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Compound symmetry was used to model the covariance structure within participants.

Upon completing the in-office portion of the baseline assessment and confirming eligibility, participants were randomized to either immediate treatment or waitlist. The Unified Protocol promotes these changes through modules that focus on motivation enhancement, interoceptive and situational exposure, cognitive restructuring, mindfulness, and self-monitoring techniques grounded in established cognitive and behavioral theories and techniques of behavior change across psychosocial problems and disorders. Sexual orientation-related disparities in depression and anxiety co-occur with alcohol use, sexual compulsivity, and risky sexual behavior to form a syndemic health threat surrounding young gay and bisexual men.

The adapted intervention targets both minority stress processes i. Session 7 focused on the impact of minority stress on behavioral avoidance with a focus on creating an emotional and behavioral avoidance hierarchy.

List of gay, lesbian or bisexual people: w–z

The GRS assesses the degree to which gay and bisexual men would be anxious about being rejected in each of 14 vignettes because of their sexual orientation, from 1 very unconcerned to 6 very concernedand the degree to which they would expect such rejection from 1 very unlikely to 6 very likely. A research assistant ensured that each participant completed at-home baseline measures before arriving to the office. The IHP assesses how troubled gay and bisexual men are about their sexual identities over the past year. Waitlist participants received treatment between the 3-month and 6-month assessment.

Lesbian, gay, bisexual, and transgender–related content in undergraduate medical education

Session 6 engaged participants in a review of the impact of emotions on mental, behavioral, and sexual health and personal emotion avoidance tendencies driven by minority stress. The CESD consists of 20 items that ask individuals to rate how often they have experienced symptoms of depression e. We also examined the ability of the intervention to reduce cognitive, affective, and behavioral minority stress processes as well as universal processes shown or hypothesized to be elevated among gay and bisexual men, as mechanisms through which the adapted minority stress treatment might operate.

The item SSSE assesses self-efficacy for condom use in various situations e. Treatment and wait-list occurred over the course of three months. In andwe recruited participants through advertisements posted to social and sexual networking websites and mobile applications e. A cutoff value of 8 balances sensitivity and specificity to identify harmful alcohol use.

All participants completed a brief screening questionnaire over the phone to confirm eligibility, which was defined as: 1 being born male and currently identifying as a man; 2 gay or bisexual identity; 3 aged 18 to 35; 4 English fluency; 5 residing in the New York City area; 6 being HIV-negative; 7 engaging in HIV risk behavior i. One therapist identified as a lesbian, one as a gay man, and one as a heterosexual woman.

Physical symptoms were unbearable. Internal consistency was not calculated since not all stressors applied to all participants. Effects were generally maintained at follow-up. Session 10 reviewed new cognitive, affective, and behavioral coping strategies and their application to future minority stress experiences Pachankis, Therapists ased homework between-session homework after sessions to promote skill generalization. We tested the preliminary efficacy of a transdiagnostic cognitive behavioral treatment adapted to improve depression, anxiety, and co-occurring health risks i.

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Response options range from 0 to 4; qualitative response anchors are specific to each question. Three advanced clinical psychology doctoral students delivered the intervention. Fourth, CBT targets the universal risk factors disproportionately affecting sexual minorities.

Session 9 continued the graduated behavioral experiments with a focus on assertiveness training as a skill for coping with minority stress. Structural stigma, in turn, justifies discrimination within families, religious communities, schools, workplaces, and everyday social interactions, elevating the stress, and therefore the mental health burden, experienced by sexual minorities across development.

Minority stress emerges from stigmatizing societal structures—termed structural stigma Hatzenbuehler, —that deny sexual minority individuals i. Second, CBT empowers clients to cope with adverse environmental circumstances such as minority stress by promoting coping self-efficacy. Session 5 raised awareness of the cognitive impact of minority stress and posed cognitive restructuring activities.

Eligible participants were sent an online link containing at-home baseline measures and scheduled for an in-office appointment to complete the remaining baseline measures and to be randomized to condition.

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Participants completed assessments at baseline, three months, and six months; demographic questions were only assessed at baseline. Try out PMC Labs and tell us what you think. The negative impact of gay-related stress predicts depressive symptoms over-and-above general life stress Lewis et al. While professional guidelines exist for LGB-affirmative clinical practice with sexual minority individuals American Psychological Association,the field currently lacks evidence for translating this guidance into practice Cochran, The effectiveness of existing mental health interventions as applied to sexual minorities and the potential for these interventions to be adapted to specifically address the cognitive, affective, and behavioral stress processes experienced by gay and bisexual men remain to be determined.

In the TLFB, a trained interviewer reviews a pastday calendar and life events e. Figure 1 describes the sample size throughout all study phases, including exclusion, ineligibility, and refusal of screened participants. All of my relationships have suffered or ended. The final analytic sample comprised 63 sexual minority men.

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The ODSIS contains five items that assess past-week depressive symptom severity and impairment and possesses strong utility for monitoring treatment response. 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. The SCS contains 10 items e.

The first author, a clinical psychologist, supervised the delivery of the intervention over one year in mobile group and individual meetings. The MOGS contains 56 stressors related to being gay e. Minority stress processes showed small improvements in the expected direction.

Waitlist participants received one phone call or per month to remind them of their upcoming appointment. For example, modules were adapted to help participants identify minority stress experiences; track cognitive, affective, and behavioral reactions to minority stress, with a focus on avoidance reactions, including substance use and condomless bisexual sex; attribute distress to minority stress rather than to personal failure; and assertiveness training for coping with minority stress in safe situations.

As described in detail elsewhere Pachankis,guidance for adapting the Unified Protocol to address minority stress was garnered from expert mental health care providers with extensive experience treating gay and bisexual men and from depressed and anxious gay and bisexual men who were experiencing co-occurring syndemic health risks. As there were no ificant demographic personals between conditions, we did not enter covariates into efficacy analyses.

Immediate treatment participants received treatment between the baseline and 3-month assessment. The CES-D contains a sensitive and specific clinical cutoff i.

All sessions were video-recorded for supervision; the first author reviewed Fidelity checklists were specific to each session and contained between five and seven items per session. After completing all surveys, they completed the timeline follow-back interview with a trained interviewer. Pachankis, in pressArchives of Sexual Behavior. The OASIS is a 5-item scale that assesses severity and impairment associated with any anxiety disorder over the past week among clinical and nonclinical samples.

Since few participants reported that the events had a positive impact on them, a mean of the absolute value of only the negatively rated personals was used. Module content is described bisexual below and in detail elsewhere Pachankis, Session 2 reviewed the impact of minority stress on health, specific manifestations of minority stress, and current coping strategies. Average age was approximately 26 years. Session 3 raised awareness of the emotional impact of early and ongoing forms of minority stress.

To ease participant burden, at each assessment point participants completed mobile half of the survey measures at home by computer and the other half of survey measures in the study office by computer. A minimum cutoff of 2. Past day condomless anal sex and alcohol use were assessed with the TLFB.

The DERS contains 36 items assessing problems regulating emotions across six domains: nonacceptance of emotional responses e. Validity data come from prospective prediction of alcohol use impairment e.

The holistic health status of chinese homosexual and bisexual adults: a scoping review

We first used t -tests and chi-square tests to examine demographic differences between the immediate treatment and waitlist control conditions Table 1. His mom comes to take him away. First, CBT locates present maladaptive behaviors in the context of their developmental function and current environmental contingencies, such as seeing depression and health-risk behaviors as learned responses for coping with minority stress.

The AUDIT is a item screening inventory used to identify hazardous drinking across settings and populations.

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Session 8 engaged participants in behavioral experiments in which ly avoided experiences were gradually confronted. The RAS is a item self-report measure of assertive behavior e. Learn More. This study represents the first test of an adapted cognitive behavioral intervention deed to alleviate minority stress among young gay and bisexual men to improve the co-occurring health conditions facing this population.

It was impossible to relax at all. Average fidelity rating However, this likely represents a conservative estimate since sessions were not reviewed randomly; therapists typically suggested their most challenging sessions for supervisory review.

Item responses e. At baseline, 3-month, and 6-month assessments, participants completed self-reports of mental health and minority stress and an interview of pastday risk behavior. Participants rate nine items e. Session 4 raised awareness of the behavioral impact of minority stress and taught mindful, present-focused reactions to minority stress.

Treatment adaptations focused on reducing minority stress processes that underlie sexual orientation-related mental health disparities. Participants ased to receive immediate treatment completed their first session immediately following their in-office baseline assessment. Thus, for immediate treatment participants, these assessments are referred to as immediate pre-treatment, post-treatment, and 3-month follow-up; for waitlist participants, these assessments are referred to as 3-month pre-treatment, immediate pre-treatment, and post-treatment, respectively.

My family life is extremely strained. Upon reviewing a physical or online study advertisement, interested individuals contacted the research office to complete an eligibility screening by phone.

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Item responses are summed to derive an overall score range 10— A score of 24 or higher is frequently used to distinguish problematic sexual compulsivity e. The ODSIS distinguishes between individuals with and without a mood disorder and is appropriate for assessing depressive symptom severity in those with clinical and subclinical levels of depression.

Participants responded to each of the four items i. During the call, a research assistant assessed consent for phone screening; described the study, including a description of the treatment and two conditions; and asked questions to assess eligibility. We focus the treatment on young adult gay and bisexual men given that sexual orientation-related mental health disparities begin relatively early in development e.

The IHP is associated with general mental and sexual health problems in a sample of adult gay men Meyer, Rumination was assessed with this item scale assessesing characteristic ways of responding to depressed mood e. Clear and consistent evidence suggests that a major source of this syndemic is minority stress—the stress associated with stigma-related social disadvantage that compounds general life stress.