The Effectiveness and Acceptability of Empirically-Supported Treatments in Gender Minority Youth Across Four Randomized Controlled Trials

Abstract

Objective: Gender minority youths (i.e., children/adolescents whose gender identity and/or expression is inconsistent with their birth-assigned sex) experience elevated rates of emotional and behavioral problems relative to their cisgender peers (i.e., youths who identify with their birth-assigned sex). Although empirically-supported treatments have proven effective in treating youth psychopathology generally, randomized controlled trials have not examined effects for gender minority youths.Method: To address this gap, we pooled data from four previously completed randomized controlled trials of a modular empirically-supported treatment with clinically-referred youths (N = 432; M(SD)age = 10.6(2.2); 55.1% White). A proxy indicator of gender identity (i.e., youths’ reports of wishing to be the opposite sex) was used classify gender minority (n = 64) and cisgender (n = 368) youths. Youth- and caregiver-reported pre-treatment internalizing and externalizing problems, treatment effectiveness on these symptom domains, and treatment acceptability (i.e., satisfaction, youth-therapist alliance) were compared across these groups.Results: Gender minority youths reported more severe pre-treatment internalizing and externalizing problems compared to cisgender youths; in contrast, their caregivers reported less severe problems. Though treatment was equally effective for both groups on most outcomes, gender minority youths’ caregiver-reported externalizing problems improved more slowly and less reliably, and their self-reported internalizing problems were more likely to remain clinically elevated at post-treatment. Further, gender minority youths reported lower treatment satisfaction.Conclusions: While findings suggest that empirically-supported treatments may effectively address many mental health problems for gender minority youths, they also underscore the need for treatment enhancements that improve acceptability and outcomes for these youths.

Associations of LGBTQ+ Identities with Acceptability and Efficacy of Online Single-Session Youth Mental Health Interventions

“…Furthermore, the portion of the intervention completers that identified as LGBTQ+ did not differ from the portion of those who started but did not complete the intervention, suggesting that LGBTQ+ youth did not drop out at a higher rate than did non-LGBTQ+ youth. These results contrast with previous work suggesting lower psychotherapy satisfaction for TGD youths as compared to their cisgender peers (Hollinsaid et al, 2020), but they are consistent with other evidence suggesting equivalent psychotherapy satisfaction across…”

“…Some mental health interventions designed or adapted specifically for LGBTQ+ youths have demonstrated efficacy and acceptability; however, the incremental clinical utility gained from LGBTQ-specific designs and modifications remains unclear, largely due to a lack of control and comparison groups in associated studies (Hobaica et al, 2018). Some emerging evidence suggests that general psychosocial treatment effects on youth psychopathology may be similar across youths with diverse gender identities, but also that gender minority youths may perceive existing psychosocial interventions as less acceptable or useful than cisgender youths do (Hollinsaid et al, 2020). Beyond this single study, there is a paucity of research on differential intervention effectiveness and acceptability among LGBTQ+ and non-LGBTQ+ youths.…”

Does Stigma Moderate the Efficacy of Mental- and Behavioral-Health Interventions? Examining Individual and Contextual Sources of Treatment-Effect Heterogeneity

“…The primary way in which psychologists and other mental-health professionals have sought to answer this question is by conducting meta-analyses that examine whether treatment efficacy is moderated by group characteristics that correlate with exposure to stigma, such as minority race or ethnicity (e.g., Weisz et al, 2017) and minority gender identity (e.g., Hollinsaid et al, 2020). With rare exceptions, these studies have generally failed to find reliable between-groups differences in intervention efficacy, suggesting that stigma may not influence how individuals respond to these health interventions.…”