Remote Cognitive Behavioural Therapy (CBT) for Anxiety Disorders in Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, and Non-Heterosexual or Non-Cisgender (LGBTQ+) People

The immediate treatment group will receive treatment consisting of 50-minute weekly appointments, delivered over eight weeks. This treatment is based on the manual for the Unified Protocol (Barlow et al., 2018), and each of the eight modules will be delivered over videoconferencing in eight one-on-one sessions. The typical eight-module treatment will cover: psychoeducation on the CBT model and goals; mindfulness of emotions; building cognitive flexibility with restructuring; addressing emotional avoidance and emotion-driven behaviours; behavioural exposures/experiments; and relapse prevention. Clients will be assigned therapeutic activities to complete in between sessions, as per standard practice in previous trials (Pachankis et al., 2015; Pachankis et al., 2020; Pachankis et al., 2023). Between-session therapeutic tasks may involve completing thought monitoring forms, doing mindfulness exercises, completing behavioural experiments or exposures, and so on. Each activity is typically short, taking approximately 5 - 30 minutes, and will differ from week to week. The time expected to be spent on these activities will depend on client goals and presenting problems and is unlikely to exceed three hours per week. The treatment provided in the trial will be delivered by generally registered psychologists or provisionally registered psychologists. All clinicians will provide treatment while under the supervision of a clinical psychologist experienced in delivering treatments for anxiety and related disorders. The project investigators will provide training in delivery of the treatment protocol, and all clinicians will receive regular clinical supervision. To monitor treatment fidelity, at least 10% of session recordings will be randomly selected for review by a study investigator. Additionally, eight to ten participants will be invited to participate in a qualitative interview to evaluate intervention acceptability from both the immediate intervention group and control group (after commencing treatment), with a total of 16 – 20 participants. This sample size is consistent with previous studies in this area of research (Jackson et al., 2022; Pachankis et al., 2020). Participants will be selected based on a representative matrix that aims to achieve a maximally diverse sample, as per previous studies (Christensen et al., 2023). Participants will be interviewed by a member of the research team who did not provide the treatment wherever possible. To encourage candid feedback, the benefits of honest feedback from participants for improving the intervention will be discussed early on during the interview. To encourage candid feedback, the benefits of honest feedback from participants for improving the intervention will be discussed early on during the interview. The interview will be audio recorded to assist with transcription and is expected to take approximately 30 to 60 minutes.