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

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.

“I wasn’t feeling like I belonged in my skin”: How self‐identified gay men in theUKexperience unhelpful incidents in talking therapy1

“…These findings point to the necessity of developing more therapeutic support group options for SIGM clients seeking therapy. As other studies have shown (e.g., Craig et al, 2021;Nel et al, 2007), such affirmative groups could, additionally, empower SIGM clients to deal with self-acceptance, loneliness and other life difficulties not necessarily or directly linked to their sexual orientation.…”

Cultural consideration for cognitive‐behavioural therapy for sexual minority young people in Chinese societies: Perspectives from practitioners and target users

“…Despite ongoing calls for culturally sensitive psychosocial interventions, limited action has been taken to create or modify empirically supported interventions for Chinese SMYP to accommodate their specific needs. Given its extensive application across cultural groups and effectiveness across a range of cultural and technological contexts (Craig et al., 2021) AFFIRM provided a solid foundation to uncover the culture‐specific concerns that matter for SMYP in Chinese societies. This study demonstrated a collaborative and empirical procedure to identify considerations for affirmative CBT with Chinese sexual minority youth.…”

“…AFFIRM is an 8‐session, manualised psychosocial intervention (see Table 1) aimed at improving coping skills and reducing psychosocial distress among SMYP (Craig & Austin, 2016; Craig et al., 2019). The results of an open pilot feasibility study (Craig & Austin, 2016) and a randomised clinical trial (Craig et al., 2021) that included large populations of Asian SYMP identified significant outcomes such as a reduction in depression and threat appraisal and improvement of hope, challenge and resource appraisals and coping with medium to large effect sizes. SMYP also reported high levels of intervention acceptability and skills acquisition.…”

“…The paucity of evidence‐based programmes for SMYP in Chinese societies warrants the development of culturally congruent interventions or cultural adaptation of existing Western‐dominant interventions (Sun, Pachankis, et al., 2020). As the first evidence‐based intervention for SMYP, AFFIRM was created and tested primarily in Canada and the United States, albeit with diverse participants of various age ranges, ethnic/racial backgrounds (including a large number of Chinese Canadians), and sexual and gender identities (Craig & Austin, 2016; Craig et al., 2021). However, the key considerations for interventions with Chinese SYMP in Eastern contexts remain uncertain.…”

An Identity-Affirming Web Application to Help Sexual and Gender Minority Youth Cope With Minority Stress: Pilot Randomized Controlled Trial

“…Although prior research suggests that face-to-face interventions that include these components may improve the mental health of SGM youth [ 20 ], the reach and scalability of these programs have been challenging, given their time intensity and need for synchronous interactions, which have become increasingly difficult to coordinate amidst the COVID-19 pandemic [ 21 , 22 ]. At the same time, the need for scalable mental health resources has become particularly acute in recent years.…”