Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada

Shelley L Craig; Andrew D Eaton; Vivian W Y Leung; Gio Iacono; Nelson Pang; Frank Dillon; Ashley Austin; Rachael Pascoe; Cheryl Dobinson

doi:10.1186/s40359-021-00595-6

Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada

BMC Psychol. 2021 Jun 7;9(1):94. doi: 10.1186/s40359-021-00595-6.

Authors

Shelley L Craig¹, Andrew D Eaton², Vivian W Y Leung³, Gio Iacono⁴, Nelson Pang³, Frank Dillon⁵, Ashley Austin⁶, Rachael Pascoe³, Cheryl Dobinson⁷

Affiliations

¹ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W., Toronto, ON, M5S1V4, Canada. shelley.craig@utoronto.ca.
² Faculty of Social Work, University of Regina - Saskatoon Campus, Saskatoon, SK, Canada.
³ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W., Toronto, ON, M5S1V4, Canada.
⁴ School of Social Work, University of Connecticut, Hartford, CT, USA.
⁵ College of Integrative Sciences and Arts, Arizona State University, Tempe, AZ, USA.
⁶ Ellen Whiteside-McDonnell School of Social Work, Barry University, Miami, FL, USA.
⁷ Planned Parenthood Toronto, Toronto, ON, USA.

Abstract

Objective: This study tested the efficacy of AFFIRM, a brief affirmative cognitive-behavioural group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY).

Method: SGMY (n = 138; M age = 22.44) were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organisations or an 8-week waitlisted control. At baseline, post-intervention or post-waitlist, participants completed self-reported assessments of depression, hope, coping, and stress appraisal. Implementation outcomes of feasibility and acceptability were also assessed.

Results: Compared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms (b = - 5.79, p = .001) as well as increased reports of hope (agency: b = 0.84, p = .001; pathway: b = 0.79, p = .001), and coping by emotional support (b = 0.59, p < .001), instrumental support (b = 0.67, p < .001), positive framing (b = 0.59, p < .001), humour (b = 0.36, p = .014), planning (b = 0.49, p < .001) as well as reflective coping (b = 0.27, p = .009). Intervention participants were also less likely to perceive stress as a threat (b = - 0.43, p = .001), and more likely to perceive stress as challenge (b = 0.67, p < .001) and have the resources to deal with that stress (b = 0.38, p = .016) in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition (8.5%) and high levels of engagement and acceptability (e.g. 99% agreed intervention was relevant to their lives). Over 63% of the community organizations that participated in the training hosted AFFIRM at least once during the study.

Conclusions: Results demonstrate efficacy for the community-based implementation of an affirmative clinical intervention designed for SGMY to address depression and foster coping with universal and minority stressors.

Keywords: Cognitive behavioural therapy; Community intervention; Coping; Depression; Sexual and gender minorities; Stress appraisal.

MeSH terms

Adolescent
Adult
Cognition
Cognitive Behavioral Therapy*
Humans
Ontario
Psychotherapy, Group*
Sexual and Gender Minorities*
Young Adult