Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members

Sexual Orientation Concealment, Hope, and Depressive Symptoms Among Sexual Minority Women: The Moderating Role of Sexual Orientation

Sexual minority women (SMW) experience higher levels of depression compared to heterosexual women, and bisexual women show higher levels than lesbian women. Sexual orientation concealment is a risk factor for depressive symptoms among SMW. Hope is protective against depressive symptoms in diverse samples, but limited research in this area has centered on SMW. This study examined the role of hope and its components, agency and pathways, as moderators of the relation between sexual orientation concealment and depressive symptoms, and whether the moderating effects were conditional on sexual orientation. An international sample of 218 lesbian women aged 18 to 69 (M = 32.93 years, SD = 12.75) and 230 bisexual women aged 18 to 67 (M = 27.83 years, SD = 7.52) completed an online survey. Hope, agency, and pathways did not moderate the relation between sexual orientation concealment and depressive symptoms. The significant negative relations between hope and depressive symptoms, and between agency and depressive symptoms, were moderated by sexual orientation: the relations were stronger among lesbian women than bisexual women. Results suggest that increasing levels of hope and agency through clinical intervention may reduce depressive symptoms for both groups of women, with more pronounced effects among lesbian women.

LGBQ-affirming clinical recommendations for compulsive sexual behavior disorder

Background and aims

Since the inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases (11th ed.), there has been little effort placed into developing clinical recommendations for lesbian, gay, bisexual, and queer (LGBQ) clients with this condition. Thus, we develop preliminary clinical recommendations for mental health professionals working with LGBQ clients who may be struggling with CSBD.

Methods

The present paper synthesizes the CSBD literature with advances in LGBQ-affirming care to develop assessment and treatment recommendations. These recommendations are discussed within the context of minority stress theory, which provides an empirically supported explanation for how anti-LGBQ stigma may contribute to the development of mental health conditions in LGBQ populations.

Results

Assessment recommendations are designed to assist mental health professionals in distinguishing aspects of an LGBQ client's sociocultural context from CSBD symptomology, given recent concerns that these constructs may be wrongly conflated and result in misdiagnosis. The treatment recommendations consist of broadly applicable, evidence-based principles that can be leveraged by mental health professionals of various theoretical orientations to provide LGBQ-affirming treatment for CSBD.

Discussion and Conclusions

The present article provides theoretically and empirically supported recommendations for mental health professionals who want to provide LGBQ-affirming care for CSBD. Given the preliminary nature of these recommendations, future research is needed to investigate their clinical applicability and efficacy.

Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial

Background

Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations.

Method

We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes.

Conclusions

This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals.

Probable PTSD, PTSD symptom severity, and comorbid PTSD and hazardous drinking among sexual minority women compared to heterosexual women: A meta-analysis

Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pronounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.

A latent class analysis of tailored substance use treatment programs: Implications for treating syndemic conditions facing sexual and gender minority populations

BACKGROUND

Syndemics (i.e., multiple, co-occurring, and synergistic conditions) contribute to elevated substance use among sexual and gender minority (SGM) people relative to heterosexual, cisgender people. Research suggests that syndemic-informed and SGM-tailored treatments are effective in substance use treatment among SGM people. However, few studies have examined 1) the proportion of substance use treatment facilities offering syndemic-informed, SGM-tailored treatment programming; and 2) the availability and accessibility of syndemic-informed, SGM-tailored treatment programs across the U.S.

METHODS

We used the 2020 National Survey of Substance Abuse Treatment Services (N-SSATS) dataset to perform a latent class analysis examining whether substance use treatment facilities' tailored treatment programs cluster together to form distinct classes indicating whether facilities offer syndemic-informed and SGM-tailored programming. We then used multinomial logistic regression to examine associations between class membership and facility availability and accessibility.

RESULTS

Analyses revealed four classes of substance use treatment facilities' tailored programs. Facilities with syndemic-informed and SGM-tailored treatment programs compared to facilities with no tailored programs were more likely to be in the Northeast compared to the Midwest and South; to offer payment assistance versus not offer payment assistance; and to be private, for-profit facilities versus public or non-profit facilities.

CONCLUSIONS

This study's findings identify the need for more facilities with syndemic-informed and SGM-tailored treatment, particularly in the Midwestern and Southern U.S. regions. Facilities offering syndemic-informed and SGM-tailored treatment might present accessibility barriers for low-income SGM people, as they were more likely to be private, for-profit facilities; however, they were more likely to offer payment assistance.

Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers

OBJECTIVES

This randomized controlled trial examined whether an 11-week synchronous (i.e., real-time) online training in lesbian, gay, bisexual, transgender, queer, and other sexual or gender diverse (LGBTQ)-affirmative cognitive behavioral therapy (CBT) could lead to increased uptake of this practice at LGBTQ community centers across 20 U.S. states and internationally.

METHOD

A total of 121 mental health providers (Mage = 37.74; 78.5% LGBTQ; 60.3% non-Hispanic/Latinx White) were randomized to receive the 11-week training either immediately (n = 61) or after a 4-month wait (n = 60). At baseline and 4 and 8 months after baseline, participants self-reported their LGBTQ-affirmative competency, cultural humility, and knowledge of the minority stress theory and practice skills underlying LGBTQ-affirmative CBT. To objectively assess uptake of LGBTQ-affirmative CBT, participants demonstrated, through simulated practice, how they would respond to two video-based clinical vignettes.

RESULTS

Compared to wait-list, participants in the immediate training condition reported greater improvements in self-reported cultural competence (d = 1.24), minority stress knowledge (d = 0.78), LGBTQ-affirmative CBT knowledge (d = 0.78), and LGBTQ-affirmative CBT skills familiarity (d = 0.91) and use (d = 0.96); effects persisted 8 months postbaseline. Cultural humility showed no significant difference by condition (d = 0.07). In objectively coded assessments of simulated practice, participants in the training condition demonstrated greater uptake of LGBTQ-affirmative practice skills (d = 0.82).

CONCLUSIONS

Findings preliminarily suggest that mental health providers can be trained to deliver LGBTQ-affirmative CBT using the low-cost, efficient reach of online training. This training can help disseminate evidence-based mental health care to LGBTQ individuals and support its implementation across practice settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).