nants of health.

THE AUTHORS WOULD LIKE TO THANK the transgender youth who partic-

ipated in AFFIRM and whose authenticity, courage, insight, and feedback

will continue to guide our work. We would also like to acknowledge the

efforts of the diligent and committed members of the AFFIRM research

and clinical team.

CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to

Ashley Austin, Barry University School of Social Work, 11300

NE 2nd Avenue, Miami Shores, FL 33161. E-mail: aaustin@barry

.edu

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

2018, Vol. 49, No. 1, 1–8 0735-7028/18/$12.00 http://dx.doi.org/10.1037/pro0000154

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