Table 3. Interventions, Adaptations, and Results.
| Study | Interventions | Any LGBTQ+-specific adaptations | Relevant outcomes (complete names and references in Tudor-Sfetea & Topciu, 2024S, Appendix I) | Relevant analyses; Number of participants included therein | Relevant results summary |
|---|---|---|---|---|---|
| 1 - Pachankis et al. (2015) | CBT: ESTEEM intervention - 10 individually-delivered sessions, based on Barlow et al.’s Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders | Yes - focus on the impact of minority stress on mental health, interpersonal functioning, unhelpful behaviours; aim of improving minority stress coping through emotion regulation, cognitive restructuring, assertiveness training | Center for Epidemiological Studies Depression Scale (CESD); Overall Depression Severity & Impairment Scale (ODSIS); Overall Anxiety Severity & Impairment Scale (OASIS); Measure of Gay-Related Stress (MOGS); Gay-related Rejection Sensitivity Scale (GRS); Internalized Homophobia Scale (IHS); Sexual Orientation Concealment Scale (SOCS); Ruminative Responses Scale (RRS); Difficulties of Emotion Regulation Scale (DERS); Rathus Assertiveness Schedule (RAS) |
Linear mixed models with maximum likelihood estimation 1) Condition comparison 2) Generalized linear mixed models predicting the odds of meeting clinical cut-offs on CESD, ODSIS, OASIS 3) Pooled data (pre-treatment measures from the baseline assessment for the immediate participants and the three-month assessment for the waitlist participants, and post-treatment measures from the three-month assessment for the immediate participants and the six-month assessment for the waitlist participants) - change comparison across all participants from immediate pre-treatment to post-treatment 4) Follow-up assessment; 63 - intent-to-treat approach |
1) Significant improvements in depressive symptoms (on ODSIS, not CESD), marginally significant improvements in anxiety (OASIS) in immediate vs waitlist condition (medium-large effects sizes), no significant condition - time interaction effects for cognitive, affective, and behavioural minority stress processes or for universal processes (small effect sizes) 2) Stronger decreases in the proportion of immediate versus waitlist participants who continued to exceed the cut-off at three months (on CESD, not ODSIS or OASIS) 3) Significant reductions in all primary outcomes, significant (apart from SOCS) reductions in all minority stress processes and universal processes from immediate pre-treatment to post-treatment (large effect sizes) 4) Treatment effects generally maintained at follow-up, few significant differences between post-treatment and follow-up, rumination scores continuing to significantly decrease from post-treatment |
| 2 - Millar, Wang, & Pachankis (2016) | CBT: ESTEEM intervention | Yes - described above | Sexual Orientation Implicit Association Test; Internalized Homophobia Scale (IHS); Overall Depression Severity & Impairment Scale (ODSIS); Overall Anxiety Severity & Impairment Scale (OASIS) |
Linear mixed models with maximum likelihood estimation, pooled data as above, two separate models - with implicit IH and explicit IH, and their respective interactions with time; 54 (who completed pre- and post-treatment assessments) |
Depression and anxiety showed significant reductions; Participants higher in implicit IH at baseline showed nearly three times greater reductions than those lower in implicit IH on depression and anxiety; At post-treatment, those higher in implicit IH showed reductions on depression and anxiety roughly equivalent to one standard deviation |
| 3 - O’Cleirigh et al. (2019) | CBT: 10-session integrated CBT for Trauma and Self-Care (CBT-TSC) intervention with HIV voluntary counseling and testing (VCT) or VCT alone (VCT-only) | Yes - participants in both conditions received HIV/STI voluntary counseling and testing (VCT) at baseline | Mini-International Neuropsychiatric Interview (MINI) - to assess symptoms and a diagnosis of PTSD Davidson PTSD Scale |
HLM (Hierarchical Linear Modeling) 43 |
Davidson Trauma Scale Immediately post-treatment: - Significantly greater reductions in posttraumatic symptom severity for the CBT-TSC condition for the Total Score and the Avoidance subscale - Trend for a difference between the conditions for the Intrusions subscale Follow-up: - Trend for a statistically significant difference between the randomization conditions on the Total Score - Significant reductions in trauma symptom severity for the Avoidance subscale - Trend for a meaningful difference between the conditions for the Intrusions subscale |
| 4 - Pachankis et al. (2020) | CBT: EQuIP (Empowering Queer Identities in Psychotherapy), a 10-session intervention adapted for sexual minority women from the ESTEEM protocol | Yes - adapted from the ESTEEM protocol, described above, with a focus on sexual minority women’s unique experiences | Center for Epidemiological Studies Depression Scale (CESD); Brief Symptom Inventory (BSI); Overall Depression Severity & Impairment Scale (ODSIS); Overall Anxiety Severity & Impairment Scale (OASIS); Sexual Minority Women's Rejection Sensitivity Scale (SMW-RSS); Sexual Orientation Concealment Scale (SOCS); Lesbian, Gay, and Bisexual Identity Scale - Internalized Homonegativity Subscale; Sexual Orientation Implicit Association Test; Difficulties of Emotion Regulation Scale - Short Form (DERSSF); Ruminative Responses Scale - Brooding Subscale (RRS); Simple RAS - Short Form (SRAS-SF) |
As Pachankis et al. (2015); 60 (intent-to-treat) |
1) Significant improvements in depressive symptoms (on CESD, ODSIS) and anxiety (OASIS) in immediate vs waitlist condition (large effect sizes), no significant condition - time interaction effects for minority stress processes or for universal processes (small effect sizes) 2) Stronger decreases in the proportion of immediate versus waitlist participants who continued to exceed the cut-off at three months (on ODSIS, not CESD, and on OASIS) 3) Significant improvements in all primary outcomes (large effect sizes), significant improvements in emotion regulation difficulties and rumination and marginally significant reductions in rejection sensitivity (small effect sizes for minority stress processes, small-medium effect sizes for universal processes) 4) Treatment effects generally continued to decrease at follow-up for mental and behavioural health outcomes, minority stress processes, and universal processes, BSI and rumination continuing to significantly decrease from post-treatment |
| 5 - Maguen, Shipherd, & Harris (2005) | CBT: 12 weekly 60-minute sessions | Yes - session dedicated to hormone maintenance, surgeries, health care; session dedicated to disclosure, passing, socialisation; session dedicated to body issues and intimate relationships etc. | Beck Depression Inventory (BDI) State and Trait Anxiety Inventory (STAI) Network Orientation scale (NOS) - utilising social support networks in times of need Life Satisfaction Index (LSI) |
N/A - individual scores; 6 | Overall: - Anxiety and depression measures: Improvement - Social support: Increases in 4/6 participants - Life satisfaction indices: Decreased for the majority of participant, perhaps due to the multitude of life changes, including becoming unemployed and homeless |
| 6 - Yadavaia & Hayes (2012) | ACT: 6-10 weekly 50-minute ACT sessions | Yes - explicitly addressing self-stigma around sexual orientation/internalised homophobia | Primary: - Daily Ratings of Thoughts About Sexual Orientation ((a) the degree to which negative thoughts about sexual orientation interfered in the participant's life, (b) the distress associated with those thoughts, (c) the believability of the thoughts, and (d) their frequency); Secondary: - Depression, Anxiety, and Stress Scales-21 (DASS-21); - Short Internalized Homonegativity Scale (SIHS); - Lesbian Internalized Homophobia Scale (LIHS); - WHOQOL-BREF (World Health Organization Quality of Life - Abbreviated Version); - AAQ-II (Acceptance and Action Questionnaire-II) |
Hierarchical Linear Modeling (HLM); Mixed Model Repeated Measures; 5 |
Daily Ratings of Thoughts About Sexual Orientation: Improvements in interference and distress from baseline to the later time points in all participants; similar pattern for believability ratings; inconsistent and smaller changes for frequency ratings During baseline: No significant time effects for time for any of the rated dimensions During treatment: Frequency of thoughts did not change, but believability declined significantly, as did distress and self-reported interference IH: Improvement on SIHS and LIHS from pre-treatment by post-treatment (23%), by the 4-week follow-up (32%), and by the 12-week follow-up (40%) Depression, anxiety stress: No significant change on anxiety (from normal range at baseline); significant reduction in depression and stress (from moderate and mild range, respectively, at baseline) by follow-up; improvements in quality of life and psychological flexibility at 4-week follow-up |
| 7 - Craig & Austin (2016) | CBT: AFFIRM intervention: eight module, manualised affirmative cognitive behavioural intervention | Yes - incorporating affirmative practices into traditional CBT models | Beck Depression Inventory (BDI-II); Stress Appraisal Measure for Adolescents (SAMA) - 3 subscales (challenge, threat, resources); Adolescent Proactive Coping Inventory (PCI-A) - Reflective Coping Subscale (RCS) |
Repeated measures ANOVA - general linear model (GLM); T1-T2 = 30; T1-T3 = 17 |
Depression: Statistically significant reduction from T1 to T2, and from T1 to T3 Reflective coping: Non-significant increase from TI to T2; significant differences between T1 and T3 Stress appraisal: Threat appraisal: Significant decrease from T1 to T2, persisted to T3 Challenge appraisal: Significant increase from TI to T2, did not retain statistical significance to T3 Resource appraisal: Significant increase from T1 to T2, did not retain significance to T3 |
| 8 - Austin, Craig, & D’Souza (2018) | CBT: 2-day retreat - AFFIRM, described above | Yes - described above | Beck Depression Inventory (BDI-II); Adolescent Proactive Coping Inventory (PCI-A) - Reflective Coping Subscale (RCS) |
Paired-sample t-tests (T1-T2, T1-T3, T2-T3); T1-T2 - 8, T1-T3, T2-T3 - 6 |
Depression: Statistically significant reduction from T1 to T2, from T1 to T3, nonsignificant reduction from T2 to T3; Mean scores at T2 and T3 remained in the BDI-II Severe range Coping: No significant differences from T1 to T2 or from T2 to T3 |
| 9 - Jabson Tree & Patterson (2019) | Online MBSR - 8 weeks, paralleled Kabat-Zinn's in-person MBSR | N/A | Perceived Stress Scale (PSS); Daily Experiences with Heteosexism Questionnaire (DEHQ) |
1) Paired samples t-tests for changes in stress from baseline to postprogram and baseline to follow-up 2) Repeated-measures ANOVA tested mean values for each measure of stress against one another at the 3 time points; 17 |
Women: - Perceived stress (PSS): Significant decrease pre-post and pre-follow-up - Overall DEHQ and Vigilance subscale: Non-significant decrease pre-post, significant decrease pre-follow-up - Vicarious trauma subscale of the DEHQ: Significant decrease pre-post and pre-follow-up - Similar but less dramatic results on ITT analyses overall Men: - Perceived stress (PSS): Significant decrease pre-post, but not pre-follow-up, similar but less dramatic results on ITT analyses - DEHQ: No significant difference in either per-protocol or ITT analyses |
| 10 - Cohen et al. (2021) | DBT; Other: Weekly 90-minute session over 10 consecutive weeks; participants were enrolled in individual psychotherapy and/or medication management concurrently | Yes - incorporates minority stress theory and adapts the teaching points of existing DBT skills to create Affirmative DBT Skills Training; including psychoeducation on the minority-specific psychological processes of rejection sensitivity, internalized stigma, and sexual orientation concealment | Difficulties of Emotion Regulation Scale (DERS); Overall Anxiety Severity & Impairment Scale (OASIS); Patient Health Questionnaire - Depression Module (PHQ-9); Gay-related Rejection Sensitivity Scale (GRS); Sexual Minority Women's Rejection Sensitivity Scale (SMW-RSS); Internalized Homophobia Scale (IHS); Sexual Orientation Concealment Scale (SOCS) |
Clinically significant reliable change, with normative data used to calculate RCI acquired through the scales original articles; RCI not calculated for the GRS, SMW-RSS, IHS, and SOCS, as relevant data were not available; 6 |
Emotion regulation: Improvements in 5/6 participants (statistically significant for ~50% of the participants); Depressive symptoms: Improvements in 4/5 of the participants who reported a clinical level of depression at baseline (statistically significant for ~50% of the participants; Anxiety symptoms: Improvements in 3/4 of the participants who reported a clinical level of anxiety at baseline; GRS/SMW-RSS, IHS, and SOCS: Improvements in the majority of participants |
| 11 - Hart et al. (2020) | CBT: Ten 1-hour, weekly sessions of CBT for treatment of social anxiety, related substance use in sexual situations, and HIV prevention | Yes - focus on participants' sexual and relationship history, goals for satisfying relationships and sex etc. | The Mini International Neuropsychiatric Interview version 6.0 (MINI 6.0); Anxiety Disorders Interview Schedule-IV-Lifetime (ADIS-IV), Social Phobia Section; Liebowitz Social Anxiety Scale (LSAS); The Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS); Center for Epidemiologic Studies-Depression Scale (CESD); UCLA Loneliness Scale Version 3 (UCLA); Brief Fear of Negative Evaluation Scale, Straight-forward Items (BFNE-S) |
Generalized estimating equations with robust estimators and unstructured correlation matrix addressing nonindependence of data across time points; Beta estimates for continuous measures and relative risk ratios (RR) for binary outcomes |
Similar pattern of results using both intent-to-treat (n = 32) and completer (n = 21) samples; therefore, results of latter reported Social anxiety: - Significant reductions in the proportion of participants who met diagnostic criteria for social anxiety disorder from baseline to all timepoints - Significant reductions in mean scores on the LSAS, SIAS, SPS, BFNE-S between baseline and all time points Depression and loneliness: - Significant reduction in the proportion of patients with current major depressive episodes pre-post-treatment, non-significant differences for 3- and 6-month follow-up; - Significant reduction in mean scores on the CESD between baseline and all timepoints; - Significant reduction in mean scores on the UCLA between baseline and all timepoints |
| 12 - Bluth et al. (2023) | Mindful Self-Compassion for Teens (MSC-T) - 8x1.5h sessions online, held over 8 days (1/day) for the first cohort, then 2x/week for 4 weeks for the second two cohorts | Yes - slight modifications to accommodate the needs of transgender adolescents e.g., ommission of body scan practice | Self-compassion scale: Youth (SCS-Y) Student life satisfaction scale (SLSS) Spielberger State Anxiety Scale - Short Form Patient Health Questionnaire-Depression Module (PHQ-9) Interpersonal needs questionnaire (INQ) Brief resilience scale (BRS) |
One-way repeated measures ANOVAs; 26 |
Overall, main effect of time for all constructs across the study Depression: Significant decrease pre-post and pre-3-month follow-up Anxiety: Significant decrease pre-post (not observed at 3-month follow-up) Resilience: Significant increase pre-post (not observed at 3-month follow-up) Mindfulness: Significant increase pre-post and pre-3-month follow-up Self-compassion: Significant increase pre-post and pre-3-month follow-up |
| 13 - Craig et al. (2021) | CBT: AFFIRM, described above - Online groups (eight weekly sessions) with 6-14 distinct participants in each age-appropriate (14-18, 19-24, 25+) group | Yes - AFFIRM, described above | Beck Depression Inventory (BDI-II); Brief COPE Inventory (BCI); Proactive Coping Inventory for Adolescents-A (PCI-A)-Reflective Coping Subscale (RCS); Stress Appraisal Measure for Adolescents (SAMA); Hope Scale (HS) |
Linear multilevel models with restricted maximum likelihood estimation (REML) to test the effects of Time, Condition, and Time X Condition for all outcomes; age (centred at the mean of the whole sample = 22.34) included as a covariate in the model; Intervention (46), Control (50) |
Compared to waitlist control, intervention condition participants experienced: - Significantly reduced depression - Significantly improved likelihood to appraise stress as challenge and to appraise that they had enough resources to deal with the stress - Significantly improved active coping, emotional support, positive framing, planning Marginally significant decrease in self-blame; no significant differences between the intervention and control conditions for substance use and behavioural disengagement - Increases for reflective coping or hope, but not statistically significant |
| 14 - Pan et al. (2021) | CBT: ESTEEM, adapted for new contexts or populations | Yes - ESTEEM, described above, but with a different (Asian/Chinese) population | Chinese version of the PHQ-9 Chinese version of the GAD-7 |
Paired sample t-tests; 7 |
Reduction in the average score of depression and anxiety symptoms by approximately 7 and 5, respectively (medium-to-large improvement) |
| 15 - Jackson et al. (2022) | CBT: Weekly 90-min group treatment sessions over 10 weeks | Yes - ESTEEM, described above, but adapted to recognise the intersectionality of racism and homophobia | Center for Epidemiological Studies Depression Scale (CESD); Overall Depression Severity & Impairment Scale (ODSIS); Overall Anxiety Severity & Impairment Scale (OASIS); Gay-related Rejection Sensitivity Scale (GRS); Self-Concealment Scale as previously modified for use with GBM; Internalized Homophobia Scale (IHS); Prolonged Activation and Anticipatory Race-Related Stress Scale - Psychological Subscale and Perseverative Cognitive Subscale; Racism-Related Vigilance Scale; Heterosexism in Racial Ethnic Minority Communities Subscale of the LGBT People of Color (POC) Microaggression Scale |
t-tests - focusing on Hedge's g effect sizes 21 (baseline), 17 (3-month follow-up) |
Depression symptoms and severity, anxiety, psychological distress, suicidal ideation: Decrease (very small effect sizes); Rejection sensitivity and concealment: Decrease (small effect sizes), but not internalised homophobia; Racial minority stress outcomes, including decreased anticipatory stress, race-related rumination, and race-related vigilance, and intersectional stress, including homophobia within one’s racial/ethnic community, racism within the LGBT community, and racism in dating and close relationships: Decrease (very small to small effect sizes) |
| 16 - Poon et al. (2022) | DBT: 18-week comprehensive DBT-A (adaptation of DBT model for adolescents and their families) outpatient program offered to adolescents between the ages of 13-18, delivered with fidelity to the standard model, including a weekly multi family skills training group, individual therapy, 24/7 phone coaching, and a therapist consultation team | N/A | Difficulties of Emotion Regulation Scale (DERS); Beck Depression Inventory (BDI-II); Beck Anxiety Inventory; The dialectical behaviour therapy ways of coping checklist (DBT-WCCL); Boderline symptoms list (BSL) |
1) Repeated-measures bootstrapped t-tests (two-tailed 0.05 p-values for treatment effects) - for LGBQ participants only 2) 2x2 mixed-model ANOVA to test group (LGBQ/non-LGBQ) effects on the outcomes; 16 - LGBQ for 1), 16 - LGBQ +23 - non-LGBQ for 2) |
1) Significant improvements on all outcomes, apart from anxiety (mostly large effect sizes) 2) No significant group - time interaction effects on any of the outcomes (changes over time did not differ between LGBQ and non-LGBQ participants); statistically nonsignificant, but small to medium interaction effect sizes on the DERS, BDI-II, and WCCL-Skill Use (sexual minorities may benefit slightly more from DBT-A with respect to emotion regulation, depression, and effective skill use) |
Note. All information was presented as found in the respective results sections of the primary reports; the same applies for evaluations of what is considered statistically or clinically significant, and effect sizes (although generally, statistically significant pertains to p < .05, clinically significant pertains to reductions in scores that either decrease to below clinical threshold of the respective scale or exceed the measurement error of the scales, and effect sizes are considered small (d/g = 0.2), medium (d/g = 0.5), and large (d/g ≥ 0.8) according to Cohen (1969), and the included studies seem to have adhered to this).