Sexual Minority Stress
Conditions
Brief summary
The aim of this study is to develop an evidence-based psychosocial intervention for sexual minority women. This intervention will specifically target the adverse mental and behavioral health outcomes disproportionately experienced by sexual minority women, including depression, suicidality, and alcohol abuse, which are known to be driven by stigma-related stressors associated with their sexual orientation (i.e., minority stress processes).
Detailed description
The purpose of this study is to adapt ESTEEM (Effective Skills to Empower Effective Men), developed by Dr. John Pachankis, to simultaneously target the multiple adverse health outcomes sexual minority women disproportionately face, including depression, suicidality, and alcohol abuse, that are linked to minority stress processes. Project EQuIP will adapt the ESTEEM program for sexual minority women in three distinct phases. The focus of this registered protocol will be Phase 3, however Phases 1, 2 and 3 are described below. Phase 1 will involve conducting interviews with 20 sexual minority women (SMW) who report experiencing depression, suicidality, and alcohol abuse. Information from these interviews will be used to gather insight from participants that can help inform the adaptation of a cognitive-behavioral treatment approach to specifically target sexual minority women's unique experiences with minority stress. Phase 2 will involve consultation interviews with 10 community-based mental health experts who treat psychosocial health problems among at-risk SMW. Involvement of key community members in intervention design optimizes intervention dissemination and allows frontline professionals to shape the intervention that they would be most willing to implement. Input of mental health experts working with the SMW community will be used in order to translate existing, but largely untapped, clinical wisdom regarding SMW's minority stress experiences, mental health, and alcohol use into the development of the intervention. Phase 3 will involve pilot testing the adapted cognitive-behavioral treatment through a randomized controlled trial with 60 SMW who report experiencing depression, anxiety, and alcohol abuse.
Interventions
BEHAVIORALEQuIP (Empowering Queer Identities in Psychotherapy)
Individuals assigned to therapy will receive 10 weekly individually-delivered sessions, directly after baseline assessment, that address minority stress mechanisms underlying SMW's depression, anxiety, and alcohol abuse.
Sponsors
National Institute of Mental Health (NIMH)
Yale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
Patients will either be immediately enrolled or wait listed for the intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
For Phase 3 Inclusion Criteria: * sexual minority status operationalized as identity (e.g., lesbian, bisexual, pansexual, queer) * aged 18-35 * self-identification as a woman with the option of selecting multiple gender identities * symptoms of anxiety or depression within the past 90 days (≥ 2.5 on the BSI-4 for either anxiety or depression) * at least one instance of past-90-day heavy drinking (i.e., ≥ 4 drinks in one sitting) * 6-month NYC residential stability and availability * English fluency
Exclusion criteria
* active psychosis or active mania * active suicidality or active homicidality * currently in mental health treatment exceeding one day per month * having received any cognitive-behavioral therapy treatment in the past 12 months * evidence of gross cognitive impairment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Depression | Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention) | The measure depression in participants, the Center for Epidemiological Studies - Depression Scale (CES-D) will be used. An overall depression score is computed as the sum of the 20 items, with Items 3, 11, 14, and 16 reversed. In cases with internally missing data (items not answered), the sums were computed after imputation of the missing values: # items on scale / # actually answered, multiplied by the sum obtained from the answered items. A higher score indicates more depressive symptomatology during the past week. Range is 0 - 60. |
| Brief Symptom Inventory | Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention) | The Global Severity Index of the 18-item BSI provides a mean score across depression, anxiety, and somatization subscales, and assesses psychological distress (e.g., feeling nervousness or shakiness inside) on a 5-point scale from 0 (not at all) to 4 (extremely) for the past 7 days. Scores range from 0-72, with higher scores indicating worse outcomes (greater symptoms severity). |
| Alcohol Use | Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention) | Alcohol use will be measured using the Short Index of Problems for Alcohol (SIP-A). The SIP-A is a 15-item, binary response (yes/no) measure that has a range of scores from 0-15. The highest score of 15 is an indicator of the greatest amount of alcohol use related problems. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Depression Severity and Impairment Scale | Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention) | ODSIS is a 5-item scale that asks individuals to rate the severity and impairment associated with past-week symptoms of depression (e.g., In the past week, when you have felt depressed, how intense or severe was your depression?) from 0 (little or none: Depression was absent or barely noticeable.) to 4 (extreme: Depression was overwhelming.). Scores range from 0-20, with higher scores indicating greater depression and associated impairment in the past week. |
| Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale | Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention) | Internalized stigma was assessed us- ing the mean score on a three-item scale, the Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale, that asks individuals to rate thoughts and feelings related to their LGBTQ identity (e.g., If it were possible, I would choose to be straight). Responses range from 1 (disagree strongly) to 6 (agree strongly). Scores range from 3-18 with higher scores indicating higher internalized stigma. |
| Overall Anxiety Severity and Impairment Scale | Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention) | OASIS is a 5-item scale that asks individuals to rate the severity and impairment associated with past-week anxiety symptoms (e.g., In the past week, when you have felt anxious, how intense or severe was your anxiety?) from 0 (little or none: Anxiety was absent or barely noticeable.) to 4 (extreme: Anxiety was overwhelming. It was impossible to relax at all. Physical symptoms were unbearable). Scores range from 0-20, with higher scores indicating greater anxiety and associated impairment in the past week. |
| Suicidal Ideation Attributes Scale | Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention) | SIDAS is a 5-item scale that assesses past-month frequency and controllability of suicidal thoughts, how close one has come to making an attempt, and distress and impairment associated with thoughts of suicide (e.g., In the past month, how often have you had thoughts about suicide?). Responses range from 0 (never or not at all) to 10 (always or extremely) on each item, with item 2 reverse scored. Scale scores range from 0-50, with higher scores indicating more (worse) suicidal ideation. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Therapy Individuals assigned to therapy will receive 10 weekly individually-delivered sessions, directly after baseline assessment, that address minority stress mechanisms underlying SMW's depression, anxiety, and alcohol abuse.
EQuIP (Empowering Queer Identities in Psychotherapy): Individuals assigned to therapy will receive 10 weekly individually-delivered sessions, directly after baseline assessment, that address minority stress mechanisms underlying SMW's depression, anxiety, and alcohol abuse. | 30 |
| Waitlist Individuals assigned to waitlist will be put on a waitlist for 3 months after baseline assessment, after which they will also receive the same treatment as the therapy group. | 30 |
| Total | 60 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 0 | 1 |
| Overall Study | Lost to Follow-up | 5 | 3 |
Baseline characteristics
| Characteristic | Therapy | Waitlist | Total |
|---|---|---|---|
| Age, Continuous | 25.27 years STANDARD_DEVIATION 3.35 | 25.90 years STANDARD_DEVIATION 3.2 | 25.58 years STANDARD_DEVIATION 3.26 |
| Education level 4-year college degree | 17 Participants | 17 Participants | 34 Participants |
| Education level Not reported | 3 Participants | 1 Participants | 4 Participants |
| Education level Some college/currently in college | 5 Participants | 8 Participants | 13 Participants |
| Education level Some graduate school or higher | 5 Participants | 4 Participants | 9 Participants |
| Employment status Full-time (40+ hours per week) | 18 Participants | 15 Participants | 33 Participants |
| Employment status Part-time employment (<40 hours per week) | 8 Participants | 8 Participants | 16 Participants |
| Employment status Student | 3 Participants | 4 Participants | 7 Participants |
| Employment status Unemployed | 1 Participants | 3 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 5 Participants | 5 Participants | 10 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 25 Participants | 25 Participants | 50 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Personal Income, annually $30,000-49,999 | 10 Participants | 2 Participants | 12 Participants |
| Personal Income, annually Less than $29,000 | 15 Participants | 17 Participants | 32 Participants |
| Personal Income, annually More than $50,000 | 5 Participants | 11 Participants | 16 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 3 Participants | 6 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 6 Participants | 8 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) White | 22 Participants | 19 Participants | 41 Participants |
| Region of Enrollment United States | 30 Participants | 30 Participants | 60 Participants |
| Relationship status Not reported | 1 Participants | 0 Participants | 1 Participants |
| Relationship status Partnered | 13 Participants | 17 Participants | 30 Participants |
| Relationship status Single or casually dating | 16 Participants | 13 Participants | 29 Participants |
| Sex/Gender, Customized Cisgender women | 13 Participants | 21 Participants | 34 Participants |
| Sex/Gender, Customized Gender diverse (transgender, gender queer, nonbinary, gender fluid) | 17 Participants | 9 Participants | 26 Participants |
| Sexual Orientation Lesbian | 6 Participants | 3 Participants | 9 Participants |
| Sexual Orientation Other (asexual, bisexual, pansexual, uncertain) | 9 Participants | 9 Participants | 18 Participants |
| Sexual Orientation Queer | 15 Participants | 18 Participants | 33 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 60 | 0 / 30 |
| other Total, other adverse events | 0 / 60 | 0 / 30 |
| serious Total, serious adverse events | 1 / 60 | 0 / 30 |
Outcome results
Primary
Alcohol Use
Alcohol use will be measured using the Short Index of Problems for Alcohol (SIP-A). The SIP-A is a 15-item, binary response (yes/no) measure that has a range of scores from 0-15. The highest score of 15 is an indicator of the greatest amount of alcohol use related problems.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Alcohol Use | Immediate Pre-intervention | 3.63 score on a scale | Standard Error 0.57 |
| Therapy | Alcohol Use | Post-intervention | 2.16 score on a scale | Standard Error 0.37 |
| Therapy | Alcohol Use | Three-month Follow-up (Post Intervention) | 1.92 score on a scale | Standard Error 0.44 |
| Waitlist | Alcohol Use | Three-month pre-intervention | 3.93 score on a scale | Standard Error 0.54 |
| Waitlist | Alcohol Use | Immediate Pre-intervention | 3.34 score on a scale | Standard Error 0.6 |
| Waitlist | Alcohol Use | Post-intervention | 2.80 score on a scale | Standard Error 0.64 |
Primary
Brief Symptom Inventory
The Global Severity Index of the 18-item BSI provides a mean score across depression, anxiety, and somatization subscales, and assesses psychological distress (e.g., feeling nervousness or shakiness inside) on a 5-point scale from 0 (not at all) to 4 (extremely) for the past 7 days. Scores range from 0-72, with higher scores indicating worse outcomes (greater symptoms severity).
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Brief Symptom Inventory | Immediate Pre-intervention | 1.74 units on a scale | Standard Error 0.14 |
| Therapy | Brief Symptom Inventory | Post-intervention | 1.38 units on a scale | Standard Error 0.11 |
| Therapy | Brief Symptom Inventory | Three-month Follow-up (Post Intervention) | 1.16 units on a scale | Standard Error 0.14 |
| Waitlist | Brief Symptom Inventory | Three-month pre-intervention | 1.80 units on a scale | Standard Error 0.1 |
| Waitlist | Brief Symptom Inventory | Immediate Pre-intervention | 1.85 units on a scale | Standard Error 0.09 |
| Waitlist | Brief Symptom Inventory | Post-intervention | 1.64 units on a scale | Standard Error 0.11 |
Primary
Depression
The measure depression in participants, the Center for Epidemiological Studies - Depression Scale (CES-D) will be used. An overall depression score is computed as the sum of the 20 items, with Items 3, 11, 14, and 16 reversed. In cases with internally missing data (items not answered), the sums were computed after imputation of the missing values: # items on scale / # actually answered, multiplied by the sum obtained from the answered items. A higher score indicates more depressive symptomatology during the past week. Range is 0 - 60.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Depression | Immediate Pre-intervention | 29.70 score on a scale | Standard Error 1.84 |
| Therapy | Depression | Post-intervention | 20.44 score on a scale | Standard Error 1.8 |
| Therapy | Depression | Three-month Follow-up (Post Intervention) | 19.00 score on a scale | Standard Error 2.18 |
| Waitlist | Depression | Three-month pre-intervention | 27.57 score on a scale | Standard Error 1.8 |
| Waitlist | Depression | Immediate Pre-intervention | 26.86 score on a scale | Standard Error 1.91 |
| Waitlist | Depression | Post-intervention | 24.83 score on a scale | Standard Error 2.44 |
Secondary
Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale
Internalized stigma was assessed us- ing the mean score on a three-item scale, the Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale, that asks individuals to rate thoughts and feelings related to their LGBTQ identity (e.g., If it were possible, I would choose to be straight). Responses range from 1 (disagree strongly) to 6 (agree strongly). Scores range from 3-18 with higher scores indicating higher internalized stigma.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale | Immediate Pre-intervention | 1.72 score on a scale | Standard Error 0.19 |
| Therapy | Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale | Post-intervention | 1.63 score on a scale | Standard Error 0.16 |
| Therapy | Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale | Three-month Follow-up (Post Intervention) | 1.49 score on a scale | Standard Error 0.13 |
| Waitlist | Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale | Three-month pre-intervention | 1.49 score on a scale | Standard Error 0.13 |
| Waitlist | Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale | Immediate Pre-intervention | 1.32 score on a scale | Standard Error 0.1 |
| Waitlist | Lesbian, Gay, and Bisexual Identity Scale-Internalized Homonegativity Subscale | Post-intervention | 1.36 score on a scale | Standard Error 0.12 |
Secondary
Overall Anxiety Severity and Impairment Scale
OASIS is a 5-item scale that asks individuals to rate the severity and impairment associated with past-week anxiety symptoms (e.g., In the past week, when you have felt anxious, how intense or severe was your anxiety?) from 0 (little or none: Anxiety was absent or barely noticeable.) to 4 (extreme: Anxiety was overwhelming. It was impossible to relax at all. Physical symptoms were unbearable). Scores range from 0-20, with higher scores indicating greater anxiety and associated impairment in the past week.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Overall Anxiety Severity and Impairment Scale | Immediate Pre-intervention | 8.80 score on a scale | Standard Error 0.64 |
| Therapy | Overall Anxiety Severity and Impairment Scale | Post-intervention | 6.00 score on a scale | Standard Error 0.7 |
| Therapy | Overall Anxiety Severity and Impairment Scale | Three-month Follow-up (Post Intervention) | 6.17 score on a scale | Standard Error 0.68 |
| Waitlist | Overall Anxiety Severity and Impairment Scale | Three-month pre-intervention | 8.20 score on a scale | Standard Error 0.46 |
| Waitlist | Overall Anxiety Severity and Impairment Scale | Immediate Pre-intervention | 8.03 score on a scale | Standard Error 0.46 |
| Waitlist | Overall Anxiety Severity and Impairment Scale | Post-intervention | 6.08 score on a scale | Standard Error 0.6 |
Secondary
Overall Depression Severity and Impairment Scale
ODSIS is a 5-item scale that asks individuals to rate the severity and impairment associated with past-week symptoms of depression (e.g., In the past week, when you have felt depressed, how intense or severe was your depression?) from 0 (little or none: Depression was absent or barely noticeable.) to 4 (extreme: Depression was overwhelming.). Scores range from 0-20, with higher scores indicating greater depression and associated impairment in the past week.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Overall Depression Severity and Impairment Scale | Immediate Pre-intervention | 6.30 score on a scale | Standard Error 0.83 |
| Therapy | Overall Depression Severity and Impairment Scale | Post-intervention | 4.09 score on a scale | Standard Error 0.71 |
| Therapy | Overall Depression Severity and Impairment Scale | Three-month Follow-up (Post Intervention) | 3.88 score on a scale | Standard Error 0.69 |
| Waitlist | Overall Depression Severity and Impairment Scale | Three-month pre-intervention | 6.17 score on a scale | Standard Error 0.78 |
| Waitlist | Overall Depression Severity and Impairment Scale | Immediate Pre-intervention | 7.69 score on a scale | Standard Error 0.73 |
| Waitlist | Overall Depression Severity and Impairment Scale | Post-intervention | 5.85 score on a scale | Standard Error 0.82 |
Secondary
Suicidal Ideation Attributes Scale
SIDAS is a 5-item scale that assesses past-month frequency and controllability of suicidal thoughts, how close one has come to making an attempt, and distress and impairment associated with thoughts of suicide (e.g., In the past month, how often have you had thoughts about suicide?). Responses range from 0 (never or not at all) to 10 (always or extremely) on each item, with item 2 reverse scored. Scale scores range from 0-50, with higher scores indicating more (worse) suicidal ideation.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Suicidal Ideation Attributes Scale | Immediate Pre-intervention | 4.13 score on a scale | Standard Error 1.51 |
| Therapy | Suicidal Ideation Attributes Scale | Post-intervention | 2.09 score on a scale | Standard Error 1.04 |
| Therapy | Suicidal Ideation Attributes Scale | Three-month Follow-up (Post Intervention) | 1.46 score on a scale | Standard Error 0.75 |
| Waitlist | Suicidal Ideation Attributes Scale | Three-month pre-intervention | 5.03 score on a scale | Standard Error 1.42 |
| Waitlist | Suicidal Ideation Attributes Scale | Immediate Pre-intervention | 5.59 score on a scale | Standard Error 1.58 |
| Waitlist | Suicidal Ideation Attributes Scale | Post-intervention | 2.73 score on a scale | Standard Error 1.05 |
Post Hoc
Difficulties in Emotion Regulation Scale-Short Form
In the Difficulties in Emotion Regulation Scale-Short Form (DERS- SF), an 18-item scale, individuals are asked how much each statement regarding emotion regulation (e.g., When I'm upset, I acknowledge my emotions) applies to them from 1 (almost never) to 5 (almost always). Scores range from 18-90 with higher scores indicating greater difficulties in emotion regulation.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Difficulties in Emotion Regulation Scale-Short Form | Immediate Pre-intervention | 47.50 score on a scale | Standard Error 1.82 |
| Therapy | Difficulties in Emotion Regulation Scale-Short Form | Post-intervention | 40.74 score on a scale | Standard Error 1.89 |
| Therapy | Difficulties in Emotion Regulation Scale-Short Form | Three-month Follow-up (Post Intervention) | 40.58 score on a scale | Standard Error 1.64 |
| Waitlist | Difficulties in Emotion Regulation Scale-Short Form | Three-month pre-intervention | 49.37 score on a scale | Standard Error 1.92 |
| Waitlist | Difficulties in Emotion Regulation Scale-Short Form | Immediate Pre-intervention | 47.07 score on a scale | Standard Error 1.74 |
| Waitlist | Difficulties in Emotion Regulation Scale-Short Form | Post-intervention | 45.85 score on a scale | Standard Error 1.72 |
Post Hoc
Multidimensional Scale of Perceived Social Support
The mean score on the Multidimensional Scale of Perceived Social Support (MSPSS), a 12-item scale, indicates the perceived support that individuals report receiving from family (e.g., My family really tries to help me), friends (e.g., I have friends with whom I can share my joys and sorrows), and significant others (e.g., I have a special person who is a real source of comfort to me) on a scale ranging from 0 (very strongly disagree) to 7 (very strongly agree). Scores range from 0-72 with higher scores indicating greater perceived social support.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Multidimensional Scale of Perceived Social Support | Immediate Pre-intervention | 3.72 score on a scale | Standard Error 0.21 |
| Therapy | Multidimensional Scale of Perceived Social Support | Post-intervention | 4.31 score on a scale | Standard Error 0.28 |
| Therapy | Multidimensional Scale of Perceived Social Support | Three-month Follow-up (Post Intervention) | 5.12 score on a scale | Standard Error 0.24 |
| Waitlist | Multidimensional Scale of Perceived Social Support | Three-month pre-intervention | 3.39 score on a scale | Standard Error 0.25 |
| Waitlist | Multidimensional Scale of Perceived Social Support | Immediate Pre-intervention | 5.39 score on a scale | Standard Error 0.14 |
| Waitlist | Multidimensional Scale of Perceived Social Support | Post-intervention | 5.35 score on a scale | Standard Error 0.17 |
Post Hoc
Ruminative Responses Scale-Brooding Subscale
The sum of the five items on the Ruminative Responses Scale- Brooding Subscale (RRS) indicates the frequency with which participants experience brooding thoughts in response to depressed mood (e.g., Think 'what am I doing to deserve this?') along a scale ranging from 1 (almost never) to 4 (almost always). Scores range from 5-20 with higher scores indicating greater rumination.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Ruminative Responses Scale-Brooding Subscale | Immediate Pre-intervention | 13.80 score on a scale | Standard Error 0.45 |
| Therapy | Ruminative Responses Scale-Brooding Subscale | Post-intervention | 12.91 score on a scale | Standard Error 0.57 |
| Therapy | Ruminative Responses Scale-Brooding Subscale | Three-month Follow-up (Post Intervention) | 11.25 score on a scale | Standard Error 0.48 |
| Waitlist | Ruminative Responses Scale-Brooding Subscale | Three-month pre-intervention | 13.57 score on a scale | Standard Error 0.55 |
| Waitlist | Ruminative Responses Scale-Brooding Subscale | Immediate Pre-intervention | 13.52 score on a scale | Standard Error 0.54 |
| Waitlist | Ruminative Responses Scale-Brooding Subscale | Post-intervention | 12.04 score on a scale | Standard Error 0.66 |
Post Hoc
Sexual Minority Women's Rejection Sensitivity Scale
The Sexual Minority Women Rejection Sensitivity Scale asks participants to rate 16 vignettes in terms of how concerned or anxious each would make them about being rejected because of their sexual orientation, and their likelihood of attributing the rejection to their sexual orientation. For example, one item states, You are on a date with a woman at a restaurant. Your waiter provides you and your date with poor service. Responses to the anxiety and likelihood stems range from 1 (very unconcerned/very unlikely) to 7 (very concerned/very likely). Total score is the sum of the products of anxiety and likelihood scores for all items. We adapted the scale to indicate woman, gender nonconforming, or non-binary partner and heterosexual, cisgender as relevant. Scale scores range from 16-112, with higher scores indicating higher rejection sensitivity.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Sexual Minority Women's Rejection Sensitivity Scale | Immediate Pre-intervention | 25.19 score on a scale | Standard Error 1.38 |
| Therapy | Sexual Minority Women's Rejection Sensitivity Scale | Post-intervention | 22.10 score on a scale | Standard Error 1.51 |
| Therapy | Sexual Minority Women's Rejection Sensitivity Scale | Three-month Follow-up (Post Intervention) | 22.78 score on a scale | Standard Error 1.72 |
| Waitlist | Sexual Minority Women's Rejection Sensitivity Scale | Three-month pre-intervention | 24.98 score on a scale | Standard Error 1.63 |
| Waitlist | Sexual Minority Women's Rejection Sensitivity Scale | Immediate Pre-intervention | 23.03 score on a scale | Standard Error 1.58 |
| Waitlist | Sexual Minority Women's Rejection Sensitivity Scale | Post-intervention | 22.12 score on a scale | Standard Error 1.76 |
Post Hoc
Sexual Orientation Concealment
In the Sexual Orientation Concealment Scale, participants rate the degree to which they have disclosed their sexual orientation on a scale from 1 (out to none) to 4 (out to all). The total score is the mean of responses in the following domains: family, LGBTQ friends, straight, cisgender friends, co- workers, and health care providers. Scores range from 1-4 with higher scores indicating lower sexual orientation concealment.
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Sexual Orientation Concealment | Immediate Pre-intervention | 1.87 score on a scale | Standard Error 0.11 |
| Therapy | Sexual Orientation Concealment | Post-intervention | 1.74 score on a scale | Standard Error 0.12 |
| Therapy | Sexual Orientation Concealment | Three-month Follow-up (Post Intervention) | 1.75 score on a scale | Standard Error 0.13 |
| Waitlist | Sexual Orientation Concealment | Three-month pre-intervention | 1.89 score on a scale | Standard Error 0.12 |
| Waitlist | Sexual Orientation Concealment | Immediate Pre-intervention | 1.67 score on a scale | Standard Error 0.12 |
| Waitlist | Sexual Orientation Concealment | Post-intervention | 1.77 score on a scale | Standard Error 0.14 |
Post Hoc
Simple Rathus Assertiveness Schedule-Short Form
The Simple Rathus Assertiveness Schedule-Short Form (SRAS-SF), a 19-item scale, asks individuals to rate the personal typicality of assertive and unassertive behavior (e.g., I find it embarrassing to return merchandise, I have avoided asking questions for fear of sounding stupid) along a scale from 1 (very uncharacteristic of me) to 6 (very characteristic of me), for a summed total score. Scores range from 19-114 with higher scores indicating greater unassertiveness (scale was reverse-scored).
Time frame: Three-month pre-intervention, Immediate Pre-intervention, Post-intervention, Three-month Follow-up (Post Intervention)
Population: Participants in the Therapy started therapy immediately after randomization, and therefore, have no data for the three-month waiting period prior to receiving the intervention. Participants in this arm started therapy three months after randomization (waitlist) and therefore, were not assessed at the three-month follow-up time point due to completion of the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Therapy | Simple Rathus Assertiveness Schedule-Short Form | Immediate Pre-intervention | 66.87 score on a scale | Standard Error 3.1 |
| Therapy | Simple Rathus Assertiveness Schedule-Short Form | Post-intervention | 62.43 score on a scale | Standard Error 3.05 |
| Therapy | Simple Rathus Assertiveness Schedule-Short Form | Three-month Follow-up (Post Intervention) | 62.46 score on a scale | Standard Error 3.13 |
| Waitlist | Simple Rathus Assertiveness Schedule-Short Form | Three-month pre-intervention | 62.80 score on a scale | Standard Error 2.67 |
| Waitlist | Simple Rathus Assertiveness Schedule-Short Form | Immediate Pre-intervention | 57.86 score on a scale | Standard Error 2.11 |
| Waitlist | Simple Rathus Assertiveness Schedule-Short Form | Post-intervention | 59.42 score on a scale | Standard Error 2.29 |