Mental Health Issue, Parent-Child Relations
Conditions
Keywords
LGBTQ, Cognitive Behavioral Therapy, Attachment-Based Family Therapy
Brief summary
The purpose of this study is to assess the efficacy of an LGBTQ-affirmative individual cognitive behavioral psychotherapy (CBT) and LGBTQ-affirmative family therapy (attachment-based family therapy for sexual and gender minority young adults; ABFT-SGM) delivered via telehealth to a sample of sexual and gender minority adults with nonaccepting parent(s) in New York, Pennsylvania, Connecticut, and Israel. The investigators will assess whether both treatments are associated with significant decreases in depressive and anxiety symptoms. The investigators will also assess whether and how each treatment achieves reductions in mental health symptoms through specific mechanisms (e.g., rejection sensitivity, internalized stigma, emotion dysregulation, parental rejection and acceptance).
Detailed description
The purpose of this study is to assess the efficacy and purported change mechanisms in an LGBTQ-affirmative individual cognitive behavioral psychotherapy (CBT) and LGBTQ-affirmative family therapy (attachment-based family therapy for sexual and gender minority young adults; ABFT-SGM) delivered via telehealth to a sample of sexual and gender minority adults in New York, Pennsylvania, Connecticut, and Israel. In this 2-arm randomized clinical trial (RCT), participants will receive 16 weekly sessions of either LGBTQ-affirmative CBT or ABFT-SGM. Investigators will assess whether both treatments are associated with significant decreases in depressive and anxiety symptoms. Investigators will also assess whether psychosocial mechanisms (e.g., rejection sensitivity, internalized stigma, emotion dysregulation, parental rejection and acceptance) mediate reductions in psychological symptoms, and whether such mediators differ between the two treatments. Finally, investigators will assess whether participants who begin treatment with higher levels of parental rejection benefit more from ABFT-SGM than from LGBTQ-affirmative CBT, and whether participants with higher initial levels of maladaptive stress responses benefit more from LGBTQ-affirmative CBT.
Interventions
BEHAVIORALLGBTQ-affirmative CBT
16-session LGBTQ-affirmative psychotherapy using cognitive behavioral techniques
BEHAVIORALABFT-SGM
16-session attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents
Sponsors
Ben-Gurion University of the Negev
Israel Science Foundation
Yale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Participants will be immediately assigned to either condition.
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* be 20 and older * be fluent in English * self-identify as lesbian, bisexual, queer, pansexual, or other non-heterosexual identity * currently experience elevated depressive or anxiety symptoms (screened initially using a cutoff of ≥ 2.5 on the Brief Symptom Inventory-4 and further confirmed by the BDI and BAI). * report at least moderate levels of parental rejection or low levels of parental acceptance, as measured using the PARSOS. * have at least one rejecting/nonaccepting parent that agrees to participate in the therapy. * live in New York State, Pennsylvania, Connecticut, or Israel.
Exclusion criteria
* report current mental health treatment ≥1 day/month (except for medication management ≤1 day/week) * report beginning a new medication within the past 30 days * exhibit active psychosis or active mania, as assessed by the SCID-Psych Screen. * exhibit active suicidality or active homicidality, as assessed by the SIDAS * be currently legally mandated to attend treatment * demonstrate gross cognitive impairment, as assessed with the Telephone Interview for Cognitive Status * do not have a parent willing to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in depression symptoms | Baseline, Immediate Post-intervention, 5-month Post-intervention | Depressive symptoms will be measured using the 21-item Beck Depression Inventory-II (BDI). Items are rated on a scale from 0-3 where higher scores indicate greater depression symptoms, with a maximum score of 63. |
| Change in anxiety symptoms | Baseline, Immediate Post-intervention, 5-month Post-intervention | Anxiety symptoms will be measured using the 21-item Beck Anxiety Inventory (BAI). Items are rated on a scale from 0-3 where higher scores indicate greater anxiety symptoms, with a maximum score of 63. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in sexual orientation and gender modality acceptance concerns, as relevant | Baseline, Immediate Post-intervention, 5-month Post-intervention | Acceptance concerns of sexual minority identity and gender identity will be assessed using the Acceptance Concerns subscale of the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). The three subscale items, rated on a 6-point scale, will be averaged for a maximum total score of 6. Higher scores indicate higher acceptance concerns. |
| Change in explicit internalized stigma | Baseline, Immediate Post-intervention, 5-month Post-intervention | Change in explicit internalized stigma will be assessed using the Internalized Homonegativity subscale of the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). The three subscale items, rated on a 6-point scale, will be averaged for a maximum total score of 6. Higher scores indicate higher acceptance concerns. |
| Change in emotion dysregulation | Baseline, Immediate Post-intervention, 5-month Post-intervention | Emotion dysregulation will be assessed using the 18-item Difficulties in Emotion Regulation Scale-Short Form (DERS-SF). Items are rated on a 5-point scale from 1-5; items 1, 4, and 6 are reverse coded. Items are averaged for a total maximum score of 5, where higher scores indicate higher emotion dysregulation. |
| Change in suicidal ideation | Baseline, Immediate Post-intervention, 5-month Post-intervention | Suicidal ideation will be measured using a single item from the Patient Health Questionnaire-9. This item is rated from 0-3, where a higher score indicates higher suicidal ideation. |
| Change in parental acceptance of sexual orientation or gender modality, as relevant | Baseline, Immediate Post-intervention, 5-month Post-intervention | Parental acceptance will be measured by the Parental Acceptance subscale of the Parental Acceptance and Rejection of Sexual Orientation and Gender Identity Scale (PARSOS). 15 items are rated on a 5-point scale from 1-5. Items are averaged for a maximum total score of 5, indicating higher parental acceptance. |
| Change in parental rejection of sexual orientation or gender modality, as relevant | Baseline, Immediate Post-intervention, 5-month Post-intervention | Parental rejection will be measured by the Parental Rejection subscale of the Parental Acceptance and Rejection of Sexual Orientation and Gender Identity Scale (PARSOS). 13 items are rated on a 5-point scale from 1-5. Items are averaged for a maximum total score of 5, indicating higher parental rejection. |
| Change in quality of attachment relationship | Baseline, Immediate Post-intervention, 5-month Post-intervention | Quality of attachment relationship will be assessed using the Experience in Close Relationships-Relationship Structures Questionnaire (ECR-RS). 9 items are rated on a scale from 1-7 and averaged for a total maximum score of 7, indicating a higher quality of attachment relationship. |
| Change in implicit sexual orientation bias | Baseline, Immediate Post-intervention | Implicit bias related to sexual orientation will be measured using the sexual orientation Implicit Association Test. Scores range from -2 to 2, where higher scores indicate higher implicit preference towards heterosexuality. |
| Change in sexual orientation and gender modality concealment motivation, as relevant | Baseline, Immediate Post-intervention, 5-month Post-intervention | Motivation to conceal sexual orientation and gender modality will be assessed using the Concealment Motivation subscale of the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). The three subscale items, rated on a 6-point scale, will be averaged for a maximum total score of 6. Higher scores indicate higher concealment motivation. |
Countries
Israel, United States
Contacts
Primary ContactJohn E Pachankis, PhD
Backup ContactDanielle M Chiaramonte, PhD
Outcome results
None listed