LGBQ-affirmative Cognitive-behavioral Therapy for Young Gay and Bisexual Men's Mental and Sexual Health: A Three-arm Randomized Controlled Trial

Overview

Journal J Consult Clin Psychol

Specialty Psychology

Date 2022 Apr 28

PMID 35482652

Authors

John E Pachankis

Audrey Harkness

Kaitlin R Maciejewski

Kriti Behari

Kirsty A Clark

Erin McConocha

Roxanne Winston

Oluwaseyi Adeyinka

Jesse Reynolds

Richard Branstrom

Denise A Esserman

Mark L Hatzenbuehler

Steven A Safren

Affiliations

Soon will be listed here.

Abstract

Objective: Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existing interventions.

Method: Participants were young HIV-negative SMM ( = 254; ages = 18-35; 67.2% racial/ethnic minority) experiencing a depression, anxiety, and/or stress-/trauma-related disorder and past-90-day HIV transmission risk behavior. After completing HIV testing and counseling, participants were randomized to receive 10-session ESTEEM ( = 100); 10-session community-based LGBQ-affirmative counseling ( = 102); or only HIV testing and counseling ( = 52).

Results: For the primary outcome of any HIV transmission risk behavior at 8 months, ESTEEM was not significantly associated with greater reduction compared to HIV testing and counseling (risk ratio [RR] = 0.89, = .52). Supportive analyses of the of HIV transmission risk behavior at 8 months showed a nonsignificant difference between ESTEEM compared to HIV testing and counseling (RR = 0.69) and LGBQ-affirmative counseling (RR = 0.62). For secondary outcomes (e.g., depression, anxiety, substance use, suicidality, number of mental health diagnoses) at 8 months, ESTEEM had a larger effect size than the two comparison conditions, but these comparisons did not reach statistical significance when adjusting for the false discovery rate. Observed effect sizes for condition comparisons were smaller than the effect sizes used to power the study. In exploratory analyses, ESTEEM showed promise for reducing comorbidity.

Conclusions: Because the control conditions were associated with stronger effects than anticipated, and given the heterogeneous nature of transdiagnostic outcomes, the study possessed insufficient power to statistically detect the consistently small-to-moderate benefit of ESTEEM compared to the two control conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Citing Articles

Randomised controlled trial of LGBTQ-affirmative cognitive-behavioural therapy for sexual minority women's minority stress, mental health and hazardous drinking: Project EQuIP protocol.

Pachankis J, Chiaramonte D, Scheer J, Ankrum H, Eisenstadt B, Hobbs R BMJ Open. 2025; 15(3):e086738.

PMID: 40032395 PMC: 11877267. DOI: 10.1136/bmjopen-2024-086738.

Thwarted Belonging Needs: A Mechanism Prospectively Linking Multiple Levels of Stigma and Interpersonal Outcomes among Sexual Minorities.

Lattanner M, Hatzenbuehler M J Soc Issues. 2025; 79(1):410-445.

PMID: 40027341 PMC: 11870642. DOI: 10.1111/josi.12564.

Cognitive Behavioral Therapy as a Game Changer in HIV Prevention for Vulnerable Populations: A Systematic Review and Meta-Analysis.

Hassan Awaji H, Awaji W, Tohari F, Alamrani A, Hamdi I, Aljuhani T Cureus. 2025; 17(1):e77560.

PMID: 39963612 PMC: 11830504. DOI: 10.7759/cureus.77560.

Efficacy of videoconferencing-delivered cognitive behavioural therapy to reduce anxiety disorder severity in LGBTQ+ people: An exploratory trial protocol.

Dunn I, Power E, Casey L, Wootton B PLoS One. 2025; 20(1):e0316857.

PMID: 39854414 PMC: 11760579. DOI: 10.1371/journal.pone.0316857.

Sexualized drug use factors among rural sexual minority men.

Owens C, Montemayor B J Rural Health. 2025; 41(1):e12917.

PMID: 39780355 PMC: 11711912. DOI: 10.1111/jrh.12917.

References

Pachankis J . Uncovering Clinical Principles and Techniques to Address Minority Stress, Mental Health, and Related Health Risks Among Gay and Bisexual Men. Clin Psychol (New York). 2015; 21(4):313-330. PMC: 4278648. DOI: 10.1111/cpsp.12078. View

Pachankis J, Hatzenbuehler M, Rendina H, Safren S, Parsons J . LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. J Consult Clin Psychol. 2015; 83(5):875-89. PMC: 4573250. DOI: 10.1037/ccp0000037. View

Nutt D . The Hamilton Depression Scale--accelerator or break on antidepressant drug discovery?. J Neurol Neurosurg Psychiatry. 2014; 85(2):119-20. DOI: 10.1136/jnnp-2013-306984. View

Mimiaga M, Pantalone D, Biello K, Glynn T, Santostefano C, Olson J . A randomized controlled efficacy trial of behavioral activation for concurrent stimulant use and sexual risk for HIV acquisition among MSM: project IMPACT study protocol. BMC Public Health. 2018; 18(1):914. PMC: 6060452. DOI: 10.1186/s12889-018-5856-0. View

DeRogatis L, Melisaratos N . The Brief Symptom Inventory: an introductory report. Psychol Med. 1983; 13(3):595-605. View

Norman S, Hami Cissell S, Means-Christensen A, Stein M . Development and validation of an Overall Anxiety Severity And Impairment Scale (OASIS). Depress Anxiety. 2006; 23(4):245-9. DOI: 10.1002/da.20182. View

Pachankis J, Williams S, Behari K, Job S, McConocha E, Chaudoir S . Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context. J Consult Clin Psychol. 2020; 88(5):429-444. PMC: 7153536. DOI: 10.1037/ccp0000497. View

Safren S, Thomas B, Mayer K, Biello K, Mani J, Rajagandhi V . A pilot RCT of an intervention to reduce HIV sexual risk and increase self-acceptance among MSM in Chennai, India. AIDS Behav. 2014; 18(10):1904-12. PMC: 4175143. DOI: 10.1007/s10461-014-0773-4. View

Saunders J, Aasland O, Babor T, De la Fuente J, Grant M . Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993; 88(6):791-804. DOI: 10.1111/j.1360-0443.1993.tb02093.x. View

10.

Safren S, Thomas B, Biello K, Mayer K, Rawat S, Dange A . Strengthening resilience to reduce HIV risk in Indian MSM: a multicity, randomised, clinical efficacy trial. Lancet Glob Health. 2021; 9(4):e446-e455. PMC: 8091574. DOI: 10.1016/S2214-109X(20)30547-7. View

11.

Carey M, Carey K, Maisto S, Gordon C, Weinhardt L . Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients. Int J STD AIDS. 2001; 12(6):365-75. PMC: 2587256. DOI: 10.1258/0956462011923309. View

12.

Blanchard K, Morgenstern J, Morgan T, Lobouvie E, Bux D . Assessing consequences of substance use: psychometric properties of the inventory of drug use consequences. Psychol Addict Behav. 2003; 17(4):328-31. DOI: 10.1037/0893-164X.17.4.328. View

13.

Hayes R, Donnell D, Floyd S, Mandla N, Bwalya J, Sabapathy K . Effect of Universal Testing and Treatment on HIV Incidence - HPTN 071 (PopART). N Engl J Med. 2019; 381(3):207-218. PMC: 6587177. DOI: 10.1056/NEJMoa1814556. View

14.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

15.

Keefe J, Rodriguez-Seijas C, Jackson S, Branstrom R, Harkness A, Safren S . Moderators of LGBQ-affirmative cognitive behavioral therapy: ESTEEM is especially effective among Black and Latino sexual minority men. J Consult Clin Psychol. 2023; 91(3):150-164. PMC: 10276576. DOI: 10.1037/ccp0000799. View

16.

Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E . The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1999; 59 Suppl 20:22-33;quiz 34-57. View

17.

Zimmerman M, Martinez J, Young D, Chelminski I, Dalrymple K . Severity classification on the Hamilton Depression Rating Scale. J Affect Disord. 2013; 150(2):384-8. DOI: 10.1016/j.jad.2013.04.028. View

18.

van Spijker B, Batterham P, Calear A, Farrer L, Christensen H, Reynolds J . The suicidal ideation attributes scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation. Suicide Life Threat Behav. 2014; 44(4):408-19. DOI: 10.1111/sltb.12084. View

19.

Babor T, McRee B, Kassebaum P, Grimaldi P, Ahmed K, Bray J . Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28(3):7-30. DOI: 10.1300/J465v28n03_03. View

20.

Pachankis J, Clark K, Jackson S, Pereira K, Levine D . Current Capacity and Future Implementation of Mental Health Services in U.S. LGBTQ Community Centers. Psychiatr Serv. 2021; 72(6):669-676. PMC: 10374348. DOI: 10.1176/appi.ps.202000575. View