Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China

IF 4.2 2区心理学 Q1 PSYCHOLOGY, CLINICAL Behaviour Research and Therapy Pub Date : 2024-07-14 DOI:10.1016/j.brat.2024.104605

Mengyao Yi , Xianhong Li , Danielle Chiaramonte , Shufang Sun , Si Pan , Zachary Soulliard , Benjamin E. Eisenstadt , Brjánn Ljótsson , Ashley Hagaman , John Pachankis

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Abstract

Objective

LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses minority stress to improve sexual minority individuals’ mental and behavioral health. This treatment has never been tested in high-stigma contexts like China using online delivery.

Method

Chinese young sexual minority men (n = 120; ages 16–30; HIV-negative; reporting depression and/or anxiety symptoms and past-90-day HIV-transmission-risk behavior), were randomized to receive 10 sessions of culturally adapted asynchronous LGBTQ-affirmative internet-based CBT (ICBT) or weekly assessments only. The primary outcome included HIV-transmission-risk behavior (i.e., past-30-day condomless anal sex). Secondary outcomes included HIV social-cognitive mechanisms (e.g., condom use self-efficacy), mental health (e.g., depression), and behavioral health (e.g., alcohol use), as well as minority stress (e.g., acceptance concerns), and universal (e.g., emotion regulation) mechanisms at baseline and 4- and 8-month follow-up. Moderation analyses examined treatment efficacy as a function of baseline stigma experiences and session completion.

Results

Compared to assessment only, LGBTQ-affirmative ICBT did not yield greater reductions in HIV-transmission-risk behavior or social-cognitive mechanisms. However, LGBTQ-affirmative ICBT yielded greater improvements in depression (d = −0.50, d = −0.63) and anxiety (d = −0.51, d = −0.49) at 4- and 8-month follow-up, respectively; alcohol use (d = −0.40) at 8-month follow-up; and certain minority stress (e.g., internalized stigma) and universal (i.e., emotion dysregulation) mechanisms compared to assessment only. LGBTQ-affirmative ICBT was more efficacious for reducing HIV-transmission-risk behavior for participants with lower internalized stigma (d = 0.42). Greater session completion predicted greater reductions in suicidality and rumination.

Conclusions

LGBTQ-affirmative ICBT demonstrates preliminary efficacy for Chinese young sexual minority men. Findings can inform future interventions for young sexual minority men in contexts with limited affirmative supports.

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基于互联网的 LGBTQ 平权认知行为疗法：在中国性少数群体男性中开展的随机对照试验

目的男女同性恋、双性恋和变性者平权认知行为疗法（CBT）针对少数群体的压力，以改善性少数群体个人的心理和行为健康。方法将中国年轻的性少数群体男性（n = 120；16-30 岁；HIV 阴性；报告有抑郁和/或焦虑症状以及过去 90 天的 HIV 传播风险行为）随机分组，接受 10 个疗程的文化适应性异步 LGBTQ 平权网络 CBT（ICBT）治疗或仅接受每周评估。主要结果包括 HIV 传播风险行为（即过去 30 天内无安全套肛交）。次要结果包括基线、4 个月和 8 个月随访时的 HIV 社会认知机制（如安全套使用自我效能）、心理健康（如抑郁）和行为健康（如酗酒），以及少数群体压力（如接受担忧）和普遍机制（如情绪调节）。结果与只进行评估的方法相比，LGBTQ 支持型 ICBT 并未在 HIV 传播风险行为或社会认知机制方面产生更大的降低作用。然而，与仅进行评估相比，LGBTQ 平权 ICBT 在 4 个月和 8 个月的随访中分别在抑郁（d = -0.50，d = -0.63）和焦虑（d = -0.51，d = -0.49）、8 个月的随访中在饮酒（d = -0.40）以及某些少数群体压力（如内化污名）和普遍机制（即情绪失调）方面取得了更大的改善。对于内化污名程度较低的参与者来说，LGBTQ 平权 ICBT 对减少 HIV 传播风险行为更有效（d = 0.42）。结论LGBTQ 支持性 ICBT 对中国年轻的性少数群体男性具有初步疗效。研究结果可为今后在平权支持有限的情况下对年轻的性少数群体男性进行干预提供参考。

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来源期刊

Behaviour Research and Therapy PSYCHOLOGY, CLINICAL-

CiteScore

7.50

自引率

7.30%

发文量

148

期刊介绍： The major focus of Behaviour Research and Therapy is an experimental psychopathology approach to understanding emotional and behavioral disorders and their prevention and treatment, using cognitive, behavioral, and psychophysiological (including neural) methods and models. This includes laboratory-based experimental studies with healthy, at risk and subclinical individuals that inform clinical application as well as studies with clinically severe samples. The following types of submissions are encouraged: theoretical reviews of mechanisms that contribute to psychopathology and that offer new treatment targets; tests of novel, mechanistically focused psychological interventions, especially ones that include theory-driven or experimentally-derived predictors, moderators and mediators; and innovations in dissemination and implementation of evidence-based practices into clinical practice in psychology and associated fields, especially those that target underlying mechanisms or focus on novel approaches to treatment delivery. In addition to traditional psychological disorders, the scope of the journal includes behavioural medicine (e.g., chronic pain). The journal will not consider manuscripts dealing primarily with measurement, psychometric analyses, and personality assessment.