LGBTQ-Affirmative CBT Training for Mental Healthcare Improvement

Overseen By Danielle M Chiaramonte, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Yale University

Disqualifiers: Experience with LGBTQ-affirmative CBT

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 16

1410 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores the best methods for teaching LGBTQ-affirmative Cognitive-Behavioral Therapy (CBT) to mental health professionals at LGBTQ community centers across the US. The goal is to enhance mental health care for LGBTQ individuals through specialized training. Participants will be divided into three groups: one will receive online materials, another will attend additional live webinars, and the last will receive local supervision. Ideal candidates for this trial are mental health providers at US LGBTQ centers who see at least one LGBTQ client and are not already trained in LGBTQ-affirmative CBT. As an unphased trial, this study offers a unique opportunity to contribute to the development of specialized training that can improve mental health care for the LGBTQ community.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What prior data suggests that LGBTQ-Affirmative CBT Training is safe?

Research has shown that LGBTQ-affirmative Cognitive-Behavioral Therapy (CBT) is generally safe. Studies have found it can reduce depression, anxiety, and substance use among gay and bisexual men. People usually tolerate this therapy well, experiencing no serious negative effects.

Other research examined LGBTQ-affirmative internet-based CBT to assess its usability and user satisfaction. The results were positive, with no major safety issues identified.

Overall, current research considers LGBTQ-affirmative CBT safe. It appears to be an effective and well-liked method for improving mental health in LGBTQ communities. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the LGBTQ-Affirmative CBT Training because it aims to provide mental healthcare tailored specifically for LGBTQ individuals, addressing gaps in current standard CBT practices. Unlike traditional CBT, which often lacks specific LGBTQ considerations, this training is designed to be affirming and inclusive, potentially improving therapeutic outcomes for LGBTQ clients. The trial explores different delivery methods: one arm includes local supervision for personalized guidance, another offers direct training through live webinars, and a third provides comprehensive online materials. Each approach is crafted to enhance therapists' ability to support LGBTQ clients, offering new possibilities in mental healthcare that align with the unique needs of this community.

What evidence suggests that this trial's treatments could be effective for improving mental healthcare at LGBTQ community centers?

Research has shown that LGBTQ-affirmative Cognitive-Behavioral Therapy (CBT) benefits both mental health providers and their clients. Studies have found that training mental health staff in this therapy is feasible and effective. For example, one study found that online LGBTQ-affirmative CBT was popular and helped reduce minority-related stress. Additionally, mental health providers trained in this method improved in meeting the specific needs of LGBTQ individuals. In this trial, participants will be divided into different arms: the Local Supervision arm, which includes guidance from an on-site clinical supervisor; the Direct Training arm, which involves 12 weekly live webinars; and the Materials Only arm, which provides access to a digital suite of online training materials. Overall, these findings suggest that LGBTQ-affirmative CBT could be a valuable tool for enhancing mental health care for LGBTQ communities. ^{1 2 5 6 7}

Are You a Good Fit for This Trial?

This trial is for mental health providers working at selected LGBTQ centers in the U.S. They must be adults providing psychotherapy and identify as LGBTQ. Clients can participate if they're legally able to consent to treatment in their state and serve at least one SGM client. Experienced LGBTQ-affirmative CBT providers are excluded.

Inclusion Criteria

Providers must be working as a psychologist, psychiatrist, social worker, mental health counselor, nurse practitioner, or peer support provider

Providers must be providing mental health services to at least one sexual or gender minority (SGM) client

I am old enough to agree to mental health treatment where I live.

Exclusion Criteria

Providers possessing substantive experience with LGBTQ-affirmative CBT (e.g., having read most of the LGBTQ-affirmative CBT treatment manual, attended LGBTQ-affirmative CBT training, or been supervised by someone who has previously attended the LGBTQ-affirmative CBT training)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training and Implementation

Participants receive training materials, live webinars, and potentially local supervision to implement LGBTQ-affirmative CBT

12 weeks

12 weekly 1-hour live webinars

Follow-up

Participants are monitored for changes in skills and client outcomes at multiple intervals post-baseline

24 months

Follow-up assessments at 4, 8, 12, and 24 months

What Are the Treatments Tested in This Trial?

Interventions

• LGBTQ-Affirmative CBT Training

Trial Overview The study tests different methods of implementing LGBTQ-affirmative Cognitive-Behavioral Therapy (CBT) across various community centers: direct training, local supervision, or just providing materials without further guidance.

How Is the Trial Designed?

Group I: Materials Only Experimental Treatment 1 Intervention

The Materials Only arm will have access to a digital suite of online training materials for LGBTQ-Affirmative CBT prepared by the research team.

Group II: Local Supervision Experimental Treatment 1 Intervention

In addition to receiving the online training materials and live webinars, the Local Supervision arm will receive guidance from an on-site clinical supervisor, who will be nominated by the center director as someone with substantial CBT experience.

Group III: Direct Training Experimental Treatment 1 Intervention

In addition to receiving access to the online training materials, the Direct Training arm will receive 12 weekly 1-hour live webinars on delivering LGBTQ-affirmative CBT led by our four expert trainers.

LGBTQ-Affirmative CBT Training is already approved in United States for the following indications:

Approved in United States as LGBTQ-Affirmative CBT for:

• Depression
• Anxiety
• Substance abuse
• Mental health issues related to minority stress

Who Is Running the Clinical Trial?

Yale University

Lead Sponsor

Trials

1,963

Recruited

3,046,000+

CenterLink

Collaborator

Trials

1

Recruited

1,400+

Miami University

Collaborator

Trials

16

Recruited

3,000+

University of Miami

Collaborator

Trials

976

Recruited

423,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Northwestern University

Collaborator

Trials

1,674

Recruited

989,000+

Arizona State University

Collaborator

Trials

311

Recruited

109,000+

Published Research Related to This Trial

Training therapists in cognitive behavioral therapy (CBT) within the Kaiser Permanente health care system led to significant improvements in their competencies, indicating effective training methods.

Patients treated by these trained therapists experienced clinically significant reductions in depression and anxiety, demonstrating the efficacy of implementing CBT in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dissemination and Implementation of Cognitive Behavioral Therapy for Depression in the Kaiser Permanente Health Care System: Evaluation of Initial Training and Clinical Outcomes. Karlin, BE., Brown, GK., Jager-Hyman, S., et al.[2019]

A quality improvement initiative successfully increased access to psychological therapy services in Westminster, London, allowing more patients, especially from high deprivation areas, to receive treatment for depression.

Despite entering the service with varying levels of depression severity based on socioeconomic status, patients from different deprivation levels showed similar improvements in their depression scores after treatment, indicating equitable outcomes across the service.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving mental health outcomes: achieving equity through quality improvement. Poots, AJ., Green, SA., Honeybourne, E., et al.[2021]

The meta-analysis of 68 studies involving 4,729 participants found that the dropout rates for Acceptance and Commitment Therapy (ACT) were around 15.8% to 16.0%, which is comparable to dropout rates in other established psychotherapies.

Interestingly, dropout rates were higher when therapy was conducted by master's-level clinicians (29.9%) compared to psychologists (12.4%), suggesting that the level of clinician training may influence client retention in therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A meta-analysis of dropout rates in acceptance and commitment therapy. Ong, CW., Lee, EB., Twohig, MP.[2019]

A national training initiative for Acceptance and Commitment Therapy for depression (ACT-D) led to a significant increase in therapist competency, with 96% of therapists achieving competency by the end of training, up from only 21% at the start.

Patient outcomes improved markedly, with average depression scores (BDI-II) decreasing from 30 to 19, indicating effective treatment, alongside increased quality of life scores and stronger therapeutic alliances.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: therapist and patient outcomes. Walser, RD., Karlin, BE., Trockel, M., et al.[2022]

A pilot randomized controlled trial tested the Sexual and Gender Diversity Learning Community (SGDLC) training, which improved LGBTQ+ climate in mental health organizations and therapist competence, showing significant positive changes in attitudes and practices among therapists.

The intervention group demonstrated greater improvements in therapist self-reported affirmative attitudes, practice self-efficacy, and affirmative practices compared to the control group, indicating that the SGDLC training can enhance the quality of care for LGBTQ+ clients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

LGBTQ+ cultural-competence training effectiveness: Mental health organization and therapist survey outcome results from a pilot randomized controlled trial. Boekeloo, B., Fish, J., Turpin, R., et al.[2023]

Starting in 2019, psychologists will need to track and report clinical outcomes for Medicare patients to avoid reimbursement penalties, highlighting the importance of performance accountability in mental health care.

The article reviews the implications of quality improvement initiatives, discussing both the potential benefits for patient care and the challenges psychologists face in adapting to these new regulations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Keeping psychologists in the driver's seat: Four perspectives on quality improvement and clinical data registries. Rousmaniere, T., Wright, CV., Boswell, J., et al.[2021]

A brief psycho-educational course based on cognitive behavioral therapy (CBT) was found to be helpful for many patients with anxiety disorders, with significant clinical improvements noted in some participants as measured by the CORE-OM and Fear Questionnaire.

The course was well-received, with high satisfaction reported by 102 patients, suggesting that such group interventions could be an effective and acceptable method for delivering low-intensity treatments in anxiety management within the NHS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An evaluation of large group CBT psycho-education for anxiety disorders delivered in routine practice. Houghton, S., Saxon, D.[2019]

A study involving 688 undergraduates found that cognitive behavioral therapy (CBT) that incorporates safety behaviors is significantly more acceptable to participants than traditional CBT that discourages such behaviors.

Cognitively based CBT was preferred over extinction-based CBT, and factors like previous treatment and higher anxiety levels were linked to lower acceptability ratings, highlighting the importance of tailoring CBT approaches to enhance their acceptance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Further Support for the Acceptability-Enhancing Roles of Safety Behavior and a Cognitive Rationale in Cognitive Behavioral Therapy for Anxiety Disorders. Levy, HC., Senn, JM., Radomsky, AS.[2020]

LGBTQ-affirmative internet-based cognitive-behavioral therapy (ICBT) was found to be feasible and acceptable for 120 LGBTQ youth, with participants completing an average of 6.08 sessions and reporting positive engagement with the treatment.

While overall outcomes showed small and non-significant differences, ICBT was particularly effective in reducing psychological distress for participants living in areas with high anti-LGBTQ bias, suggesting that the therapy may be especially beneficial for those facing greater stigma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guided LGBTQ-affirmative internet cognitive-behavioral therapy for sexual minority youth's mental health: A randomized controlled trial of a minority stress treatment approach. Pachankis, JE., Soulliard, ZA., Layland, EK., et al.[2023]

When cognitive behavioral therapy (CBT) is conducted effectively, the rate of adverse events is very low, comparable to or even lower than that of a placebo, indicating its safety and efficacy.

Many adverse events arise from poor-quality CBT due to therapists' insufficient training, highlighting the importance of regular patient assessments and supervision to ensure high standards in therapy delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Adverse Events and Precautions Regarding Cognitive Behavioral Therapy]. Okmaoto, Y., Jinnin, R., Yoshino, A., et al.[2018]

LGBQ+ affirmative psychotherapies are essential for addressing the unique needs of sexual minority clients, but there is a lack of empirical research on their effectiveness and specific practices.

The authors propose that these therapies should not be limited to sexual orientation-specific approaches but can be beneficial for all clients, emphasizing the need for further research and diverse therapeutic practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Engaging in LGBQ+ affirmative psychotherapies with all clients: Defining themes and practices. Moradi, B., Budge, SL.[2019]

Training in LGBT-affirmative psychotherapy significantly improved the knowledge and skills of 96 mental health professionals, regardless of their years of experience or personal characteristics.

The training also led to notable reductions in negative attitudes towards LGBTQ+ individuals, indicating that such educational programs can effectively enhance therapists' cultural competence and affirming practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Affirmative LGBT psychotherapy: Outcomes of a therapist training protocol. Pepping, CA., Lyons, A., Morris, EMJ.[2020]

An 11-week online training program significantly improved mental health providers' self-reported LGBTQ-affirmative competencies and skills, with effects lasting up to 8 months after training, indicating its efficacy in enhancing care for LGBTQ individuals.

Participants who received immediate training demonstrated a greater uptake of LGBTQ-affirmative CBT skills in simulated practice compared to those who waited, suggesting that online training is an effective method for disseminating evidence-based mental health practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers. Pachankis, JE., Soulliard, ZA., Seager van Dyk, I., et al.[2023]

Clinicians who received training in trauma-focused cognitive-behavioral therapy (TF-CBT) demonstrated a strong understanding of the model, achieving an average knowledge score of 80% on clinical scenarios 10-15 months post-training.

While there was high attendance and parental involvement in therapy sessions, the actual implementation of certain TF-CBT components, particularly child and parent trauma narratives, was lower than expected, indicating areas for improvement in practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dissemination of trauma-focused cognitive-behavioral therapy: a follow-up study of practitioners' knowledge and implementation. Woody, JD., Anderson, DK., D'Souza, HJ., et al.[2019]

A pilot study involving 35 therapists tested different support models after initial training in cognitive-behavioral therapy (CBT) for youth anxiety, finding that all support options (expert streaming, peer consultation, and fact sheet self-study) were equally satisfactory and effective in increasing the use of CBT strategies.

Despite positive feedback on the support programs, there were concerning trends indicating a decline in knowledge and self-reported skills among participants, highlighting the need for ongoing development of effective, low-cost training support options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Scalable Options for Extended Skill Building Following Didactic Training in Cognitive-Behavioral Therapy for Anxious Youth: A Pilot Randomized Trial. Chu, BC., Carpenter, AL., Wyszynski, CM., et al.[2018]

Citations

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Training in LGBTQ-affirmative Cognitive-Behavioral Therapy At the same time, 83% of respondents indicated that their mental health staff would benefit from training in LGBTQ-affirmative CBT and 100% of respondents ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0005796723001511

A randomized controlled trial of a minority stress treatment ... This study examined the feasibility, acceptability, preliminary efficacy, and multi-level stigma moderators of LGBTQ-affirmative internet-based CBT (ICBT).

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/35901370/

Training in LGBTQ-affirmative cognitive behavioral therapy Conclusions: Findings preliminarily suggest that mental health providers can be trained to deliver LGBTQ-affirmative CBT using the low-cost, efficient reach of ...

4. bmchealthservres.biomedcentral.com bmchealthservres.biomedcentral.com/articles/10.1186/s12913-025-13136-3

Implementing LGBTQ-affirmative CBT: study protocol for an ... LGBTQ-affirmative cognitive-behavioral therapy (CBT) was developed to bring scientific evidence and stigma theory to bear on SGM people's mental ...

5. psycnet.apa.org psycnet.apa.org/record/2022-86096-004

Training in LGBTQ-affirmative cognitive behavioral therapy This randomized controlled trial examined whether an 11-week synchronous (ie, real-time) online training in lesbian, gay, bisexual, transgender, queer, and ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT05408858

NCT05408858 | LGBTQ-affirmative CBT for Youth The purpose of the proposed mixed-methods study is to assess the feasibility, acceptability, and need for refinement of LGBTQ-affirmative cognitive behavior ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10601985/

Guided LGBTQ-affirmative internet cognitive-behavioral ... This study examined the feasibility, acceptability, preliminary efficacy, and multi-level stigma moderators of LGBTQ-affirmative internet-based CBT (ICBT).