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

Trial Summary

What is the purpose of this trial?

The purpose of the proposed study is to identify effective strategies for implementing lesbian, gay, bisexual, transgender, and queer (LGBTQ)- affirmative Cognitive-Behavioral Therapy (CBT) at LGBTQ community centers across the United States.

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 data supports the effectiveness of the treatment LGBTQ-Affirmative CBT Training for Mental Healthcare Improvement?

Research shows that cognitive behavioral therapy (CBT) is effective in improving mental health outcomes, such as reducing depression and anxiety. Training therapists in CBT has led to significant improvements in their skills and patient outcomes, suggesting that LGBTQ-Affirmative CBT could similarly benefit mental health by addressing specific needs of the LGBTQ community. ^{1 2 3 4 5}

Is LGBTQ-Affirmative CBT generally safe for humans?

Research on cognitive behavioral therapy (CBT) shows that when practiced correctly, it has a low rate of adverse events (unwanted effects), similar to or lower than a placebo (inactive treatment). Safety issues are more likely if the therapy is not done properly due to a therapist's lack of experience or skills. ^{6 7 8 9 10}

How is LGBTQ-Affirmative CBT different from other treatments for mental health in LGBTQ individuals?

LGBTQ-Affirmative CBT is unique because it specifically addresses the stress and challenges faced by LGBTQ individuals, using a culturally sensitive approach that acknowledges and affirms their identities. This treatment is often delivered online, making it more accessible, and it focuses on reducing the negative impacts of minority stress, which is not typically addressed in standard CBT. ^{11 12 13 14 15}

Eligibility Criteria

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

I am 18 years old or older.

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

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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 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]

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]

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]

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]

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

A meta-analysis of dropout rates in acceptance and commitment therapy. [2019]

2. England 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. [2019]

3. England pubmed.ncbi.nlm.nih.gov

Improving mental health outcomes: achieving equity through quality improvement. [2021]

4. England 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. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Keeping psychologists in the driver's seat: Four perspectives on quality improvement and clinical data registries. [2021]

6. Japan pubmed.ncbi.nlm.nih.gov

[Adverse Events and Precautions Regarding Cognitive Behavioral Therapy]. [2018]

7. Ireland pubmed.ncbi.nlm.nih.gov

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

8. United States pubmed.ncbi.nlm.nih.gov

Dissemination of trauma-focused cognitive-behavioral therapy: a follow-up study of practitioners' knowledge and implementation. [2019]

9. United States 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. [2020]

10. England 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. [2018]

11. England 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. [2023]

12. United States pubmed.ncbi.nlm.nih.gov

Affirmative LGBT psychotherapy: Outcomes of a therapist training protocol. [2020]

13. United States pubmed.ncbi.nlm.nih.gov

Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers. [2023]

14. England pubmed.ncbi.nlm.nih.gov

LGBTQ+ cultural-competence training effectiveness: Mental health organization and therapist survey outcome results from a pilot randomized controlled trial. [2023]

15. United States pubmed.ncbi.nlm.nih.gov

Engaging in LGBQ+ affirmative psychotherapies with all clients: Defining themes and practices. [2019]